Nigeria’s Mental Health Desert

By Ifeanyi Nsofor & Bell Ihua

ABUJA – To most Nigerians, mental illness is “when someone starts running around naked.” It is a shocking misconception, yet a full 70% of respondents to a recent mental-health survey – the country’s largest in nearly 20 years – believe it. And that was just one of the many misguided and harmful beliefs that the poll revealed.

The survey of 5,315 respondents, conducted by our organizations – EpiAFRIC and the Africa Polling Institute – found that 84% believe that mental disorders are attributable to drug abuse, 60% link such disorders to “sickness of the mind,” 54% to “possession by evil spirits,” and 23% to “punishment by God.” Nearly one-third – 32% – believe that mental disorders run in families.

Given these misconceptions, it is perhaps not surprising that 69% of respondents said they would not engage in any form of relationship with a person with mental-health issues – mostly, said 58%, for reasons of personal safety. Only 26% of respondents would so much as be friends with a person with mental illness, while just 2% would do business with such a person and a mere 1% would consider marriage. Nigerians are often encouraged to check for a history of mental illness in the family of a prospective spouse.

This stigma has serious consequences for those who struggle with mental-health issues. If someone was seen to be suffering from a mental disorder, 8% of survey respondents would take them to a traditional healer; 4% would lock them up; and 2% would try to beat the disease out of them. Given that 48% of the survey’s respondents reported knowing someone who suffers from a mental disorder – a group that includes up to 30% of the population, by some estimates – the implications of these responses are far-reaching.

Making matters worse, Nigeria’s mental-health stigma is embedded in its legal system. As it stands, the 1958 Lunacy Act, a colonial law that effectively legalizes violations of the rights of the mentally ill, governs mental-health care. For example, the act authorizes medical practitioners and magistrates to identify “lunatics” and determine when and for how long they should be detained – usually in prisons alongside criminal inmates. The National Assembly has had a replacement bill since 2003. Although its Senate Committee on Health recently held a public hearing on the bill, it has yet to be passed.

Given the social stigma and lack of legal protection, Nigerians struggling with mental illness are understandably reluctant to get help. But even those who do seek support might have difficulty finding it. Even if they went to a hospital – where 65% of survey respondents said they would take a person with mental illness – there is no guarantee that a qualified professional would be available. According to the Association of Psychiatrists in Nigeria, only 250 psychiatrists provide services to Nigeria’s 200 million people – one per 800,000 people. The United States, with 28,000 psychiatrists and 330 million people, has one for every 11,786.

Given the extensive training psychiatrists must undertake, it will take decades to address this shortfall – and only if young people are encouraged to enter the field. That is why policymakers must act now, both to reduce the stigma – especially by correcting misconceptions about mental illness – and to provide adequate care and support for those who need it today.

To that end, innovative approaches are already emerging. The Mentally Aware Nigeria Initiative uses the power of social media to educate the public about mental-health issues. It has also established a suicide/distress hotline, which provides immediate intervention and “mental-health first aid,” before referring callers for specialized care.

Nigeria is hardly alone. In Zimbabwe, the Friendship Bench is pioneering a community-based approach, in which local lay health workers – especially “grandmothers” (elderly women) – deliver evidence-based talk therapy on benches under trees. A clinical trial published in the Journal of the American Medical Association showed that, after six months, those who received the intervention had significantly lower symptom scores than the control group, who received enhanced conventional care.

Farther afield are even more unexpected innovations. For example, in the United States, the Oasis Alliance, a Virginia-based non-profit, uses interior design to “encourage and accelerate recovery, growth, and mental wellbeing” in trauma survivors.

Of course, programs like these cost money. So, beyond changing its mental-health laws, Nigeria’s government must allocate more funds to the sector. According to the World Health Organization, the world spends less than $3 per person, on average, on mental health each year; in low-income countries, that rate can be as low $0.25 per person. In Nigeria, the national mental-health budget essentially covers just capital costs and staff salaries at federal neuropsychiatric hospitals, and only a fraction of the allocated budget is routinely released.

One way to make more of limited funds would be to add mental health care to existing donor-funded public-health programs. For example, HIV/AIDS programs should include mental-health services for affected people. Furthermore, health insurers should be required to include mental-health services in their plans, so that people are not forced to pay out of pocket – an insurmountable barrier for many.

Nigeria is failing those of its people who struggle with mental-health issues – no small share of the population. But with improved legislation, education, and support systems – designed and implemented with the engagement of mental-health advocates, practitioners, and donors –Nigeria can turn the tide on mental health, laying the groundwork for a healthier, happier, and more productive future.

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Nsofor, a medical doctor and Senior Atlantic Fellow for Health Equity at George Washington University, is CEO of EpiAFRIC and Director of Policy and Advocacy at Nigeria Health Watch. Follow him on Twitter: @ekemma. Bell Ihua, a social researcher and survey expert, is Executive Director of the Africa Polling Institute (API). Follow him on Twitter: