How a brother’s illness sparked a plan to put mental health on the agenda across Africa

Jean Kaseya heard regularly from his younger brother, an army officer in the Democratic Republic of Congo, until the day in 2018 when all contact stopped. “Suddenly we ran out of information,” recalls Dr. Kaseya, Director General of the African Centers for Disease Control and Prevention (Africa CDC).

It took two years before an acquaintance approached the family to say that his brother Dieudonné was still alive, but in prison in the north of the country. Kaseya was able to have him brought back to the capital, Kinshasa. ‘I went to see him. To be honest, this person deserved to be in a hospital, not in prison.

“We were able to get him to the hospital,” he says. “But it was too late.” Untreated psychological problems had snowballed and Dieudonné had also developed physical problems, including diabetes and kidney disease. “And after two months he died,” says Kaseya.

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

“This motivation is not anger. The main thing is that I don’t want others to go through the same experience – how we can stop this, and how we can start screening people before they come (to the same level as) my brother.’

Africa CDC is committed to integrating mental health care into community health programs across the continent. In May it launched one Mental Health Leadership Program, which will train healthcare workers at different levels in prioritizing mental health. Psychiatric medications are included in the organization’s list of basic medicines for primary care programs.

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

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

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

Many people with poor mental health are being fired from their jobs “and in countries where you don’t have social security, you don’t have insurance, you’re being left behind. I think that’s what’s happening in a lot of countries and that’s what happened to my brother,” Kaseya says.

The circumstances that led to Dieudonné’s imprisonment and the downward spiral he entered remain unclear.

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

Dieudonné wanted to be a soldier, unlike his older brother’s plans for a medical degree. “He said, ‘You want to save lives when people are sick. Me, I want to save (the) lives of people who are threatened by war and things like that.'”

After graduating, Dieudonné joined the army and rose through the ranks. He sent messages to the family about what he was doing until that day in 2018.

By the time Kaseya found him, he was showing symptoms of depression and anxiety, sometimes running away during conversations saying, “They’re killing people outside.”

“I think it was mainly caused by the consequences of what he went through (during) the war. And as you know, sometimes soldiers start using certain substances, such as 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 went on medicine. Kaseya said more regional production of “affordable and quality medicines” — another key part of the Africa CDC’s work — could bring prices down.

Kaseya has since visited military prisons in the DRC and estimates that at least half of the people held “don’t deserve to be there.” They are locked up for drug use or violent behavior stemming from poor mental health.

There is a major problem in many African countries, he says, of people being improperly imprisoned, pointing to some national laws that criminalize homosexuality.

Those attitudes – and the misogynistic ideas that daughters are less valuable than sons – also need to be addressed to improve mental health, he says.

“Mental health is not just about DNA, but also about the environment. Anyone can be affected if you are in the environment that pushes you,” he says.