Workplace mental health is a growing concern in Africa with daily increasing burden as a result of the fast mutation in work pace, work processes and changes in employment patterns. This is expected to go even worse as we all gradually slide into the new global concept known as the “Future of Work” which will be characterised by very high technology, high use and dependency on machines and robots who will fiercely compete for work with their human counterparts. This will further change the entire landscape of workplace mental health with an increased burden of disease traceable to excess work demand, burnout, longer hours of work, workers overdraw, the fear of loss of job, lone worker syndrome which will further dismantle the existing human interactions and socialization between and amongst workers in workplaces.
There is an urgent need to change the notion of seeing an employee solely as a tool for the profitability of the employer who makes little or no provision for the maintenance of the employee’s health and wellbeing. This is very crucial because these same employers have dates when their machines are due for servicing and they never fall short of those dates but they never in same way have a scheduled dates within their calendars for employees’ health and wellness assessment.
Concerns as highlighted above are underpinned with the absence or poor legislation on mental health at work in Africa. Owing to the fact that even mental health was not amongst the illness classified by ILO in the list of Occupational diseases, most countries in Africa still lag behind in trying to have mental health concerns captured and rightly provided for in workplace safety and health legislations. There exist a number of countries now that have National Mental Health Act or Policies but these are domiciled with the Ministry of Health while most OSH Departments or Agencies are under Ministry of Labour and Employment. In a number of those mental health policies, it is assumed there was never a broad consultations that included the Ministry of Labour and Employment and other Workplace safety and health stakeholders in arriving at those polices hence these actors do not see themselves as co-owners of such policies. Absence of these policies has made it difficult in holding employers accountable for violation of national workplace mental health provisions, we must first have a document of reference before holding employers accountable.
We need a strong political will for review and updating of existing National legislations. A number of countries across Africa govern their workplaces with highly obsolete OSH legislation that have no bearing with the new workplace and work-life-balance realities, no element of mental health and employees’ wellbeing provisions. The urgent need for an early review of these documents is so crucial, at OSHAfrica we are doing something about this. Even where these documents or legislations exist, they are not promoted or sold to employers of labour, instead they are stacked in a certain office where they are made unreachable to those who need to interpret and domesticate them into their corporate OSH policies.
Advocacy and education and the right definition of what workplace mental health is all about will be a quick fix to the current level of information deficit along the lines of mental health and wellbeing at work. The mentality and understanding of mental health generally has to scale up if we must change the current perception of mental health in Africa. There are currently little or no definite programs that are directed at mental health at work and psychosocial hazards that are imminent in our current workplaces.
In having an honest conversation and drawing programs on mental health at work, it will be wrong to isolate business leaders, Human Resources Managers, employers of labour and others who are daily actors in the implementation of these policies and programs. This is the current situations across many countries in Africa, there is an urgent need to shift from the idea of developing a policy for them and embrace the friendly participatory approach of developing a policy with them. Let them own it.
Mental Health Treatment and Rehabilitation.
Stigma: When we talk of mental health stigmatization, we must first also look at the current location and design of mental health facilities. This is the root of the stigma.
In many facilities, mental health units are located in some isolated and lonely wing of the hospital almost far off other adjoining facility. This makes it so obvious to identify any patient walking towards that direction for care as patient having a mental illness. This on its own, turn people away from accessing care.
We have specialised facilities called Psychiatrist Hospital, owing to the poor level of information on mental health in our locality, no one wants to wake up, get dressed and walk into a psychiatric hospital. He is careful and ashamed of who may have seen him walk in, he ends up not accessing the service and his condition is left untreated. So we need to look at the location and design.
Shortage of mental health experts: The region needs more mental health experts. Virtually every country in Africa needs more hands to support the system in managing mental health. Kenya with almost 50 million population has only 80 Psychiatrists and 30 clinical psychologists, Nigeria has 130 Psychiatrists as documented in many studies but lately Association of Nigeria Psychiatrists through their website reported are now 250 Psychiatrists for 200 million population. This shortage of mental health experts is common. Ethiopia with a population of 61 million people has only 10 Psychiatrists, the shortage led to an estimated 85% of emotionally disturbed people seeking help from traditionally healers, this is according to a publication by Prof Oye Gurege etal
Training of healthcare workers on mental health: When you are presented with co-morbidity of physical illness and mental illness, only the physical illness are mostly taken care of in the hospitals at the expense of mental health or other emotional disorders. The patients are allowed to leave with a mental health condition that was not even diagnosed let alone being treated.
Funding is a critical issue. At the Abuja declaration 2001, leaders of all countries in Africa met and pledged to increase the healthcare budget to 15%. Only 1 country has met this target, 26 countries have increased theirs, 11 countries have reduced theirs and there were no significant trend in the other 9 countries.
In most countries in Africa, only an average of 1% or less of their healthcare budget is allocated to mental health when compared with 6 – 12% allocation in Europe and North America. This poor funding does not allow growth and improvement in management of mental illnesses in the region.
Insufficient mental health facilities: There are no enough mental health departments or facilities, even when they exist, they are mostly in the cities. How do we cater for people who live in rural communities knowing that mental illness does not discriminate or have location biases? This has led to wide spread of traditional practice including spiritual healers in mental health who end up complicating the presenting conditions with physical tortures and leaving their victims in chains.
OSHAfrica and AU-DA partnership project
We are currently reviewing the Occupational Safety and Health legislation across the 54 African countries, we are looking for the similarities and peculiarities in content and also making provisions for areas that were hitherto not covered or were not adequately covered inn existing legislations. Upon completion of these reviews, we will come up with a harmonised document called “The African Occupational Safety and Health Act” which will be presented for further review by the African Union leadership for adoption and possible sign off for use across all 54 countries in Africa.
One of the key things we have in mind while on this project is to make clear and robust provisions for:
In this partnership, we are also looking at how we can run Train-The-Trainer program on mental health at work across all the 5 sub regions in Africa.
Another discussion we had along this line is designing a Mental Health at Work Training for Business Leaders, this is currently in the mandate of the Scientific Committee in charge of OSH Education and Competency Improvement.