Access to low-cost, one-on-one digital mental health services is helping to reduce deeply entrenched stigma and discrimination across sub-Saharan Africa—and facilitate better access to care.
Technology-based mental health services eliminate structural, cultural, and geographic barriers to care, says Kawekwa Douglas. Photo: MindLyfe
Maria Gore is a widow and mother of three who runs a mobile money transfer business in Nairobi’s Eastlands area. In 2021, her 25-year-old son suffered from a mental breakdown due to prolonged unemployment stress. At Mathari Mental Hospital, he was treated as an outpatient and discharged. “We did not return for follow-up services for fear that he would be seen as a muguruki—madman. People would fear and shun him, preventing him from having a normal life, starting a family, or holding a job,” Gore says.
Across Africa, there is poor knowledge about mental health, and mental illness is widely believed to be a spiritual problem rather than a medical one; it is also largely considered incurable. Mental health problems are strongly linked to witchcraft, curses, evil spirits, and other adverse interactions with departed relatives or the supernatural.
Extreme stigma and discrimination towards people with mental illness are systemic and deeply entrenched in many African societies, leading to fears of social exclusion and abuse like those experienced by Gore and her son. Internalised stigma can also cause feelings of shame and self-loathing among those with mental illness and hinder their decision or ability to seek help. These challenges impede mental health care, escalating Africa’s mental health crisis.
Amid the search for solutions, the anonymity and accessibility offered by a growing number of digital mental health platforms is emerging as a frontrunner.
Tech start-ups for mental health care
African countries have the highest suicide rates—predominantly driven by depression and anxiety—at 11 deaths per 100,000 people against the global average of nine deaths per 100,000 people. Sub-Saharan Africa’s outdated and resource-strapped mental health system provides for one psychiatrist per million people. Mental health programs are significantly underfunded.
Africa spent less than US$0.50 per capita on mental health in 2020 against a global spending of US$7.49 per capita. Europe spent US$46.49 per capita. There is low coverage of outpatient facilities and a low number of hospital beds for patients with mental illness. Ultimately in Africa, the annual rate of visits for mental health outpatient facilities is 14 per 100,000, against a global annual rate of 1,051 per 100,000.
To halt and reverse the spiralling mental health care crisis in some of the most affected regions, a growing number of mental health care start-ups are turning to digital modes of delivery.
Mental health start-ups are using technology to eliminate structural, cultural, infrastructural, and geographic barriers to mental health care inherent in traditional systems.
Kawekwa Douglas, founder and CEO of MindLyfe, a Uganda-based online service that launched in 2021 and offers sessions with qualified therapists, says traditional approaches to mental health care cannot meet the high demand for support. Instead, mental health start-ups are using technology to eliminate structural, cultural, infrastructural, and geographic barriers to mental health care inherent in traditional systems.
The platforms match professionals to potential clients with precision, Douglas explains. Plus, services are delivered to wherever the client lives, ensuring that rural, underserved populations have access to critical services. “Technology closes the distance. Our clients are in Uganda and other African countries—we meet our clients wherever they are,” Douglas says.
Services can be provided through web-based and mobile phone apps. Sometimes users pay a subscription fee to access a web-based or mobile platform with games, chat-based tools, and access to mental health caregivers. MindLyfe, for instance, allows users to sign in, review the profiles of seven in-house counsellors, psychiatrists, and psychologists, and message the mental health professional of their choice. A session costs US$13.
Online safe spaces for mental health support
Confidentiality and privacy are key advantages of this mode of delivery. People afraid of being seen in and around mental health facilities can easily access online services without fear of judgment and stigma.
“It enables people to receive mental health care support free from the discomfort, anxiety, and fear of stigmatisation that comes from sitting on a bench, waiting for a consultation in a mental health facility,” says Kenyan-based Gloria Itooi of Sema, a web-based app developed by Hopewell Counselling Firm that launched in 2022.
Despite the shortage of mental health care providers across Africa, there are still qualified mental health graduates who remain unemployed and are keen to leverage technology.
Sema—Swahili for ‘speak up’—connects users with 24 professional counsellors whose support is rooted in cultural competence. Itooi says there is a strong focus on being aware of and responsive to clients’ cultural perspectives and backgrounds. This includes recognition and respect for their values, cultural traditions, language, and socioeconomic conditions.
Cost ranges from US$16 to US$25 for people in Kenya, depending on the duration of the session and the nature of support needed, and US$46 for users outside the country. In Kenya, a similar in-person session with a private therapist would cost between US$30 and US$50.
Despite the shortage of mental health care providers across Africa, there are still qualified mental health graduates who remain unemployed and are keen to leverage technology to kickstart their practice without capital, as they do not need to accommodate any overheads.
Africa’s telecommunications density
At a basic level, widespread availability and adoption of mobile internet services make this mode of healthcare possible. African countries including Kenya, Nigeria, Ghana, and South Africa now have a telecommunications density exceeding 100%. Mobile telephone connections in sub-Saharan Africa will hit 1.05 billion by 2025, up from 816 million in 2019.
“Youths struggling with anxiety, depression, and stress can simply download and run through self-therapy prompts, assessments, and exercises at no cost.”
Bright Siame, director of Zambia-based Vent Mental Health Service, an online counselling platform that uses video calls, phone calls, and chat-based apps, says tech-based start-ups are excelling where traditional systems have failed.
“We provide mental health services that are not available at primary healthcare facilities across Zambia, with the exception of a pilot project ongoing in Lusaka,” he says. “We offer a network of licenced and professional counsellors to be contacted through our user-friendly website. Sessions are conducted on WhatsApp or direct mobile telephone calls.”
Some mental health startups also run question-and-answer sessions with the public on platforms such as X and Instagram to gauge mental health awareness and improve knowledge of mental wellbeing. Mental health experts hold live sessions on Facebook, TikTok, X, and Instagram discussing various issues related to mental health. These platforms are also proving effective in running research surveys on mental health.
Hopewell Counselling Firm runs monthly webinars on various mental health topics; this includes free sessions specifically targeted at mental health care providers where they can learn from more experienced colleagues.
When cost is a barrier, Vent Mental Health Service offers digital toolkits for people unable to pay US$12 for a one-on-one online session with a therapist. People can use the self-help toolkits free of charge to navigate their mental health challenges.
Vent Mental Health Service’s primary focus is young people aged 18 to 35. Africa is home to the world’s youngest population and nearly 60% of the population is under the age of 25. Globally, mental illness contributes to 45% of the burden of disease among 10- to 24-year-olds. “Youths struggling with anxiety, depression, and stress can simply download and run through self-therapy prompts, assessments, and exercises at no cost,” Siame says.
Ending language-based mental illness stigma
Gloria Itooi says digital mental health platforms alleviate fear of stigma associated with in-person therapy. Photo: Joyce Chimbi
Siame says a tech-based approach better facilitates open conversations about mental health and helps to reduce stigma, starting with discouraging use of derogatory words that have become part of society’s diction.
Like muguruki in Kenya, many African local dialects have derogatory terms for mental illness such as omulalu in Uganda and silu and chizende in Zambia, which translate to ‘mad’ or ‘madman’. Other dialects in Kenya refer to mental illness as a bad demon or people with mental illness as ‘separated from their head’. Derogatory terms are also used to refer to mental health facilities.
Raising awareness that mental health is a health condition that can be treated, cured, or successfully managed is a key area of focus.
Many mental health start-ups promote mental wellbeing by building on a person’s strengths rather than focusing on their deficits. They use empowering and humanising language that is free from negative, value-laden judgement to rewrite longstanding and harmful narratives around mental health.
Likewise, they work to combat prevailing myths and misconceptions around mental illness in Africa—that it is contagious, or a curse, or a result of witchcraft and hence untreatable. Raising awareness that mental health is a health condition that can be treated, cured, or successfully managed is a key area of focus.
“We promote access to factual mental health information in order to reduce existing strong negative reactions towards people with mental illness,” Kawekwa says. “Stigma is a major barrier to help-seeking and it is especially destructive when it comes from mental health providers who still view mental illness from a rigid perspective.”
Siame concurs, stating that mental illness is often viewed as a lack of faith, a foreign and western concept, a personality flaw, a sign of weakness, and an inability to cope with life. Men in particular are expected to ‘man up’. Meanwhile, Africa’s male suicide rate is the highest in the world, almost 50% higher than the global average. Discreetly and even anonymously, technology is connecting men with the mental health support they need.
Exploring new frontiers for mental wellbeing
Looking forward, Kawekwa says mental health start-ups will continue to reach underserved or marginalised young people in ways that traditional systems cannot. “It is more likely that a young person can be on TikTok receiving mental health support than in a mental health facility,” he says.
As AI begins to reshape our world, Siame says African countries are exploring avenues to unlock the potential of AI and machine learning as the next frontier of low-cost, high-impact mental health models to reduce prevailing inequalities—and the scourge of stigma.
South Africa is already exploring how AI-driven chatbots can provide a non-judgemental, readily available, cost-effective avenue for young people to access information, support, and guidance. On a continent grappling with mental health stigma and inadequate resources, the rise of tech-based mental health start-ups offers a glimmer of hope, promising to bridge gaps in care, dismantle harmful stereotypes, and provide support to those most in need.
Comments