This is a critical question to understanding how and why mental health related service delivery is funded. When COVID-19 precautions were imposed and even in effected several months after restrictive lockdowns; mental health remained an afterthought. Have there ever been conversations about mental health at a political rally? The HIV response ensured to include counselling at various service points – but does this provision really look at the individual? I am speaking from a holistic perspective – where one is recognised as a human with needs, aspirations, societal influences, and underlying conditions.
How invisible are mental wellbeing provisions at work, church or even in guidance and counselling school service points?
Why is it only allowable at Junior High School and not primary or Senior level?
Why is there no readily available data on this kind of spending?
Government spending is political. This is reflected in how Botswana committed resources through religious institutions to provide counselling to public servants. A self-serving government that could not agree with other countries on the importance of mental health. This politicizing of mental health is a wrangling of different interests, including the private sector, and civil society. Money is political, as civil society is always an afterthought. The same can be argued about mental health – whether in the context of COVID-19, HIV, Cancer, SRHR, Life Skills programming or elsewhere.
We are making a commitment to center our work and advocacy on the importance of mental health. This is not because I have been diagnosed as bi-polar. This is because it is a political issue and too few people are visibly affected by it. Maybe if we invested in mental well-being in all service delivery, sectors, and education – we would have a little less violence or corruption. That we would have a little less depression and stress. We are being political by tracking spending on mental health.
Public discourse and political declarations have increased over recent years. However, funding commitments specific to mental health are not forthcoming. There’s an estimated deficit of more than $1 billion per annum across all Low-Income Countries (Jessica Mackenzie, 2016), which equates the $1.05 billion needed for spending an additional $2 per person to meet the global average. This has translated to 9 out of 10 people living with mental health disorders without basic or dignified treatment (Caddick, et al., 2017).
Average spending on mental health averages less than USD 3 per capita per year globally. Low income countries peg as low as USD 0.25 per person per year (World Health Organisation, 2018). African countries spend less than 1% of public health budgets on mental health. The same can be attributed to Official Development Assistance financing of health (Mental Health Innovation Network, 2019). Mental health spending is underreported in Southern Africa (Jack, 2018). Even more glaringly, mental health spending in Botswana is 1% of the total health budget, compared to up to 8% in South Africa (Seloilwe, 2016). There is further readily available evidence on mental health spending in Botswana (Atlas , 2017).
The Botswana government charges mental health in-patients and ambulance related services at all levels. These are subsidized for citizens and charged fully to foreign nationals. This has been estimated at 40% of the total cost of mental healthcare borne by patients and not the government. It is relatively higher than the African estimate of 51%. Other countries like Nigeria, charge all patients for all kinds of health care. Botswana’s Mental Health Act of 1971 does not speak to spending or comprehensive services in different sectors or districts. It notably speaks on the enrolment or discharge of most patients who have been placed in institutional care (Commonwealth Health Professions Alliance, 2015). There are calls for de-institutionalizing mental healthcare towards more community-based services. This would allow for more holistic and stakeholder collaborative primary care (World Health Organisation, 2017).
Atlas , 2017. World Health Organisation. [Online]
Available at: https://www.who.int/mental_health/evidence/atlas/profiles-2017/BWA.pdf?ua=1
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Caddick, H., Horne, B., Mackenzie, J. & Tilley, H., 2017. ODI Insights, s.l.: ODI Publication.
Commonwealth Health Professions Alliance, 2015. A Review of Mental Health Legislation in Commonwealth Member States, s.l.: Commonwealth foundation.
Jack, H., 2018. Closing the mental health treatment gap in South Africa: a review of costs and cost-effectiveness. Journal Global Health Action, 7(1).
Mental Health Innovation Network, 2019. Mental Health Innovation Network. [Online]
Available at: https://www.mhinnovation.net/blog/2019/oct/10/mental-health-africa-innovation-and-investment
[Accessed 03 August 2020].
Seloilwe, E. S., 2016. Community mental health care in Botswana: Approaches and opportunities: Original Article. Intrnational Nursing Review, 54(2).
World Health Organisation, 2017. The European Mental Health Action Plan 2013–2020, s.l.: World health Organisation Publications.
World Health Organisation, 2018. World Health organisation. [Online]
Available at: https://www.who.int/mediacentre/news/notes/2011/mental_health_20111007/en/#:~:text=Average%20global%20spending%20on%20mental,on%20World%20Mental%20Health%20Day.
[Accessed 03 August 2020].