Dignity in mental health care in East Africa: A critical synthesis of human rights, autonomy, participation, and equity.

BACKGROUND

Dignity is central to ethical, person-centred, and rights-based mental health care, yet evidence from East Africa remains fragmented. This review synthesised evidence on dignity and related dimensions of mental health care.

METHODS

Following PRISMA 2020, PubMed, Scopus, Web of Science, PsycINFO, African Journals Online, and Google Scholar were searched for studies published between 2010 and 2025. Eligible studies examined mental health services in East Africa and dignity or related constructs. Comparative evidence from Ghana, South Africa, Nigeria, and Malawi was also considered. Findings were synthesised thematically.

RESULTS

Of 276 records identified, 54 duplicates were removed, 222 screened, 54 full texts assessed, and 19 studies included. Dignity was compromised by stigma, discrimination, limited autonomy and participation, coercion, inequitable access, inadequate resources, poor continuity, cultural incongruence, and weak accountability. Empowerment, community-based care, supported decision-making, culturally responsive practice, and stronger safeguarding emerged as promising approaches.

CONCLUSION

Dignity should be addressed as a system-level outcome through rights-based, equitable, participatory, culturally responsive, and accountable mental health systems.