The global economy has been devastated by the COVID-19 pandemic. In Africa it has led to significant contraction of national economies, and more people living in poverty.
The journey to recovery will be a long and difficult one for African economies and will be strongly dependent on the resilience and productivity of the workforce. There is increasing global evidence that productivity in the workplace is profoundly influenced by mental health.
“The capacity of thought, emotion, and behaviour that enables every individual to realise their own potential in relation to their developmental stage, to cope with the normal stresses of life, to study or work productively and fruitfully, and to contribute to their community”. – Lancet Commission on Global Mental Health and Sustainable Development
It is estimated that mental illnesses cost $2.5 trillion globally in 2010, and this cost will rise to over $6 trillion by 2030. Most of these costs are indirect and are due to productivity losses associated with mental illness. These losses include absenteeism and presenteeism, which refers to reduced productivity while physically present at work.
Adverse working conditions that involve poor communication and management practices, low autonomy, effort-reward imbalance, unclear tasks or organisational objectives, occupational uncertainty and lack of value and respect in the workplace are particularly associated with mental health problems.
Despite the massive economic costs of mental illness, African countries have historically under-invested in mental health. Most African countries spend less than 1% of their health budgets on mental health, when a minimum of 5% is recommended for low-income countries. High level policy commitments have been made by most countries, but allocation of appropriate budgets and human resources for mental health are sorely lacking. In Ethiopia, Ghana, Nigeria and South Africa more than 90% of people living with mental illness do not receive any form of evidence-based care.
COVID-19 has had a further devastating impact on mental health, including elevated levels of health anxiety, social isolation, loss and the economic consequences of the pandemic. For example, in Ethiopia a survey in April 2020 found that the number of people experiencing depressive symptoms had tripled compared to pre-COVID-19 levels.
Investing in mental health would benefit African governments and employers in several ways.
- A global return on investment (RoI) analysis shows that for every dollar invested in treatment for depression and anxiety there will be a $2-5 RoI over the 15 years of the Sustainable Development Goals (2015-2030).
- Workplace mental health programmes do not only lead to improved mental health and wellbeing. They also improve productivity.
- There are important human rights reasons to invest in mental health: people have a right to gain access to mental healthcare that can improve their wellbeing.
- There is growing consensus from international development agencies, such as the World Bank, that mental health is not only a health need, but also a social and economic development priority.
It is vital that African governments proceed with implementing the WHO Global Mental Health Action Plan (2013-2020), which has been endorsed by most UN member states and provides a roadmap for national investments in mental health.
Mental health also needs to be included in national health insurance schemes, as part of universal health coverage. The WHO mhGAP programme provides a set of clinical and operational guidelines for scaling up mental health services in primary care and community settings, and has now been implemented in over 100 countries.
In response to COVID-19, African governments need to consider stimulus packages and improve the regulatory environment to incentivise employers to protect and promote the mental health of their workforces.
In addition, employers have a vital role to play in building workforce resilience during and in the aftermath of COVID-19 and should consider establishing workplace mental health programmes as part of good business practice. Key components of such programmes include:
Building resilience: Employers can promote mental wellness in the workplace through supportive environments that create opportunities for career growth and innovation; involving employees in decision-making; and recognising and rewarding employee contributions.
Mainstreaming mental health: Employers should create awareness about mental health and common problems like depression, anxiety and alcohol and other substance misuse. For example, awareness campaigns about mental health could include the use of personal story telling to reduce stigma, especially by company leadership.
Minimising shame and discrimination by reducing stigma against mental illness. There are different approaches to reducing stigma in the workplace, including raising education and mental health literacy among employees and supervisors, and personal contact with people with lived experience of mental illness.
Focusing on interpersonal relations: Managing conflict and effective communication in the workplace is essential. There is evidence that group-based stress education in emergency personnel, which included conflict management, communication and relaxation training, achieved a significant reduction in depressive symptoms. Clear communication from management in times of organisational change also appears to improve depression outcomes.
Strengthening systems: Screening, detection and care pathways for people with mental health problems should be established in the workplace. While there is a debate regarding who to screen and how, there is evidence that a two-stage process of screening and referral to care reduced depression, can increase job retention and number of hours worked.
Effective delivery of employee and family assistance programmes (EFAP): Counselling (including peer counselling and digital platforms) and specialist mental healthcare should be made available, where needed. For persons with confirmed clinical depression, referral to appropriate providers is key, and strategies such as reducing or removing co-payments from medical insurance may facilitate this. People with sub-clinical, or low-grade depression, may benefit from psychoeducation or internet-based treatments.
Mental health scorecard: alongside the design of effective workplace mental health programmes, it is vital to collect accurate indicators of the costs, process and outcomes of implementing these programmes, in order to measure the RoI over time.
There are compelling reasons for governments and employers to invest in the mental health of their workforce on the African continent. From the available evidence, these investments are likely to strengthen the capacity of African economies to recover from COVID-19 and move forward on a more sustainable and resilient development path – in short they have the potential to super-charge the African economic recovery.
Department of Psychiatry and Mental Health, University of Cape Town
Professors Lund and Joska have received funding from Prudential Africa for research on mental health workplace programmes in Africa.