Closing the gap between student mental illness and treatment

Mental health issues such as stress, anxiety and depression are higher among university students in Sub-Saharan Africa than in the general population, a situation that raises concerns about the relatively poor rates of treatment and the shortage of intervention facilities available on higher education campuses in the region.

According to recent research by Professor Jason Bantjes, a chief specialist scientist at the South African Medical Research Council, and associates, published in the International Journal of Mental Health Systems, the prevalence of clinically significant mental health problems among South African students is high relative to international comparisons, with prevalence of severe, mild and moderate symptoms of any disorder and-or self-harm of 24.8%, 18.8% and 27.6% respectively.

However, treatment rates were only 35.2% among those with mental health problems who perceived need for treatment and 21.3% irrespective of perceived need, the research notes.

In a separate study published earlier this year in the Journal of International Students, Bantjes noted that students encounter a number of barriers to accessing treatment, including stigma and perceptions about confidentiality, structural barriers such as insufficient information about where to access treatment, and a failure to recognise their need for professional help.

A study conducted in Kenya by a team of researchers from the University of Nairobi and Machakos University, with associates from the United States and Finland, published last year in Nature confirmed high levels of stress among tertiary students in that country and noted an association between such stress and socio-economic uncertainties.

Dr Victoria Mutiso, a senior lecturer of psychiatry at the University of Nairobi and lead author of the study, noted that the main stressors were poor financial situations, family-related problems, and concerns about the future.

That study, which profiled 9,741 respondents, also identified pressure to succeed, difficulties in integrating into the higher education system, social and emotional problems, feelings of loneliness and low levels of social support, and worry about academic results as key stressors.

Treatment gap

Despite their reported prevalence, the treatment gap for mental health disorders among young people, including university students in Sub-Saharan Africa, is wide, according to Dr Lotenna Olisaeloka, a medical researcher at the Institute for Global Health, University College London.

In a study published on 22 June that reviewed interventions for depression among youth in Sub-Saharan Africa, Olisaeloka said the region has the lowest ratio of mental health workers per population in the world.

Beyond common mental health disorders, Bantjes and other researchers have pointed out that few university students in the region get proper treatment for severe mental problems such as panic disorder, post-traumatic stress disorder, or PTSD, bipolar spectrum disorder, disruptive behaviour disorders and schizophrenia.

This is partly owing to a shortage of trained professionals. According to a World Health Organization and the United Nations Children’s Fund joint briefing, there are about 0.1 psychiatrists per 100,000 people across Sub-Saharan Africa, translating to only one psychiatrist per one million people.

The kind and scale of interventions available to students suffering from mental health challenges obviously differs from country to country – and from institution to institution.

At the University of Cape Town (UCT) in South Africa, the Mental Health Task Team was established in 2016 with a mandate to develop a broad-based student mental health policy. According to Debbie Kaminer, an associate professor of psychology at UCT, the team established criteria to identify and lend support to students at risk before they reach critical points.

A mental health policy formed the basis for the establishment of the Student Wellness Services, a primary health care provider of medical and psychological services to students at the university.

Stellenbosch University in South Africa has also developed a staff and student mental health policy implemented by the Centre for Student Counselling and Career Development. While students are encouraged to declare their mental state to get treatment and to be supported, the policy also recognises the right not to declare mental health challenges.

In Kenya, the Centre for Global Mental Health, which is embedded at King’s College London, is set to establish a project on mental health and well-being on campus at Kenyatta University and Chuka University. The two universities will be assisted in developing mental health units that will enable students to get access to treatment, including clinical and low-intensity psychosocial therapies.

Expanding access to treatment

Amid the shortage of mental health facilities and interventions, several researchers are advocating online counselling as a more effective and cost-effective way to expand psychological services.

Dr Chiedu Eseadi, a postdoctoral research fellow at the University of Johannesburg in South Africa, argued that, with increasing demand for university mental health services, online counselling interventions should be adopted.

“Web-based interventions are known to reduce psychological stress symptoms and they could be used to benefit stressed and depressed students in African universities,” said Eseadi.

Dr Jessica Coetzer and her associates at the Netherlands’ Vrije Universiteit (Free University) in Amsterdam, while exploring mental health interventions for youth in Southern Africa, noted that online interventions have been found to be successful in treating some mental health disorders. However, they pointed out that the evidence of such interventions is still emerging and evidence from Southern Africa is scarce.

Bantjes, too, acknowledged that digital interventions, including the use of smartphones and chatbots, could be a way of increasing accessibility and convenience as well as reducing costs of mental health treatment.

However, he urged caution, pointing out that, whereas there is growing evidence that digital mental health interventions for anxiety, depression and enhancing well-being are effective among university students, more research was required.

He noted that problems associated with unequal access to technology and internet access could exacerbate inequality in access to treatment, particularly among the most economically vulnerable students, if digital interventions are widely implemented.

Peer counselling was another strategy increasingly being used to reduce stress and depression in most universities across Africa as professional mental health services on campus come under strain. Available evidence shows that such strategies are being used widely in universities in Kenya, Tanzania and Uganda to overcome stress among university students, including those with academic burnout.