Mental health priorities and challenges in Zambia: A scoping study

Background The design and delivery of safe and effective mental healthcare requires data on local needs and priorities. The aim of this scoping review is to provide background information on the prevalence of mental health conditions and local stakeholder experiences of mental healthcare in Zambia. Methods We searched electronic databases of published (Medline, PsycINFO, Embase, African Index Medicus) and unpublished (University of Zambia repository) literature to retrieve relevant epidemiological and qualitative articles from database inception to January 9th, 2024. Qualitative studies were synthesised using thematic synthesis and key themes were triangulated with experiences of local stakeholders. Results Eleven epidemiological papers were identified. These reported on the prevalence of mental distress in the general population (16.9%); depressive symptoms in adolescents (29.7%); problematic alcohol consumption in the general population (dependence, 7.4%; binge, 11.6%; and unhealthy consumption, 15.3%) and in adolescents (45.1%); suicidal ideation (7.8%) and behaviour (8.5%) in the general population and in adolescents (31.3% and 39.6%, respectively); suicide attempts in the general population (2.3%). Synthesis of 10 qualitative articles identified interrelated themes relating to barriers to access and provision of mental healthcare. Mental health stigma is perceived to be pervasive across all sectors of society and partly attributed to the language used in the previous Mental Health Act and the national psychiatric hospital. Structural stigma is perceived to drive the low priority of mental health in Zambia in policy, funding, advocacy and research. Reported consequences include low availability of safe and effective mental healthcare, particularly at community level, resulting in a cycle of coercive hospital admission, discharge, relapse and readmission. This is perceived to place significant social, emotional and economic stress on patients and their families. Carer burnout and the lack of visible recovery perpetuates the stigma that people with mental illness have little value to society. Conclusions Findings from this review indicate the need for a multisectoral approach to tackle structural stigma, increase national advocacy for mental health, and facilitate the provision of safe and effective community-based mental healthcare in Zambia. While epidemiological data is limited, the current evidence indicates that adolescents are a high priority group for early intervention.