When it comes to mental health awareness and mental illnesses, Nigeria is walking on a landmine, but many people do not even know it yet.
According to statistics provided by the World Health Organisation, one in four Nigerians – about fifty million people – are suffering from one mental illness or another. Nigeria has Africa’s highest caseload of depression, and when it comes to the frequency of suicides, it ranks 15th. Across Nigeria, the number of suicides and suicide attempts surges from a rate of 0.6 per 100,000 people (among those fourteen years and younger) to 6.9 per 100,000 people (among those aged fifteen to nineteen years), even where attempting suicide is a crime punishable by an imprisonment term of one year, under Nigerian criminal legislation.
In the early hours of October 17, 2020, Iyanuoluwa Williams, a 25-year-old Nigerian actress based in Ibadan, ingested the pesticide popularly known as Sniper. She yelled in pain after this, and her parents tried to mitigate the situation by making her drink palm oil, but it was too little, too late. By the time her parents were able to get her to the hospital, her vital organs had already stopped functioning.
Iyanuoluwa’s best friend, Oreofe Oguntola, who is still trying to process the grief occasioned by the death of the former undergraduate of Tai Solarin University, revealed to Neusroom that Iyanuoluwa had been driven to suicide by a huge sense of disillusionment.
“Iyanu was depressed, she was tired of so many things,” says Oguntola. “She was tired of nagging parents, tired of being bullied into taking minor roles because producers felt she was not beautiful enough for lead roles, tired of being body-shamed, and tired of feeling like she meant nothing to anyone. She got fed up with education, Nigeria, and life. The worst part is that when she was sinking, none of us around her was sensitive enough to note it.”
Stella Chiejina, a writer and interior designer based in Abuja, was diagnosed with depression in 2019. In a lengthy phone conversation with Neusroom, she explains the effect of this discovery on her outlook to life.
“My mental health hadn’t been great for a very long while,” Chiejina reveals. “It was up and down for a whole year until I lost my job in January 2019. This was what broke the camel’s back. Losing my job made things worse. I did the usual thing by trying to hold in the pain, but I had reached my last bandwidth. I had a manic episode, which marked the beginning of my awareness of mental health. Initially, the doctors had several diagnoses for me because they couldn’t pinpoint what it was, but it ended up being Manic depression.”
Chiejina contemplated suicide, but for the emotional presence of her (then) boyfriend.
“I had reached the end of myself,” Chiejina says. “The only thing that kept me from not committing suicide was a love interest. He knew something was wrong, but didn’t know what it was and so he would leave his items with me so he could come to pick them up, and his cue was whenever I was speaking in ways he didn’t understand, or saying things that were not common to our regular conversations. However, he left the scene when I started getting professional help.
“I was sent to a rehabilitation centre and was administered medications. On leaving the centre, I began to gain weight rapidly because of the drugs and because of binging on comfort food. With help from friends, I started working out. I also thought I was ready to quit the medication, which I did, but in hindsight, it wasn’t the best decision. I lost a lot of weight but I had another episode the next year (2020). At this point, my medications were switched to better ones and that’s what I’m currently on.”
When asked by Neusroom about how the diagnosis has impacted her current lifestyle, Chiejina says the ‘experience has made me revisit the past, address past traumas, understand myself better, know my triggers and control my thoughts. It has taught me to be mindful, and made me connect with my mind and body. For example, I learnt that I clench my entire body when I panic, and although I would get comments from people saying that my shoulders looked tight, I didn’t realize that it was a thing until I became more self-aware. Mindfulness has exposed me to this. I’m a lot more in touch with myself than I ever was, and I can see the progress I’m making.”
The situation surrounding Nigeria’s mental health statistics is worsened by the fact that the country’s mental health facilities are stretched to its limits: there are currently only eight federal and three state-run neuro-psychiatric hospitals in Nigeria. According to the World Health Organisation, there are only about 250 certified psychiatrists in the country, and less than 10 percent of Nigerians who are mentally ill have access to the medical care they need. In November 2019, Nigerian journalist Fisayo Soyombo carried out an undercover investigation at the Federal Neuro-Psychiatric Hospital, Yaba, exposing the poor state of hospital facilities, low quality of service delivery, and implicit stigmatisation of patients.
“There is a lot to contend with in terms of patient load and work,” says a former senior registrar at the Federal Neuro-Psychiatric Hospital, Yaba, who has pleaded anonymity for professional reasons. “It was almost always full to capacity. The social work services system is a bit redundant, and that is because of funding and not enough input from other organisations, such as NGOs.”
The former Managing Director of the Federal Neuro-Psychiatric Hospital, Yaba, Oluwayemi Cecilia Ogun, declined to comment.
It’s not all gloom and doom, as organisations like Mentally Aware Nigeria Initiative (MANI) have stepped into the fray. Launched in June 2016, the youth-focused community, which started out in Lagos and now has 15 chapters across the country, dedicates itself to providing education and working to erase the stigma surrounding mental illness in Nigeria. With free mental health counselling sessions, therapy recommendations, frequent outreaches, and a functional suicide helpline, MANI has taken concrete measures in stirring up meaningful conversations pertaining to mental health. However, as their leadership admits in a phone conversation with Neusroom, there is still a lot to be done, and the obstacles in the way are not only laid out by society, but by policy and legislation as well.
“The challenges we face are multi-layered,” says Iyewande Dipeolu-Lawal, co-founder of MANI. “In reaching out and educating the public, we still have to deal with people who still harbour negative perceptions about mental illness. There is also the stigma attached to issues like depression and bipolar disorder. Simply put, Nigeria is a long way off.”
On the subject of policy and legislative indifference, Dipeolu-Lawal says: “For starters, suicide attempts are criminalised in Nigeria. That is very discouraging, for people who feel like giving up. We have also been trying to get the National Assembly to pass a new Mental Health Act into law. The bill has passed its second reading, but we haven’t heard anything lately.”
When asked if religion could be part of the problem, Dipeolu-Lawal replies, “It definitely is. Religious leaders often pretend to understand mental health and refuse to acknowledge professional help as a treatment modality. Their views worsen public perception and stigma.”
In other countries, therapy is widely recognised as a method of dealing with mental health challenges, but in Nigeria, the practice of sitting on an armchair with a psychologist is yet to be fully embraced. This is down to a number of factors, including lack of information, an acute shortage of professionals, and the general assumption that therapy sessions are too expensive for the average working-class Nigerian to cope with.
Kemi Adetore, a mental health advocate based in Lagos, who hosts frequent Instagram Live and YouTube sessions to discuss self-care, thinks that the problem is the general approach of Nigerians to therapy.
“I think the major issue is a lack of exposure,” Adetore explains, in a phone conversation with Neusroom. “There are Nigerians who don’t even know that professionals exist. Even for those that know, they complain that it’s really expensive. A lady once mentioned that she was paying N30,000 a week for sessions; not many people can afford that. But I feel like the major problem is that Nigerians don’t really think that problems like depression can be solved just by talking to someone. It’s been tough even trying to explain what depression means, we are just slowly catching on.”
Harriet Uchechukwu, a lawyer and HR practitioner at Lagos-based law firm The Law Crest, questions the professionalism of Nigerian therapists. For her, some of them are heavily tethered to religion, even in the practice of their craft.
“Let’s just say that what we have as therapists in Nigeria are pastors in disguise”, Uchechukwu tells Neusroom in a phone conversation. “The only difference is that they have a couch in their office and you don’t see the Bible lying around.”
For Precious Ajoonu, a psychologist who also runs an online support group called The Thinking School, Nigerians are not readily disposed to therapy because of societal conditioning.
“It’s a lot,” says Ajoonu. “Part of the problem is our culture of silence. Down here, we are not usually cool with the idea of opening up and being vulnerable, it’s perceived by many as a sign of weakness. There is also the ‘shame’ that comes with turning yourself in for therapy: many people don’t want to be seen as mentally lazy. The fear that people have of confronting their own shadows also makes it difficult to see therapy as the first port of call. It’s a lot of things.”
Ultimately, finding a lasting solution to Nigeria’s mental health crisis would require the concerted efforts of everyone involved in these conversations. Non-governmental organisations would need to keep lobbying for improved legislation pertaining to mental health, and lawmakers in turn would need to show some seriousness in enacting those laws that would positively impact some of the society’s most vulnerable people. There is also the need to increase allocations for health in the national budget: the country’s health facilities are in dire need of renovation. More importantly, increased awareness of mental health and its intricacies should be prioritised in discussions relating to the youth. If religious leaders would stop demonising mental illnesses and instead recommend professional help for their flock, if more workplaces would integrate provisions for mental health into their system, then Nigeria would make more progress in dealing with this malaise.