How a brother’s illness spurred a plan to get mental health on the agenda across Africa

Jean Kaseya would hear regularly from his younger brother, an army officer in the Democratic Republic of the Congo, until the day in 2018 when all contact stopped. “Suddenly, we didn’t have any information,” remembers Dr Kaseya, director general of the Africa Centres for Disease Control and Prevention (Africa CDC).

It was two years before an acquaintance approached the family to say his brother, Dieudonné, was alive, but in jail in the north of the country. Kaseya was able to have him brought back to the capital, Kinshasa. “I went to see him. Honestly, this person deserved to be at a hospital, not to be jailed.

“We managed to bring him to the hospital,” he says. “But it was late.” Untreated mental health problems had snowballed and Dieudonné had also developed physical issues, including diabetes and kidney disease. “And after two months he passed on,” says Kaseya.

Dieudonné was 45 years old and had three children. His death had a profound impact on his brother. Mental health care for Africans became a priority for Kaseya, who was appointed to his current role in February 2023.

“This motivation is not anger. It’s mostly I don’t want others to go through the same experience – how we can stop it, and how we can start to screen people before they get [to the same level as] my brother.”

Africa CDC is pushing to integrate mental health care into community health programmes across the continent. In May, it launched a Mental Health Leadership Programme, which will train health professionals at various levels in how to prioritise mental health. Psychiatric drugs are included in the organisation’s list of basic medicines for primary healthcare programmes.

Kaseya remembers how expensive it was to deal with his brother’s problems. “We were paying around $500 per week to take care of him – for medication, for any kind of support – because he was admitted to a specialist centre.

“And I was asking myself what are others doing? If you don’t have money, what can you do?”

The World Health Organization estimates there are at least 116 million people in African countries with mental health conditions. But there are very few services, and only 1.4 mental health workers for every 100,000 people.

Many people with poor mental health find themselves dismissed from their job “and in countries where you don’t have social insurance, you don’t have insurance, you are left behind. I think this is what’s happening in many countries and this is what happened to my brother,” says Kaseya.

The circumstances that led to Dieudonné’s imprisonment and downwards spiral remain murky.

“I was the firstborn of my father and my mother, and he was the second,” says Kaseya. “When we were young, we were like twins. He was the most intelligent one at school level. He was beating me every time.”

Dieudonné wanted to be a soldier, in contrast to his older brother’s plans for medical school. “He said, ‘you want to save lives when people are sick. Me, I want to save [the] lives of people threatened by war and things like that.’”

Dieudonné joined the army after graduating, and progressed through the ranks, sending the family messages about what he was doing – until that day in 2018.

By the time Kaseya found him, he was displaying symptoms of depression and anxiety, and would sometimes run away during conversations, saying “they are killing people outside”.

“I think it was mostly driven by the consequence of what he was experiencing [during] war. And as you know, sometimes soldiers start to use some substances like drugs. It’s a combination of so many factors, you know – war, drugs and living conditions.”

Much of the $500 a week the family spent on Dieudonné’s care was for medication. Kaseya said more regional manufacturing of “affordable and quality medicines” – another key component of the Africa CDC’s work – could bring prices down.

Kaseya has since visited military prisons across the DRC and estimates that at least half of those in detention “don’t deserve to be there” – having been incarcerated for drug use, or because of violent behaviour driven by poor mental health.

There is a big issue in many African countries, he says, of jailing people inappropriately, citing some national laws that criminalise homosexuality.

Those attitudes – and misogynist ideas that daughters are less valuable than sons – must also be tackled to improve mental health, he says.

“Mental health is not just about DNA, it’s about the environment. Anyone can be affected if you are in the environment that is pushing you,” he says.