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 legislation. 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 legislation. 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 legislation 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 legislation. 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:
·
Mental
Health at Work
·
The
Informal Sector
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.
Ehi Iden
ehi@ohsm.com.ng
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