Mental Health is an incredibly misunderstood issue in Nigeria, as it is in most parts of the world. In this week’s Thought Leadership piece, Nigeria Health Watch Program Manager Dara Ajala-Damisa writes about the need to focus particularly on the mental health needs of men. This comes on the heels of the release of the largest mental health survey in Nigeria by public health consulting firm EpiAFRIC and polling organisation Africa Polling Institute (API).
At the Emirates FA Cup’s third round tie played last week, every match began with the observation of a minute’s silence, during which those present were encouraged to reflect on their mental health. It was part of the Heads Up campaign launched by the English FA and partners to encourage public awareness of mental health.
The idea is to harness the popularity of the English Premier League watched by 4.7 billion people globally to encourage more people to feel comfortable talking about and taking action to improve their mental health.
Because more than 50% of the world population watch the English Premier League, this campaign could play an important role in reducing the stigma associated with mental health.
The stigma and lack of awareness around mental health produces particularly marked results for men. Worldwide, even though more women are reported to suffer depression than men, men are more likely to die by suicide compared to women.
Nigerian men, like many across the world, especially those who grow up with the strong perception that ‘African man no dey cry’ often bottle up emotions that cause mental stress. These often lead to taking up unhealthy ways of dealing with stress such as smoking, drinking excessively or compulsive spending.
Even when the rare Nigerian man is able to overlook the stigma associated with seeking mental health care, the next challenge is that there are too few mental health professionals in Nigeria, and often, people are unsure of when they should seek professional help for a mental health issue.
On January 14th, our related organisation, EpiAFRIC and the Africa Polling Institute released the results of the largest public survey on mental health ever conducted in Nigeria. A sample of 5,315 respondents were interviewed across all 36 states of the country.
Overall, the study showed that people want to know about mental health issues. Forty percent of the respondents said that more awareness should be created about mental health, with 36% suggesting social media as a strong medium to share information about mental health issues.
This suggests that Mentally Aware Nigeria Initiative (MANI) has the right idea. MANI works to raise awareness and end the stigma around mental health and related issues, while also supporting and connecting service users to mental health professionals.
Effective use of online and social media platforms are a strong part of their approach and they host the best known hotline for mental health issues in Nigeria.
With an estimated 1 in 8 Nigerians somewhere on the spectrum of mental ill health, mental disease should be a disease of public health concern. Nigeria’s Federal Ministry of Health and other relevant agencies should spearhead widespread advocacy, promotion, prevention, treatment, and rehabilitation. Research recommendations support this.
The EpiAFRIC/API survey examined the knowledge and perceptions of Nigerians regarding mental health, with some disturbing results showing poor levels of knowledge around mental health and huge stigma towards mental health disorders.
For instance, 23% of respondents believed that mental health disease is caused by some ‘punishment from God’ and shockingly, 2% (a projected 4 million of Nigeria’s population of 200 million) said they would beat mental illness out of anyone they know suffering from mental health disease!
The survey suggested that most Nigerians (70%) only perceive mental disorders as those where there is a display of disruptive behaviour that attracts public attention. Other research supports these findings.
With an estimated population of 200 million Nigerians, human resources for mental health are scant at best. A WHO-AIMS report estimated that there are only about 1.5 psychiatrists for every 1 million Nigerians, and less than 1 psychologist per 1 million Nigerians. This is 120 times less than the ratio in high income countries.
The top two ways to improve mental health in Nigeria suggested by respondents in the just released mental health survey were to: invest in training more mental health professionals; and to develop a mental health policy.
Although Nigeria has a mental health policy, the fact that 61% of respondents do not know that it exists suggests its implementation is not optimal.
People living with mental illness often deal with stigma arising from the society’s misunderstandings about the various mental health disease conditions. The pressure on men seems to be heightened by the societal beliefs, responsibilities and expectations which often make it difficult for them to talk about and seek care.
At the health service provider level, there is a degree of stigma from other medical professionals towards psychiatrists and other mental health professionals, reflecting the wider problem of a poor literacy level about mental health.
A 2007 study conducted in Western Nigeria, by Abiodun Adewuya showed that culturally enshrined beliefs about mental illness were prevalent among Nigerian medical personnel. This suggests that the curriculum for training doctors and probably other health professionals should be reviewed.
Societal expectations place incredible pressure on men and it is important that men recognise that “bodi no be firewood” and take their mental health seriously. It should be a sign of strength and something positive, for men to understand the things that lead to poor mental health.
Men should help protect their health by having honest conversations, exercising and seeking health care, even if they think what they’re dealing with isn’t ‘bad enough’.
Men generally seem to have poorer health seeking behaviours than women, as research has shown. Most men wait to be cajoled, coaxed and reminded to go to the hospital for scheduled visits.
These poor health seeking behaviours among Nigerian men, which is also seen in many parts of the world may have roots in the prevalent expectations in patriarchal societies that men are to be strong and not show any signs of weakness, including illness.
As a society, it is critical to create safe spaces for men to talk about their mental health struggles. Part of the recommendations from the Mental Health in Nigeria Survey include task-shifting similar to what Friendship Bench, an organisation in Zimbabwe, is doing.
Task shifting can be a vital strategy in overcoming the acute shortage of mental health professionals in Nigeria. MANI uses volunteers to support people who approach them, while signposting them to sources of professional help.
Such strategies get more community members involved in and committed to ensuring holistic mental health for one another.
Safe spaces can include actual physical facilities which harness the power of the outdoors where men can de-stress non-destructively. These are needed especially in urbanised areas but would also be incredibly useful in changing behaviour even in rural areas.
Recreation spaces can become a meeting point for men and women of all ages in a community while making physical exercise an more acceptable and appealing norm, and physical exercise is one way to help reduce mental stress.
As the many Nigerian fans of the English Football League watch these matches, we hope they are reminded that mental illness is just like any other physical illness. We hope they feel more comfortable in talking openly about their mental health challenges.
Hopefully, the Mental Health in Nigeria Survey will serve as evidence for care providers, governments, policymakers and all stakeholders working in mental health in Nigeria to improve services.