For most Nigerians, mental illness occurs “when someone starts running around naked.” It is a shocking mistake. But 70% of those surveyed in a recent study – the largest in the country in nearly 20 years – believe it. And that was just one of the many misguided and harmful ideas the report showed.
The survey, which had 5,315 participants and was carried out by our organizations – EpiAFRIC and the Africa Polling Institute – found that 84% believe that mental problems are due to excessive consumption of narcotic drugs, the 60% link these diseases to “evil of the mind”, 54% to “possession by evil spirits” and 23% to “punishment from God”. Almost a third, 32%, believe that mental problems come from the family.
Given such mistakes, it may come as no surprise that 69% of respondents said they would have no relationship whatsoever with someone with mental problems – 58% due to personal safety. Only 26% of the participants consider that they could become friends with a person with mental illness, only 2% would do business with someone like that and a tiny 1% would consider marriage. Nigerians are often recommended to check whether the family of a potential spouse has a history of mental illness.
This stigma has serious consequences for those facing mental health problems. Respondents responded that if they see someone suffering from mental disorders, 8% would take him to a traditional healer, 4% would lock him up, and 2% would try to beat him out of the disease. Considering that 48% answered that they know someone with a mental problem – a group that can include up to 30% of the population, according to some estimates – what these answers imply is vast.
To make matters even worse, Nigeria’s mental health stigma is embedded in its legal system. The Lunacy Act of 1958, still in force — a colonial law that legalizes the violation of the rights of the mentally ill — governs care for psychiatric illnesses. For example, the law authorizes medical practitioners and magistrates to identify “madmen” and detect when and for how long they must be detained (usually in prisons with criminals). The National Assembly has a bill to replace it since 2003. Although the Senate Health Committee recently held a public hearing on the bill, it has not yet been passed.
Given the social stigma and lack of legal protection, Nigerians struggling with mental illness are understandably reluctant to seek help, but even those who do try may have a hard time getting it. Even if they went to a hospital – where 65% of those surveyed said they would take a person with mental illness – there is no guarantee that a qualified professional is available. According to the Nigerian Psychiatric Association, only 250 psychiatrists provide services to Nigeria’s 200 million people, one in 800,000 people. The United States, with 28,000 psychiatrists and 330 million people, has one every 11,786.
Given the extensive training that psychiatrists require, it will take decades to resolve this deficit (and only if young people are encouraged to pursue this specialty). So policymakers must act now, both to reduce stigma – especially by correcting misconceptions about mental illness – and to provide adequate care and attention for those who need it today.
To this end, innovative approaches are already emerging, the Mentally Aware Nigeria initiative uses the power of social media to educate the public on mental health issues. It has also established a suicide and distress hotline, which provides immediate intervention and “mental first aid” before referring callers for specialized care.
69% of respondents would not have any relationship with someone with mental problems
Nigeria is far from alone, in Zimbabwe, Friendship Bench promotes a community-based approach, whereby non-health-related neighbors – especially “grandmothers” (elderly women) – offer empirical conversational 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 this intervention had significantly lower symptom scores than the control group, who received expanded conventional care.
In more distant places there are even more unexpected innovations. For example, in the United States, the Virginia-based non-profit Oasis Alliance uses interior design to “promote and accelerate recovery, growth and mental well-being” in people who have suffered trauma.
Of course, these programs cost money, so in addition to changing mental health laws, the Nigerian government must allocate more funds to the sector. Less than three dollars a year per person in the world are spent, on average, on mental health, according to the World Health Organization; In low-income countries, that allowance can even drop to $ 0.25 per person. In Nigeria, the national budget for mental health basically covers capital costs and staff salaries in federal neuropsychiatric hospitals, and usually only a fraction of the allocated budget is executed.
One way to make those limited funds work better 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. In addition, health insurers should be forced to include these services in their plans, so that people do not have to pay for them directly, an insurmountable barrier for many.
Nigeria is failing its people with mental health problems, which are not a small part of the population; But by improving legislation, education, and support systems — designed and implemented with the participation of donors, advocates, and professionals — the country can reverse the problem of mental health and lay the foundation for a healthier, happier, and more productive future. .
Ifeanyi M. Nsofor He is a physician and senior fellow at Atlantic Fellows for Health Equity at George Washington University, and executive director of EpiAFRIC and director of Policy and Support for Nigeria Health Watch. Her Twitter account: @ekemma. Bell Ihua He is a specialist in social science methodology and an expert in surveys, he is executive director of the Africa Polling Institute (API). Her Twitter account: @Bellemskey.
Copyright: Project Syndicate, 2020.
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