By Zenanile Dlamini

As the country drives towards a knowledge economy, mental health will more than ever become a fundamental component of economic growth, where well-being – including mental stability – is an essential ingredient to creativity, innovation and development.

Mental health is increasingly becoming a major threat to productivity worldwide. According to Health at a Glance 2017: OECD Indicators, an average 20% of the working-age population is affected by mental illness at any given time. The estimated direct and indirect economic costs for mental ill health in the OECD accounted for 3.5% of gross domestic product (GDP) in 2017, rising to 4% in 2018. Considering that Eswatini has been struggling to increase its GDP in past years, it is unknown how much of this potential economic growth is lost to mental ill health.

In sub-Saharan Africa, studies show that rates of post-traumatic stress disorder (PTSD), anxiety, and depression range from 20% to 60%, yet mental health is rarely taken into consideration in the public health policies of countries in this region. Research shows that in 2010, mental disorders contributed 10.4% to the global burden of disease and were the leading cause of years lived with disability. As a result, mental illnesses are classified as a leading global development issue.

Why focus on mental ill health?

In as much as mental illness is largely a medical issue, studies show that mental disorders result from factors other than health related or hereditary. Macintyre (2018) cites experiences of socioeconomic disadvantage, poverty, unemployment, level of education, and poor housing, as some of the factors detrimental to a person’s mental health. Unemployment, in particular, is well documented as inducing the most adverse psychological effects on people.

The inability to work and contribute to society inhibits self-actualisation, which leads to negative emotions that can manifest in anxiety, depression, and self-dissatisfaction – including higher incidence of suicide among young people. Yet, high unemployment, especially among the youth, continues to be a key characteristic of developing countries. Lack of economic opportunities does not only prevent these countries from attaining their potential GDP, unemployment also threatens people as a source of human capital by robbing them of their ability to function properly and contribute to nation building through income and wealth creation activities.

Mental ill health in Eswatini

Data from the Health Management Information System (HMIS) shows that between 2017 and 2019, about 8 229 people were affected by mental health related illnesses in Eswatini. This figure represents only those individuals who accessed health facilities, which means it could be significantly higher.

In her study on ‘the experiences, perceptions, and meaning of recovery for Swazi women living with schizophrenia’, Dr Nxumalo-Ngubane notes that mental illness in Eswatini is most prevalent amongst 25 to 45-year-olds. Bearing in mind that 79.1% of the population in Eswatini is below the age of 35 and HMIS data indicates that 40% of mental health patients in clinics and healthcare centres between 2017 and 2019 are young people between 15 and 35 years, mental health needs to be emphasised in social and economic development policy going forward. Also, the Labour Force Survey of 2016 finds that unemployment amongst this group is even higher at 47.4%, more than double the national unemployment rate (23%).

What it means for the economy is that Eswatini’s labour force cannot be as productive because the stock of entrepreneurs available to drive innovative business concepts is under threat. Consequently, government will have to find means to fund increased public health expenditure within a space of limited economic activities and a thin tax base.

Fortunately, the National Development Strategy (NDS) recognises the importance of human capital development as a key strategy to take the country to vision 2022. In addition, in the 2019/20 national budget speech, Minister of Finance Neal Rijkenberg emphasised the importance of human capital development in promoting sustainable and inclusive economic growth, poverty eradication, income inequality reduction, and laying a foundation for future prosperity.

Above all, the government has made considerable investments in human capital development in the country, such as the introduction of free primary education (FPE). However, issues of mental health seem to be left out, yet they are slowly depleting the country’s current and future human capital base. It is in the interest of policymakers to understand how mental illness is affecting productivity in the workplace and ultimately, economic competitiveness.

The reality is that despite the evidence pointing to the significance of mental issues to social and economic development, mental health tends to be overlooked. To understand the cost of mental ill health on the economy, the Eswatini Economic Policy Analysis and Research Centre (ESEPARC) is conducting a study that examines the relationship between youth unemployment and mental health. This study will provide policy recommendations on how to address youth unemployment before it deteriorates into a mental health crisis that could potentially decapitate Eswatini’s economy and future generations.

The role of public policy

Government needs to recognise mental ill health as an economic issue. In addition to promoting preventative measures such as mental health education and awareness, government needs to consider the economic losses due to not investing in mental health – particularly as it relates to the youth – as part of larger human capital development policies in Eswatini.

Investing in measures to address the social causes of mental health requires policies that will help the government save on medication, therapy, and neurobiological innovation costs necessary to mitigate or cure mental illnesses. It calls for strategies that will challenge, improve, and address youth unemployment as a key treatment for mental-ill health.

Such policies should aim to, amongst other things, address unfavourable living conditions, improve education and employment opportunities for all, provide conducive working environment (SDG 8), and reduce poverty and income inequality. In doing so, Eswatini would be carving new pathways for employment creation opportunities for the youth and prioritising the country’s young population as key drivers of private sector growth.

In short, the issue of mental ill health is about channelling a major share of the country’s population into productive economic activities. Of course, this will require considerable resources to provide the social and economic space to keep the country’s youth active so they escape the harsh realities of unemployment and prolonged idleness. For instance, a lot still needs to be done to support the youth through internship programmes, apprenticeships, and skills training to enhance production and productivity among the country’s youthful labour force.

In conclusion, the issue of youth unemployment and mental ill health is not something that government can tackle alone. The private sector, civil society, individuals and communities need to be involved. Getting the country’s human capital on the right track is one of the major pathways that could lead to productivity and increased economic growth in Eswatini.