key: cord-0805168-ulb7ya82
authors: Musesengwa, Rosemary
title: The long road to equality in mental healthcare for Young People in Africa
date: 2021-01-06
journal: EBioMedicine
DOI: 10.1016/j.ebiom.2020.103201
sha: 92f412abe5be4885c7e398c04c4a27abb8030474
doc_id: 805168
cord_uid: ulb7ya82

nan

Adolescence and early adulthood is marked by several transitions of life; economic, biological, social, and psychological [1] . These factors, separately and combined, become the determinants of health inequalities in young people, particularly in Low and Middle Income Countries (LMIC) [2] . Young people in Africa have been systematically disempowered from birth due to issues such as structural racism and poverty embedded in the societies they are born into [3] . The environment a young person grows up in determines whether they succeed or enter the vicious cycle of poverty, stigma and social injustice which can lead to mental health challenges. Social disenfranchisement, structural barriers and a lack of personal agency can impact negatively on a young person's ability to access mental health services [2] . Globally, a significant shift to online mental health services has occurred during the COVID-19 crisis to enable continuity and delivery of care. However, a significant proportion of young people in LMIC lack internet access or appropriate devices, and they also have low levels of digital literacy [4] . So, whilst the digital solution may be effective for a few young people in LMIC, it also exacerbates inequalities through digital exclusion.

Whilst I am privileged to be making a career for myself studying the ethics of digital mental healthcare for young people in Africa, I come from an LMIC background and have experienced and witnessed the impacts of health inequalities in mental health, as well as the micro-aggressions that propagate these inequalities. I believe my contribution as a Black woman in academia is to advocate for ethical reflection on digital inclusion, the digital divide, poor digital literacy, data ethics, acceptability and trustworthiness [5] . I am part of a young-people led network in Africa looking into the Ethics of Digital Innovation in Mental Health of Young People in Africa (EMDIYA). It focuses on putting ethical reflection at the centre of mental health intervention development. The network will explore how ethical challenges serve as barriers to digital mental health care. To reduce the development of another health inequality in itself, my goal is working to turn the transformative promise of the Sustainable Development Goals into reality: "Leave no person behind" means that we must overcome these inequalities in mental healthcare delivery for young people in Africa.

Author declares no conflict of interest.

Poverty and common mental disorders in low and middle income countries: a systematic review

Barriers and facilitators of mental health programmes in primary care in low-income and middle-income countries

Youth Transforming Africa

Multidisciplinary research priorities for the COVID-19 pandemic

I would like to acknowledge the work by EMDIYA network (https://neurogene.org/groups/emdiya/) and my mentor who reviewed and strengthened this submission: Ilina Singh.