Mental health in Nigeria: Breaking the silence, By Levi Judith Chinwe

Historically, mental health in Nigeria has been shrouded in misconceptions and stigma. Traditional beliefs often attribute mental illness to spiritual or supernatural causes, leading to discrimination and marginalisation. While modern treatment approaches have emerged, challenges persist in accessing quality mental health care in many regions of the country, particularly in suburban and rural settings. The negative impact of untreated mental health disorders in Nigeria is profound.

Mental disorders are among the ten global causes of morbidity and mortality in the world. In Nigeria, mental health often takes a back seat, despite its profound impact on individuals, families, and communities. About 20 per cent to 30 per cent of Nigeria’s population is affected by one or more mental disorders, which are often associated with poor awareness, misconception, stigmatisation, socioeconomic factors, and limited healthcare systems. It is usually easy to see mentally challenged individuals, both children and adults, roaming the streets of Nigeria, unkempt, with no food, shelter and families, or government caring for them, as against what is obtainable in developed countries. Nigeria, as of 2022, with a population of 218.5 million people, lacks comprehensive statistics on the general mental health care population, highlighting the urgent need for advocacy and awareness on this issue.

As it may be, the burden of drug abuse is on the rise and becoming a public health concern, with a bidirectional relationship between drug use and mental health issues exacerbating the problem. Nigeria, which is the most populous country in Africa, has developed a reputation as a centre of drug trafficking and usage, mostly among the youth population. According to the 2018 United Nations Office on Drugs and Crime (UNODC) report, “Drug Use in Nigeria” — the first large-scale, nationwide drug use survey in the country — one in seven persons (aged 15–64 years) used at least one drug in the preceding year. In addition, one in five individuals who had used drugs in the past year was suffering from drug-related disorders. Drug abuse has been linked to numerous criminal offences, including theft, burglary, sex work, and shoplifting.

Understanding the reasons why people indulge in drug abuse in Nigeria may guide the development and implementation of targeted interventions for reducing its burden. According to studies and research, the commonly reported reasons are to increase physical performance, derive pleasure, enhance sexual performance, enable relaxation/sleep, as experiment/out of curiosity, to keep awake, relieve stress and anxiety, assuage the depression of unemployment, and give temporary lifts out of frustration and economic hardship, etc. Regardless of any justifiable reason for drug abuse, it still has a huge impact on mental health, which refers to our emotional, psychological, and social well-being. It affects how we think, feel, and act, while influencing our ability to handle stress, relate to others, and make choices. Mental health disorders span a wide spectrum, including depression, anxiety, bipolar disorder, schizophrenia, and post-traumatic stress disorder (PTSD). These conditions can affect people of all ages and backgrounds. In this article, we will be exploring the current state of mental health in Nigeria, its negative impact, and the factors hindering the accessibility and availability of mental health resources, alongside mental health advocacy in the country.

Historically, mental health in Nigeria has been shrouded in misconceptions and stigma. Traditional beliefs often attribute mental illness to spiritual or supernatural causes, leading to discrimination and marginalisation. While modern treatment approaches have emerged, challenges persist in accessing quality mental health care in many regions of the country, particularly in suburban and rural settings. The negative impact of untreated mental health disorders in Nigeria is profound. It can lead to impaired functioning in daily life, an increased risk of substance abuse, higher rates of physical health problems, social stigma, and an economic burden due to misdiagnosis, mismanagement, healthcare costs, insurgency, and high crime rates; all of which impact the nation’s overall productivity. Therefore, for national progress, it is crucial to understand the challenges that contribute to mental health crises in the country.

Common Challenges Hindering Mental Health Care in Nigeria

Stigma and Discrimination: Widespread stigma surrounding mental illness prevents many from seeking help or disclosing their conditions to others for the fear of being humiliated. In some societies, there is a strong stigma attached to mental illness, leading to shame and the fear of judgment. Turning to religious institutions can seem more acceptable and less stigmatising than admitting to a mental health issue and seeking medical help.

Lack of Awareness: There is a general lack of awareness and understanding of mental health issues, thereby perpetuating stigma and hindering early intervention. In 2019, a survey on mental health in Nigeria, by Africa Polling Institute (API) and EpiAFRIC, showed how the awareness about it is low in the country, with most respondents who are conscious of having mental health disorders, recognising these as essentially caused by drug abuse, the possession of evil spirits and sickness of the brain, while majority of the patients are however taken to prayer houses for spiritual interventions.

Limited Access to Care: Inadequate resources, including the limited availability of mental health professionals and facilities, contribute to limited access to care mental health issues, particularly in rural areas. Nigeria, with over 200 million people, has only eight federal neuropsychiatric hospitals, with fewer than 300 psychiatrists in them, accounting for a ratio of about 700,000 people per psychiatrist (1:700,000), most of whom are urban-based, and because of poor knowledge of mental disorders at the primary health-care level, caring for people with these illness is typically left to family members. This can be attributed to the shortage of mental health professionals, inadequate funding, and poor infrastructure, leading to insufficient and often inaccessible services for the population.

Creating green spaces in Nigeria can greatly improve mental health by integrating natural green areas into city plans or modifying existing plans. These could be in the form of parks, man-made lakes, ponds, lake fountains, etc. Natural settings such as these have been proven to reduce stress as they encourage exercise, promote social connections, boost brain function, clean the air, support therapy, and help people cope better, making cities healthier and more supportive.

Religious and Cultural Beliefs: These can significantly influence the attitudes of individuals toward seeking mental health care. In many cultures and religions, mental health issues are often seen through a spiritual lens rather than a medical one. This can lead to the preference for seeking help from religious houses and leaders, instead of health facilities. While religious and cultural contexts are important and can offer support, relying entirely on them for mental health care can hinder timely and effective treatment, potentially worsening the individual’s condition.

Insufficient Funding: Mental health services in Nigeria receive inadequate funding, leading to a lack of infrastructure, research, and training programmes. Nigeria faces a significant shortage of trained mental health personnel, with only a few hundred psychiatrists and an even smaller number of clinical psychologists, welfare officials, and social workers, for its large population. The government has made some efforts to support mental health professionals through initiatives like the Mental Health Act of 2021, but challenges remain regarding the quality of training and resource allocation.

To address mental health issues in Nigeria, a few things have to be put in place:

Recommendations

Access to Care: This can be achieved by allocating increased funding for the construction and renovation of mental health facilities, practicing a planned preventive maintenance culture in the facilities, and ensuring they are adequately equipped and staffed. The government can also allow mentally challenged individuals to access quality free medical treatment. Mental health services could be integrated into every primary and tertiary healthcare setting, while comprehensive and multidisciplinary care is provided. This can be achieved by training primary care providers in mental health diagnosis and treatment, and by ensuring that mental health services are available at all private and government healthcare centres.

Public Awareness Campaigns: These are to reduce stigma, and develop culturally sensitive mental health policies and programmes that would go a long way in stimulating the populace on the importance of mental health care and inform on the negative impacts of not seeking appropriate care. The Nigerian government at the federal, state, and local government levels, in conjunction with the private health sector and other interest groups, can achieve this by partnering with media outlets, community leaders, leaders of faith-based groups, and healthcare professionals, to share accurate information about mental health and promote positive narratives.

Social Media Anti-stigma Campaigns: In addition to public awareness campaigns, these sort of campaigns can also be effective in improving mental health by teaching people the facts virtually, clearing up wrong ideas, and encouraging them to get help when necessary, thereby reducing discrimination and creating a supportive community. These efforts can also lead to better policies, the training of health workers, and involvement of community leaders in making the talk about mental health normal. According to research published in the National Library of Medicine in 2020 by Dr K Latha of the Department of Mental Health Education and others, using social media platforms to conduct mental health campaigns is an effective initiative, as one can reach out to many people within a short time frame. With the help of technology, participants could easily participate in the campaigns. There is an increasing trend in mental health awareness through the effective use of digital media as information dissemination platforms.

Environmental Modifications: Creating green spaces in Nigeria can greatly improve mental health by integrating natural green areas into city plans or modifying existing plans. These could be in the form of parks, man-made lakes, ponds, lake fountains, etc. Natural settings such as these have been proven to reduce stress as they encourage exercise, promote social connections, boost brain function, clean the air, support therapy, and help people cope better, making cities healthier and more supportive. A study by Greenhaven Landscape in 2020 found that the negative ions produced around waterfalls and fountains are known to be therapeutic, and they help regulate sleep patterns and mood, reduce stress, and boost immune system function.

In addition, the Nigerian government at all levels can revitalise historic natural sites like the Yankari game reserve, Obudu Cattle Ranch, and pleasure parks, that not only serve as tourism centres but also green spaces for therapeutic purposes.

Integrating culturally sensitive medical care with spiritual support could provide a more holistic approach to mental health, rather than discouraging people from seeking help. Seeking medical help while waiting upon the Lord for healing is a great step towards combating mental health issues. Religious leaders can also educate mentally challenged individuals and their families to visit mental health facilities for tests and treatment.

Religious and cultural beliefs: Integrating culturally sensitive medical care with spiritual support could provide a more holistic approach to mental health, rather than discouraging people from seeking help. Seeking medical help while waiting upon the Lord for healing is a great step towards combating mental health issues. Religious leaders can also educate mentally challenged individuals and their families to visit mental health facilities for tests and treatment. In Nigeria, some religious leaders, after praying for their sick members, should encourage them to get proper medical help. Research published in MDPI by Dr Rene Hefti shows that mental health care programmes that integrate spiritual issues, range from short-term psycho-educational groups to open-ended discussions of “religious issues” and the way they relate to mental health concerns. Programmes illustrate possible forms of integration. For psychotherapy, the Probst study, as well as the Azahr study, indicate that the outcome in religious patients can be enhanced by integrating religious elements into therapy and that this can be successfully done by religious and non-religious therapists alike.

Mental Health Advocacy Policies

Parity Laws: These help solve mental health cases by ensuring that health insurance covers mental health treatment, making it more accessible and affordable for everyone. By this, all mentally challenged individuals will receive quality medical care and won’t have to roam the streets anymore. These laws exist in the United States, as well as in countries such as Chile, Colombia, and neighbouring Ghana, etc. Where they are trying to push for equality for mental illnesses and addiction treatment, a common barrier to overcome is clauses on pre-existing conditions that deny health insurance coverage.

Policy Development: HR can develop policies and procedures that prioritise employee mental health, such as flexible work arrangements, mental health leave, and employee assistance programmes. These policies provide employees with resources and support to manage their mental well-being.

Community Engagement: Community-led efforts will spread awareness about mental health and offer support by encouraging communities to tackle stigma, provide resources, and create caring environments for people dealing with mental health issues.

Rights Protection: Rights Protection policy helps mentally challenged individuals in Nigeria by ensuring they receive equal access to healthcare, education, and employment opportunities, while protecting them from discrimination and abuse. It also promotes public awareness and provides legal recourse, thereby enhancing their quality of life and integration into society.

By prioritising mental health advocacy and policy reforms, Nigeria can work towards breaking the silence surrounding mental illness and building a more inclusive and supportive society for all.

Levi Judith Chinwe writes from Port harcourt Nigeria, a biomedical engineer, mental health enthusiast and an entrepreneur.