In the era of the COVID-19 pandemic, how global is mental health? Exploring the conceptualisation of mental health in Ghana and Nigeria

I argue in this study that the global mental health (GMH) framework and activities do not reflect the diverse understandings, experiences and conceptualisations of mental health within a global society. In former colonies like Ghana and Nigeria, psychiatric institutions and care practices embody colonial legacies, evident in the tensions and conflicts surrounding the contemporary care process under the GMH initiative and the diverse local healing systems in the two contexts.

Low- and middle-income countries (LMICs), such as Ghana and Nigeria, remain the primary targets of the GMH initiatives. However, it is uncertain to what extent the unique sociocultural, economic, political, and historical conditions that shape the conceptualisation of mental distress in these contexts are fully considered in the framework of GMH. Using the COVID-19 pandemic as an entry point, the study recognises that, despite its global impact, lived experiences of the pandemic varied significantly across societies. Yet, GMH discourse largely framed COVID-19 as producing a universal ‘global mental health impact’.

The purpose of this study, therefore, is to explore the limits of the globality of mental health in specific contexts. The broad aim is to examine how people in Ghana and Nigeria conceptualise mental health in the context of the COVID-19 pandemic, considering their historical foundations. Ghana and Nigeria, with their shared colonial histories and sociocultural contexts, were chosen as case studies. Employing a multidisciplinary methodology that combined archival, ethnographic, and psychological approaches, data were analysed through reflexive thematic analysis. The findings demonstrate that the mental health experiences of the COVID-19 pandemic in Ghana and Nigeria diverged significantly from the global discourse, with emotional distress during the period not relating directly to the biological effects of the virus. Rather, restrictive measures, transnational communications, and resultant sociopolitical factors emerged as the most significant determinants of psychological experiences, which did not uniformly translate into mental illness.

Furthermore, GMH initiatives revealed enduring colonial legacies, an overreliance on the biomedical model of care, and the persistence of universalist ideologies. Importantly, the study uncovers a persistent knowledge gap in GMH regarding what and whose knowledge is prioritised, how it is transported to the Global South, and how this unresolved knowledge gap generates an intervention gap. By foregrounding the perspectives of Ghana and Nigeria, the study contributes to critical debates in global mental health, challenging universalist assumptions and underscoring the need for pluralistic, context-sensitive approaches that acknowledge diverse epistemologies and experiences of mental health and distress.