Gatekeeping Mental Health Care: A Critical Analysis of mhGAP-HIG Implementation in Cameroon's Anglophone Crisis...

The Anglophone crisis in Cameroon (2016-2026) has created a severe mental health treatment gap, yet the implementation of evidence-based interventions like the WHO's mhGAP-HIG remains poorly documented. This paper critically analyzes mhGAP-HIG implementation in Cameroon through an anti-oppressive practice (AOP) lens, examining how structural barriers, power dynamics, and systemic exclusion shape access to mental health training and services.

Drawing on a scoping review of peer-reviewed literature (2016-2025), a document analysis of publicly available organizational reports (CBCHS, UNFPA, Action Against Hunger, WHO), and AOP frameworks, we conducted a critical thematic analysis of barriers to mhGAP-HIG implementation in Cameroon's Northwest and Southwest regions.

The analysis identifies four mechanisms of structural exclusion: opaque training access privileging INGO staff; linguistic and cultural barriers marginalizing Anglophone populations; infrastructure collapse disrupting service delivery; and political denial restricting humanitarian access. Document analysis revealed 92 clinicians and 20 stakeholders trained, but trainings are geographically concentrated with no public registry. These mechanisms constitute structural violence perpetuating the treatment gap.

We propose an AOP-informed framework with five principles: naming structural violence, centering marginalized voices, decentralizing power, ensuring cultural and linguistic safety, and addressing daily stressors. For each, we specify practice strategies, including accessible training pathways, English/Pidgin materials, community supervision, and advocacy.

mhGAP-HIG can resist the state's abandonment of Anglophone populations, but only if implemented through an explicit anti-oppressive lens that names oppression, centers marginalized communities, and addresses structural determinants of distress.