Decolonizing Africa Mental Health

I knew that I was going to lecture about mental health in Africa for months before the actual lecture on 24th March 2026. Yet, every time I would sit down to start working on the slides my mind would hit a blank. The task felt impossible. Because the truth is, it is difficult to put Africa into a box, let alone something as nuanced and culturally rooted as mental health. We are talking about a continent made up of 54 sovereign countries!

They do not share one single culture, one language, or even one history. Nations like Ethiopia and Liberia were never formally colonized in the same way the rest of the continent was. We also have economic powerhouses like South Africa, Egypt, and Nigeria, and high GDP-per-capita nations like Seychelles and Mauritius. On the other end of the spectrum, we have nations facing severe economic and infrastructural challenges, such as Burundi, South Sudan, and the Central African Republic. We really cannot compare the mental health infrastructure of a wealthy, stable nation to one navigating extreme poverty or post-conflict recovery.

Finally, a month before the lecture, I had an aha moment. The only way the lecture would make sense to the students, who were mostly medical students and not psychology students, was to take a broad, overarching framework to help them understand (and if I am honest, myself as well) the historical and systemic forces that have shaped the continent's mental health landscape.

I divided the lecture into four areas: pre-colonial times, colonial times, post-independence to modern day, and the future of mental health in the age of AI.

We began by tracing the mental health constructs in the pre-colonial era. During the pre-colonial era, mental health was not viewed as an isolated medical condition confined to the brain. Instead, it was considered a state of wholeness and balance—a three-dimensional relationship connecting humanity, the divine, and the natural environment. For example, among the Bambara people in Mali, mental health was linked to the elements of nature, such as earth, water, and fire.

Psychosocial disabilities were often attributed to worry or moral retributive magic. What is fascinating is that indigenous systems had clear diagnostic categories long before the DSM existed. These included conditions present from birth, as well as social or spiritual disruptions caused by broken relationships or neglecting ancestral duties. For example the Shona people of Zimbabwe attributed disturbances to ancestral spirits. In Northern Africa, milder psychosocial disabilities were believed to occur when someone was possessed by invading spirits. Furthermore, symptoms that mirror Western definitions of psychosis, like hallucinations and wandering, were mostly diagnosed as an ancestral calling that required spiritual initiation rather than psychiatric confinement.

Healing during this time was communal. You could not treat the individual without treating the collective. Therapy involved physical space, identity, and communal bonds. Common treatments included suggestion, confession, faith, medication, and group support. For instance, the Ndembu of Zambia used kinsmen to join individuals in group therapy for confession and social reintegration , while spiritual healers in Northern Africa practiced exorcisms to reconcile possessed persons with invading spirits.

Enter the colonial era. This period was largely defined by the weaponization of psychiatry and the subjugation of African people. The entrance of Western health, religious, and education systems did not seek collaboration; it sought the annihilation of African indigenous practices. Western logic labeled traditional spiritual and health practices as demonic, archaic, and invalid. Consequently, this violent rejection pushed African mental health practices underground, turning indigenous identity into a source of shame. Colonial legislation actively banned and criminalized traditional healing practices, magic, and other traditional medical practices. Furthermore, colonialism physically separated communities from their land, such as sending men to mines and restricting access to sacred forests. This disruption to natural and communal connections created an environment of restriction that damaged collective mental wellbeing.

And so during the colonial time, mental health was introduced to Africa not as a tool of care, but as a tool of policing.

Early psychiatrists went so far as to label Black people as psychologically unfit for freedom. For instance, American physician Samuel Cartwright invented a mental illness called drapetomania, which was described as the disease that caused enslaved people to flee. In Africa, the community-based care model was replaced by the Western asylum model, which prioritized incarcerating the mentally unfit rather than restoring communal balance. These early psychiatric asylums, such as how Mathari Hospital was started in its early days, were largely built to incarcerate, control, and pathologize Africans who resisted colonial rule rather than to heal them.

Colonial asylums resembled prisons rather not medical facilities. They were used to control persons with psychosocial disabilities, often housing an amalgamation of patients, people with no settled residence, and criminals. For example, the British Lunacy Ordinance in Zimbabwe empowered magistrates to apprehend and convey to prison or hospital any person found wandering at large. The conditions within these institutions were often atrocious, characterized by overcrowding, substandard hygiene, and exposure to infectious diseases. Ultimately, colonial psychiatry was inextricably tied to racism and oppression. Africans cognitive abilities were unjustly equated with those of lobotomized Europeans, and they were characterized as childish, impulsive, and biologically incapable of suffering. Race played a key role in the system, with Europeans receiving better treatment and accommodations compared to Africans in these colonial asylums.

Today, mental health in Africa is still plagued by the echoes of this history. When many African nations gained independence, they did not dismantle the colonial psychiatric infrastructure; instead, they inherited it. We adopted outdated Western mental health policies and "lunacy acts" that were designed to isolate and control rather than to treat and rehabilitate.

As a result, our modern mental health systems suffer from chronic, systemic underfunding. On average, African governments allocate less than 1% of their national health budgets to mental health. This lack of investment leaves our centralized facilities overwhelmed, understaffed, and unable to provide dignified care.

Perhaps the most tragic legacy of these inherited colonial laws is the continued criminalization of mental distress. In numerous African countries today, attempting suicide is still classified as a criminal offense. Suicide is the tragic result of great psychological distress and a desperate cry for help, it is not a crime requiring police intervention and imprisonment. Punishing pain only deepens the stigma and pushes vulnerable people further underground, away from the care they desperately need.

As I concluded my lecture we came to a fascinating paradox. Today, the World Health Organization and leading global health bodies are recommending a shift away from institutionalization. The new global gold standard is to decentralize mental health care, moving patients out of large psychiatric hospitals and integrating them back into community-based care models. When you look at the statistics today, Africa faces a huge mental health treatment gap; often cited as high as 85% because we are relying on these broken, centralized, Western-style institutional systems.

The paradox is this: colonial systems dismantled our indigenous, community-centered healing practices to force us into asylums, and now, decades later, global health frameworks are instructing us to dismantle those very asylums. We are now playing catch-up to something that we were originally doing all along: community mental health.

But mental health in the Africa of today is not all gloom.

In fact, if we look beyond the broken institutional infrastructure and look at the people, we see great resilience. Recently, the 2026 Global Mind Health Report by Sapien Labs revealed a disruption of the global narrative.

Sub-Saharan African young adults (ages 18 to 34) consistently outperform their peers in higher-income regions—including North America and Europe—in overall mental wellbeing.

 Even more remarkably, the top five countries for youth mental health globally are all African. Ghana took the number one spot worldwide, followed closely by Nigeria, Kenya, Zimbabwe, and Tanzania.

The report identified key protective cultural factors driving this resilience, and they are essentially the practices that the colonial era tried so hard to erase. Our success stories are rooted in our closer family bonds and our stronger spiritual connections. Add to that modern public health realities, such as the later adoption of smartphones during childhood (which protects early social and cognitive development) and a lower consumption of ultra-processed foods, and clear picture emerges.

For far too long, the global health community has looked at Africa through a lens of deficit. But the data is showing us something different. When it comes to the mental wellbeing of the next generation, Africa does not just need help; we hold the global blueprint for mental resilience.

As we look toward the future, we must remain vigilant against new iterations of old systems. We discussed the real threat of digital colonialism. As Artificial Intelligence begins to permeate emotional support tools, we risk importing biases embedded in foreign clinical data sets, coding a new era of cultural erasure into the algorithms meant to help us. If we do not actively participate in building these digital systems, we will find ourselves subjected to a silicon version of the same colonial gaze.

Unpacking this historical context is heavy work. It requires us to look at the tools we use every day and question their origins. By the end of our time together, the weight of the conversation was palpable for all of us . Recognizing this, we closed the lecture by doing a collective grounding exercise. We took a moment to breathe, to feel our feet on the floor, and to honor the heaviness of the history we had traversed.

To redesign global urban health, we must find the courage to dismantle the colonial frameworks that no longer serve us. Healing, in its truest and simplest form is this: having the ability to remember where we came from so we are clear on where we are going.