Africa’s Mental Health Crisis: World’s Highest Suicide Rates and Lowest Spending on Mental Health Services
Mental Health 14/08/2024 •
Participants gather to share their mental health struggles and offer support at a Friendship Bench meeting in Zanzibar, part of a nonprofit initiative to improve well-being across the continent.

Africa has the highest rate of suicide in the world, and the lowest per capita spending on mental health – with critical shortages, in particular, of community health workers and facilities that could help prevent many mental health conditions from becoming even more severe. 

Two recent high-profile suicides in Tanzania have cast a stark spotlight on the nation’s growing mental health crisis, reflecting a broader struggle across the African continent.

On the evening of May 16, 2024, Archbishop Joseph Bundala of the Methodist Church in Tanzania was found dead inside his church building in Dodoma Region. Eyewitnesses reported that the respected religious leader had taken his own life by hanging, shocking the community and leaving many grappling with unanswered questions.

Just days later, on May 21, another tragedy unfolded as Rogassion Masawe, a 25-year-old Roman Catholic seminarian, was discovered hanged in his room at the seminary. Local media reports suggest that Masawe’s death may have been triggered by his failure to advance to the next stage of priestly formation, which involved taking his first religious vows.

These incidents have brought Tanzania’s mental health challenges into sharp focus. Tito Kusaga, Archbishop Bundala’s brother, expressed disbelief that overwhelming debts could have driven the bishop to such a drastic decision. The fact that Bundala did not seek help underscores a common issue faced by many struggling with emotional distress in the region.

Africa’s mental health crisis

The African continent has the highest suicide rate in the world, according to WHO.

The twin tragedies in Tanzania are not isolated incidents but part of a larger crisis gripping the African continent. Africa has the highest suicide rate in the world, according to the World Health Organization (WHO), driven predominantly by depression and anxiety. Someone dies by suicide approximately every 40 seconds, resulting in roughly 700,000 deaths per year globally.

Globally, someone dies by suicide every 40 seconds, totalling about 700,000 deaths annually. In Africa, the rate is 11 per 100,000 people, compared to the global average of nine. African men are at particular risk, with 18 suicides per 100,000 — significantly higher than the global male average of 12.2. Experts believe these statistics could well be an undercount given the lack of data.

Approximately 29 million people in Africa suffer from depression. The 2023 World Happiness Report found that 17 of the 24 least happy countries are in Africa. Yet mental health programs remain severely underfunded.

In 2020, Africa spent less than $1 per capita on mental health, while Europe spent $46.49. This stark underinvestment is directly correlated with higher suicide rates and poorer mental health outcomes across the continent.

Africa averages just one mental health worker per 100,000 people, compared to the global average of nine. The continent faces critical shortages of psychiatrists, hospital beds, and most important of all – community outpatient facilities.

Few Africans receive needed treatment as a result. The annual rate of mental health outpatient visits in Africa is 14 per 100,000 people, far below the global rate of 1,051.

Tanzania mirrors continental crisis

A stressed patient stands in deep thought in the wards of Mirembe National Mental Health Hospital. Perched on the rolling hills outside the capital, Dodoma, it is the only mental health facility in the country.

The state of Tanzania’s mental health workforce mirrors the continent’s challenges. The country has 1.31 mental health workers per 100,000 people, including 38 psychiatrists, 495 mental health nurses, 17 psychologists, and 29 social workers for its 65.5 million population.

Community-based mental health services are limited in Tanzania. Despite policies to integrate mental health into primary healthcare, resources remain scarce, especially for children and adolescents.

Neighboring Uganda faces a similar situation, with 2.57 mental health workers per 100,000 people, including just 42 psychiatrists . Kenya fares slightly better with 15.32 workers per 100,000, including 115 psychiatrists and 6,493 psychologists. However, Kenya still struggles to meet growing mental health service demands.

Chained to beds  

Perched on rolling hills on the outskirts of the country’s capital, Mirembe National Mental Health Hospital in Dodoma struggles with overcrowding and limited resources. Patients’ recovery and discharge times average six weeks, but many face relapses due to long distances, financial problems, and the side effects of antipsychotic medications.

It is Tanzania’s only mental health hospital for its population of over 65 million, offering just 600 beds in the capital and 300 more in satellite buildings.

With a lack of preventive services at community level, patients suffering from mental health issues often wind up in prison for either petty or serious crimes, where they face practices reminiscent of a bygone era. At Isanga Correctional Facility, a unit for a unit for convicted criminals with mental health issues, aggressive patients are sometimes chained to metal beds, their anguished cries echoing through urine-scented corridors, according to eyewitness accounts.

Dosanto Mlaponi, head of forensic psychiatry at Isanga, defends these measures as necessary to prevent violence. Yet the facility’s challenges extend beyond its walls.

Aziz Kessy, a 27-year-old speaking under a pseudonym, exemplifies a common post-discharge struggle. Suffering from psychosis, Kessy heard voices urging him to kill himself, prompting his father, a grape farmer, to seek professional help.

After initial treatment stabilized him, Kessy was discharged. He soon relapsed after refusing to take his prescribed medications.

“It’s very difficult to track discharged patients and ensure they stick to prescribed medications,” Mlaponi told Health Policy Watch.

Abandoned patients

Tanzania has only one mental health hospital for its population of over 65 million.

Beyond patient care, Mirembe Hospital faces another troubling issue:  some fully recovered patients remain on its grounds due to a lack of family support. Hospital guidelines require patients to be discharged into a relative’s care.

“Each patient costs between $6-8 per day,” said Dr Paul Lawala, the hospital’s director. “It’s troubling when families disappear after treatment, leaving patients in limbo.”

Extensive research maps a strong correlation between suicide and socioeconomic crises, including unemployment, failed relationships, and domestic abuse, compounding the dangers for abandoned patients.

“It’s as if some people don’t want to be associated with those who had mental health issues, even after they’ve recovered,”  Lawala explained. “We must continue to provide accommodation and food, increasing our costs and impacting our ability to care for others.”

Experts emphasize the dire need for innovative solutions. Over 70% of Tanzania’s population resides in rural areas with limited access to health services. Primary health facilities are ill-equipped to handle psychological problems, as many staff lack diagnostic expertise and medication is scarce.

Dr Praxeda Swai, a senior psychiatrist at Muhimbili National Hospital, agrees. She told Health Policy Watch that the country  is facing “a serious mental health crisis that requires a [more] holistic approach to address it.”

Desperate need for solutions at primary healthcare level

The need for innovative solutions is particularly dire at the primary healthcare level. The Health Ministry is investigating options and seeking funding for a feasibility study on using mobile phones to connect patients with health workers, potentially enhancing communication and reducing relapses.

One approach under consideration is harnessing mobile technology for mental health counseling.

A recent study, “Using Mobile Phones in Improving Mental Health Services Delivery in Tanzania: A Feasibility Study,” explores how technology can bridge the gap between mental health patients and health workers.

“An ICT/mobile phone-driven platform can significantly reduce the need for patients to physically visit hospitals, saving time and money,” says lead researcher Perpetua Mwambingu of the University of Dodoma.

Patients could receive medical advice, information on medication side effects, and reminders for appointments and medication refills via their phones. Health workers could monitor symptoms and provide therapeutic interventions remotely.

This continuous communication could also lead to earlier diagnosis and treatment, potentially reducing hospital stays.

Causes and solutions

Dr Michelle Chapa, the founder and CEO of a Dar es Salaam-based  Foundation that innovative mental health programs, attributes the rise in suicides to clinical depression, exacerbated by poverty, unemployment, and cultural stigma.

“Poverty and unemployment are major contributors to the mental health crisis in Tanzania,” she told Health Policy Watch. “Unemployment can lead to a loss of identity, purpose, and self-worth, which are significant contributors to depression and anxiety or poor mental health.”

Chapa explained that constant financial instability, lack of access to basic needs, and uncertainty about the future trigger chronic stress, often manifesting as anxiety and depression.

“Poverty can lead to unemployment, which results in food insecurity and increases the likelihood of substance abuse,” she noted. “Inadequate nutrition directly impacts brain function and development, increasing vulnerability to mental health disorders.”

Traditional beliefs may hinder individuals from seeking professional help, Chapa added. Men, for instance, are expected to be stoic and self-reliant, and are thus less likely to seek help for mental health issues, perceived as weak or unmanly.

“Exposure to violence also can lead to long-term psychological trauma, including PTSD, depression, and anxiety,” Chapa said. “Violence disrupts community cohesion and family structures, leading to social isolation and a lack of support systems, which are crucial for mental well-being.”

Mental health services are not well-integrated

Chapa described Tanzania’s mental health services as “often not well integrated with general healthcare, resulting in fragmented care and missed opportunities for early intervention.”

“This issue is particularly pronounced in rural and remote areas, where access to mental health services is more limited,” she added.

Chapa emphasized the need for increased funding to build and renovate mental health facilities, integration of mental health services into primary healthcare, and robust training programs for mental health professionals.

She also called for public awareness campaigns to reduce stigma and encourage individuals to seek help. Chapa stressed that suicide should be decriminalized.

New directions and long-term strategies 

Experts told Health Policy Watch that long-term strategies to build a robust mental health support system in Tanzania are multifaceted. These include policy reform to prioritize mental health, workforce development to increase the number of mental health professionals, and infrastructure expansion to improve facilities and services.

Community-based care initiatives and education campaigns are also crucial, the experts noted. They emphasized the need for increased research and innovation, as well as stronger collaborations and partnerships across sectors.

To guide these efforts effectively, improved data collection and policy advocacy are necessary. These strategies aim to address the diverse mental health needs of Tanzania’s population and improve overall mental health outcomes.

‘Grandmothers’ as mental health workers 

The Friendship Bench (FB) project, an innovative mental health initiative founded in neighbouring Zimbabwe, bridges the treatment gap with a unique approach. Developed over two decades, the FB uses problem-solving therapy delivered by trained lay health workers, focusing on individuals suffering from anxiety and depression.

The project employs ‘grandmothers’ as community volunteers, who counsel patients through six structured 45-minute sessions on wooden benches within clinic grounds.

“Since 2006, we have trained over 600 grandmothers who have provided free therapy to more than 30,000 people in over 70 communities,” said Dr Dixon Chibanda, who leads the project.

The FB model has expanded beyond Zimbabwe to Malawi, Zanzibar, and even New York City, demonstrating how mental health interventions from low-income countries can be adapted globally. Several ongoing studies, including the Youth Friendship Bench and FB Plus, continue to expand the project’s impact.

In Africa, the initiatives are supported by private philanthropies and donors. Government officials express interest in mainstreaming these approaches but cite financial constraints as a persistent challenge.

A series of local initiatives are pushing to make a difference in the mental health of people in Zanzibar. Zanzibar Mental Health Shamba (ZAMHS), established in 2014 by UK mental health nurses, has been pivotal in enhancing services on the island. ZAMHS has provided consistent support for mental health care in Zanzibar’s rural areas, including medication delivery.

“Here in Zanzibar, the need for mental health interventions is pressing, especially for our young people who are grappling with drug abuse and mental distress,” said Amina Hassan, a coordinator at the Friendship Bench of Zanzibar. “The Ministry of Health has been incredibly supportive of our initiative, recognizing the importance of addressing these issues head-on.”

Hassan explained that the mental health policy and legislation introduced in 1999 have led to significant enhancements in mental health activities over the past decade. “Despite our extremely low resources, we’ve seen progress, but it’s a constant struggle,” she added.

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