Mental Health Advocacy in Nigeria
Mental health advocacy takes no time off, and sometimes it gets very personal. Being home with my family during the COVID-19 lockdown brought me in close contact with an uncle who had always been a bit segregated from the extended family because of his frequent incoherent behaviors. He had always said he heard voices, said God spoke and appeared to him in dreams, and denounced religion. His different behaviors had been chalked up to the influence of voodoo and the evil eye for so many years. Unbeknownst to us, he had been suffering from schizophrenia, which flared up during the lockdown. Over time, his symptoms became more acute, and after much discussion with and explanation to the extended family members, it was agreed to take him to the hospital for psychiatric evaluation. Yet, the implication of having a ‘crazy’ relative in the family and the stigma of having a mental health condition for him seem to be greater than helping him stick to the prescribed hospital admission and medications.
The stigma surrounding mental health conditions has eaten deep into the fabric of society. A lot of people – including Imams and clerics – believe that having a mental health disorder is a sign of weak Imaan or a test from Allah which needs to be managed with prayers.
This societal stigma begets self-stigma, which makes it difficult for those with mental health conditions to access the help they need. In Nigeria, as in many other countries and societies, it is difficult to say you have a mental disorder when mental illnesses always have a negative connotation that is constantly reinforced in the media.
My personal lived experience was the major prompt for me into the world of mental health awareness, and getting to know how those with similar experiences navigate society was one of my reasons for advocacy. I started my advocacy work in August 2018 by signing up to join Mentally Aware Nigeria Initiative (MANI) – the biggest and most successful NGO advocating for mental health awareness in Nigeria. MANI offers emergency physiological aid and free counselling sessions, operating rapidly across social media – especially Twitter – getting in touch with people in emergent suicidal situations to de-escalate them. Being a member has been a learning experience for me – helping me navigate my mental health issues and providing a safe space for others – and it has reinforced my interest in specializing in psychiatry. As a final-year medical student, I intend to specialize in psychiatry, In Shaa Allah, to reach more people and provide specialized, high-quality care.
Most of my advocacy revolves around helping community members manage their emotions and referring symptomatic individuals to therapy. I have had people reach out to me asking for help in dealing with certain difficulties, and I often point them in the direction of therapists. I have noticed many do not think therapy is necessary or are skeptical about its efficiency or effectiveness. In cases like this, I use my own personal experience with therapy to persuade them, as well as others’ experiences. Finding the right therapist to work with might be difficult for some, but as long as one is open to psychotherapy (and sometimes medication), there is a great deal of improvement to be seen.
As encouraging as the increased individual awareness is, there is still a lot to be done, especially at the community level. Spreading mental health awareness is a necessary first step, but mental health services should be made more accessible and affordable, especially in rural areas. There is a need for policymaking in this direction. Nigeria has not amended its mental health legislation since 1958. The current legislation is archaic, and it echoes the reality of a time when mental health was not fully understood. The legislation robs patients of their agency, going as far as to criminalize attempted suicide. There are about eight neuropsychiatric hospitals in Nigeria, and these cannot serve 200 million Nigerians. Private psychologists are springing up, and while this is a welcome development, they are often expensive and unaffordable. It is not enough to tell community members to seek help — it is also important that when they reach out to seek this help, there are resources available, accessible, and affordable to them.
Mental health conditions are a global phenomenon, and the stigma around them abounds in most cultures. Provision of mental health resources and widespread awareness — especially among older generations and in religious institutions — would result in people knowing enough about mental illnesses to recognize the symptoms early, which means a high percentage treated easily and effectively.
People struggling with their mental health would be willing to access mental health care without worrying about societal stigma and the associated financial burden. This would collectively lead to a lower socioeconomic burden associated with mental health conditions as mental illnesses often affect personal income, the capacity of the patients and sometimes their caregivers to work, and contributions to the national and global economies. Communities will prosper when mental health needs of community members are met.
All of these efforts will have a long term effect of encouraging more people to specialize into mental health care. As more emphasis is made on prioritizing mental health, more people will be interested in furthering the cause which will create more jobs in society, and more importantly, increase access to specialized, high-quality care. In a world where mental health is prioritized and community members are well cared for, people like my uncle will experience a new level of wellness and a new sense of belonging.
Mariam Adetona is a mental health advocate, writer, and medical student at the University of Ilorin in Nigeria. She runs a bimonthly newsletter where she talks about positive psychology topics such as resilience, positive thinking, and the power of incremental change. She writes across genres and has been featured on Al Jazeera, Meeting of Mind, and Punocracy. She runs a literary outfit called “The Shade Book Club” in Ilorin and believes in the restorative powers of ice cream and chocolate chip cookies.