Research Topic and Goals
Mental health and substance abuse are public health issues that have shown to be highly interconnected. Numerous population surveys indicated that around half of individuals who have experienced mental health issues during their lifetime also indicated struggling with substance use disorders and vice versa (Vorspan et al., 2015). Data show high comorbidity rates between substance use disorders and anxiety disorders, such as generalized anxiety disorder, posttraumatic stress disorder, and panic disorder (Vorspan et al., 2015). Besides, substance use issues have been linked to the co-occurrence of mental disorders, such as antisocial personality disorder, psychotic illness, borderline personality disorder, depression, and bipolar disorder, as well as attention-deficit hyperactivity disorder (Chapman, Jamil, & Fleisher, 2021). Drawing from the national data for the United States using a representative sample, individuals with personality, mental, and substance abuse disorders are usually at an increased risk for non-medical use of prescription opioids (Katz et al., 2013).
In the context of West African countries, studying both mental health and substance use disorder prevalence can be significantly beneficial due to the need to reveal persistent trends. Besides, it is imperative to determine the efforts implemented by governments to address the challenges that populations face as a result of policymakers’ ineffectiveness. Therefore, the goal of this research is to explore both mental health and substance use in West Africa as a means to shed light on the challenges that the entire economic region faces. In addition, one can suggest that many Africans and their governments turn a blind eye to the issues of mental health and substance abuse. Moreover, 46% of countries in Africa did not have or had not carried out standalone interventions as mental health policies, while the rate of mental health workers in the region is 1.4 per 100,000 population compared to a global average of 9.0 per 100,000 people (Sankoh, Sevalie, & Weston, 2018). Thus, it is notable that the region performs relatively poorly in mental health and drug use compared to the rest of the world. This research will point out the key challenges that affect the population that is majorly underserved in these areas of life, which results in poor life quality and reduced well-being.
Research Objectives
The research objectives for the current study are twofold: exploring the occurrence and prevalence of mental health issues in West African countries and studying the occurrence and prevalence of drug abuse in the region. In addition, because the two public health challenges are interconnected, the research will also study the points of correlation between mental health and illicit drug use in West Africa. The study can help researchers and policymakers devote more time and space to the exploration of the prevalence and occurrence of risk factors for mental health and substance use disorders (Sankoh et al., 2018). In addition, it can help assess the effectiveness and cost-effectiveness of efforts associated with interventions of prevention and treatment, as well as the part that policies and governmental healthcare systems play in responding to the challenges. This research can be a good contribution to the limited body of research dedicated to addressing mental health problems facing West Africans. The specific research objectives are the following:
- To explore the prevalence and occurrence of major mental health challenges in West African countries.
- To explore the prevalence and occurrence of illicit substance use in the population of West Africa.
- To study the impact of available policies and governmental initiatives for addressing mental health and substance abuse among the population.
Research Questions
The research questions for this research are intended to reflect the nature of the prevalence of mental health issues and substance abuse disorders among the population of West African countries. The questions are the following:
- What is the rate of mental health issues among the populations of West Africa? Which psychological health challenges are the most persistent?
- What is the prevalence of illicit drug use among West Africans? Which drugs are the most prevalent among the population?
- What is the availability of healthcare services for populations with mental health and substance use disorders?
- What initiatives and programs have governments implemented to address the mental health and drug abuse needs of populations?
Hypotheses
In the research topic exploration, it has been suggested that the healthcare sphere of the region lags behind the global standards and expectations of mental health and substance use disorder care. Therefore, the following hypotheses were formulated for the current study:
- Africa is not well-equipped for addressing the mental health challenges of its population, which leaves many underserved individuals alone in the efforts to deal with psychological issues on their own.
- The overall unfavorable socioeconomic environment in the region limits success and achievement, causing populations to resort to drug abuse.
- There is not enough attention given to projects, programs, and available services aimed to alleviate the burden of mental health and drug abuse among the population.
The Rationale for Research Objectives and Hypothesis
The rationale for formulating the abovementioned research objectives and hypothesis is concerned with the fact that the topic of mental health in Africa has been scarce in research articles. As suggested by Sankoh et al. (2018), who conducted a systematic literature review, only twenty-one articles have alluded to studies of depression in Africa, seven explored anxiety, six evaluated suicide, four alluded to addition, and only one to psychosis. Therefore, there is a large gap in research into mental health problems and substance use disorders in the region. The scarcity of studies is reflective of the weaknesses that the mental health sphere in the region has when it comes to addressing the public health challenges within the population. As a consequence, the African populations who consistently receive treatment for their mental health issues are very limited. While the worldwide annual rate of mental health outpatient facility visits is 1051 per 100,000 people, the African rate is 14 per 100,000 (Sankoh et al., 2018). Drawing data from a West African country Sierra Leone, the treatment gap has been estimated at 98.8%, representing the rate of those in need of mental health care going untreated (Yoder et al., 2016).
In the West African region, epidemiological surveys on the prevalence of mental health disorders and conditions are limited. Among the recent standardized surveys was the Nigerian Survey of Mental Health and Well-being, which offered estimated data on the prevalence of mental health challenges among adults (Esan et al., 2014). According to the survey, there was a 12.1% lifetime prevalence rate for common DSM-5-defined mental disorders, with a 5.8% prevalence rate over the last twelve months (Esan et al., 2014). A finding of crucial relevance is that despite the fact that 23% of Nigerian adults were diagnosed with severe and disabling mental health conditions, less than 10% of that group received any health care within a twelve-month period (Esan et al., 2014). In Nigeria, similar levels of mental health disorders were reported as the country remains in recovery from a fourteen-year civil war (Ajayi & Somefun, 2020). A community-based cross-sectional study revealed that among 1,666 adults involved in a survey, 44% of people suffered from posttraumatic stress disorder, while 40% indicated struggling with major depressive disorder (Esan et al., 2014). However, the extent of care for the identified mental health challenges remained at a low level. This is indicative of the lack of psychiatric services in West Africa and limited financial and human resources.
Concerning the challenge of illicit drug use in West Africa, the overall picture is similar to that concerning mental health care. According to the article by the Society for the Study of Addiction (2013), drug use has often been neglected because some high-level officials were involved in the drug trade. From the 1980s, cocaine and heroin that were smuggled through Nigeria to other West African countries made it to local drug markets, facilitating a spike in population numbers seeking treatment for drug abuse disorders (Society for the Study of Addiction, 2013). Moreover, anecdotal evidence from Guinea-Bissau and several other neighboring countries suggests that crack cocaine has become widely used in urban centers during the past decade, with the trend continuing to grow upward (Society for the Study of Addiction, 2013). Besides the government’s neglect of drug use, there is also an issue concerning the neglect of treatment. Specifically, instead of supporting people throughout the treatment of their drug addiction, the Nigerian government left many citizens arrested, harassed, and incarcerated (Society for the Study of Addiction, 2013). There are generally limited options for treatment for individuals struggling with drug abuse in the region, which is why people are left on their own to deal with drug abuse disorder. Notably, the neglect of treatment for drug abuse is commonplace in the majority of West African countries, with substance abuse policies being non-existent.
The current study is relevant because mental health issues are increasing in importance in the region. Specifically, the population on the continent increased by 49% between 2000 and 2015, while the time lost to a disability stemming from mental health issues rose by 52% (Sankoh et al., 2018). For example, in 2015 alone, 17.0 million years were lost to disability as a result of mental health challenges, with such challenges being as impactful as parasitic and infectious diseases, which accounted for 18.5 million years lost to disability (WHO, 2018). Because the population of the region is expected to grow twofold over the next thirty years, there will be increasing pressures on young people to survive within highly competitive environments and deal with arising mental health issues. Many may experience psychological problems as they do not reach their ambitions, while some may engage in illicit drug use as a way to alleviate frustrations (British Council, 2018). Therefore, more attention from research to the challenges of mental health and substance use is needed.
Despite the generally bleak picture concerning the mental health and drug use climate in the majority of West African countries, with states pushing repressive responses, there were some positive developments in the area of addressing drug abuse. For example, the initiatives are driven by the African Union (AU) and the West African Commission on Drugs (WACD) recognized a significant health burden of illicit drug use, such as the repressive and human rights-violating nature of control policies (Society for the Study of Addiction, 2013). Both AU and WACD underlined the importance of research on drug use prevalence as well as the availability of treatment to the affected populations. Even though the steps in the positive direction are minor, they show that there is some hope for the region to begin addressing the drug abuse problem without repressive measures.
Research Methodology
Considering the fact that mental health and drug abuse are public health challenges that have been studied both quantitatively and qualitatively, either methodology could work in the context of the topics being explored. However, considering the lack of comprehensive and up-to-date data on the prevalence of mental health and substance use disorders in the West African region, a qualitative study design is the best fit for this scenario. A systematic qualitative review can help bring together available studies on the topic of mental health and drug use in West Africa, systematically search for various evidence from primary studies, and draw findings. Because the identified problems are under-researched and poorly explored, a systematic literature review will synthesize relevant data that is aggregated and interpretive, offering a framework for future quantitative studies implemented in West African countries specifically (Seers, 2015). From the interpretation of data, it is also possible to form further understandings leading to theory formulation and development, helping understand and predict future occurrences. Currently, there are such types of interpretive qualitative systematic reviews as meta-ethnography, critical interpretative synthesis, narrative, and realist syntheses (Seers, 2015). Meta-ethnography could be chosen as the methodology for the current research because it is flexible and can be used for varied purposes. The data from a meta-ethnography represent themes and concepts drawn from primary studies, which can be used for thematic analysis and identification of relevant trends within datasets. Moreover, meta-ethnography allows one to look at varied experiences and perspectives to identify themes that unify multiple studies and make recommendations as to the issues on which future studies should elaborate.
References
Ajayi, A., & Somefun, O. (2020). Recreational drug use among Nigerian university students: Prevalence, correlates and frequency of use.PloS ONE. Web.
British Council. (2018). Next generation Kenya: Listening to the voices of young people.Web.
Chapman, J., Jamil, R., & Fleisher, C. (2021). Borderline personality disorder.Web.
Esan, O., Abdumalik, J., Eaton, J., Kola, L., Fadahunsi, W., & Gureje, O. (2014). Mental health care in Anglophone West Africa. Psychiatric Services, 65(9), 1084-1087.
Juma, K., Murunga Wekesah, F., Kabiru, C., & Izugbara, C. (2019). Burden, drivers, and impacts of poor mental health in young people of West and Central Africa: Implications for research and programming. In McLean M. (Ed.). West African youth challenges and opportunity pathways: Gender and cultural studies in Africa and the diaspora (pp. 223-265). Palgrave Macmillan.
Katz, C., El-Gabalawy, R., Keyes, K. M., Martins, S. S., & Sareen, J. (2013). Risk factors for incident nonmedical prescription opioid use and abuse and dependence: Results from a longitudinal nationally representative sample. Drug and Alcohol Dependence, 132(1-2), 107–113. Web.
Sankoh, O., Sevalie, S., & Weston, M. (2018). Mental health in Africa.Comment, 6(9), 954-955. Web.
Seers K. (2015). Qualitative systematic reviews: Their importance for our understanding of research relevant to pain. British Journal of Pain, 9(1), 36-40. Web.
Society for the Study of Addiction. (2013). West Africa’s drug trade: Reasons for concern and hope. Addiction, 108, 1871-1872.
Vorspan, F., Mehtelli, W., Dupuy, G., Bloch, V., & LĂ©pine, J-P. (2015). Anxiety and substance use disorders: Co-occurrence and clinical issues. Current Psychiatry Reports, 17(4). Web.
WHO. (2018). Global health estimates: Life expectancy and leading causes of death and disability. Web.
Yoder, H. N., Tol, W. A., Reis, R., & de Jong, J. T. (2016). Child mental health in Sierra Leone: A survey and exploratory qualitative study.International Journal of Mental Health Systems, 10, 48. Web.
Annotated Bibliography
Esan, O., Abdumalik, J., Eaton, J., Kola, L., Fadahunsi, W., & Gureje, O. (2014). Mental health care in Anglophone West Africa. Psychiatric Services, 65(9), 1084-1087.
The article is beneficial for illustrating the overall state of practice and resources available to the population of West Africa to address their mental health concerns. Focusing on Anglophone countries of the region, such as Ghana, Nigeria, Sierra Leone, Liberia, and The Gambia, the researchers assessed the prevalence of mental health issues, human resources, and research (Esan et al., 2014). Several factors limiting mental health care delivery in the region were identified. They include the stigmatization of mental health specialists and patients, inadequate funding, limited public awareness, low prioritization by policymakers, as well as the loss of professionals (Esan et al., 2014). The overall lack of psychiatric services and policies to help populations manage their mental health is indicative of the long-term ignorance of governments and policymakers of the importance of the challenge. While there are some developments pointing to the slow progress of the issue, there is still no comprehensive program or policy that facilitates ongoing research and development of solutions.
Society for the Study of Addiction. (2013). West Africa’s drug trade: Reasons for concern and hope. Addiction, 108, 1871-1872.
The study aimed to add to the limited body of scientific literature with regard to substance abuse in West Africa. The researchers acknowledged that drug abuse remains a debated topic in the region because governments have consistently overlooked the need for interventions and implemented repressive policies instead of helping populations overcome addiction (Society for the Study of Addiction, 2013). There has been a neglect of drug use, research, and treatment for decades, which resulted in the region persistently struggling with illicit substance trade and use. The limited reliable and valid data that discusses drug abuse in the region is problematic considering the prevalence rates and the lack of services available to the population. Besides, the researchers suggested that foreign-inspired interventions to end illicit drug use in Africa are not effective because they do not consider the experiences of the region nor the nature of policymaking (Society for the Study of Addiction, 2013). Therefore, the article can be greatly beneficial for pointing out the limitations of current efforts of West African governments regarding alleviating the burden of illicit drugs.
Juma, K., Murunga Wekesah, F., Kabiru, C., & Izugbara, C. (2019). Burden, drivers, and impacts of poor mental health in young people of West and Central Africa: Implications for research and programming. In McLean M. (Ed.). West African youth challenges and opportunity pathways: Gender and cultural studies in Africa and the diaspora (pp. 223-265). Palgrave Macmillan.
The source is a chapter from West African Youth Challenges and Opportunity Pathways, which summarizes available research on mental health issues among young people in West and Central Africa. Even though the authors acknowledged the fact that data in the region is limited, several small-scale non-representative studies allowed us to identify important trends regarding the critical challenges that young people in the region face. Mental health disorders have been shown to occur in youth because of political and socioeconomic instabilities in their home countries, poverty, unemployment, sexual violence, substance abuse, as well as the HIV/AIDS diagnosis (Juma et al., 2019). As a result of low quality of mental health, young West and Central Africans are at a higher risk of poor education, limited access to healthcare services, and low outcomes of livelihood (Juma et al., 2019). Besides, as a result of limited public awareness, young people who have mental health issues are more prone to be subjected to stigma, discrimination, isolation, and abuse of their human rights (Juma et al., 2019). Therefore, the source is useful for shedding light on the situation with mental health and young people. The context of the younger population is important to consider in this study because it is indicative of the environment in which new generations grow and the challenges they have to face.
Final Comments
In the development of the research proposal, it became clear that the issue that I set to explore is persistent but ignored by the extensive scientific research community. Even though researchers have indicated that data on mental health and drug abuse in West Africa is highly limited, there is still not enough evidence in 2021 to show a positive trend in research and policymaking. Therefore, I realized that my study would be highly important for synthesizing the available evidence and presenting a ‘full picture’ of the public health challenge. The majority of the world is accepting of mental health and works on developing valuable and practical strategies to alleviate its burden, and the same applies to illicit drug abuse. However, West Africa lags behind the global community in this sense, which creates significant limitations to the overall prosperity of countries and their future potential for development.