According to the UN, millions of people worldwide have mental health conditions, and an estimated one in four people globally will experience a variation of mental illness in their lifetime. Dr. Olugbenga Owoeye, a consultant psychiatrist and clinical psychologist at the Federal neuropsychiatric hospital, Yaba, Lagos, Nigeria, describes mental illness as, “Any psychological disturbance in emotion, memory, thinking, and behaviour; disturbances severe enough to cause pain or distress to the person affected, or to the family of that person. It is also associated with what we call impairment in social and occupational functioning.”
Over the years, there has been some progress in the mental health space across the continent of Africa. Antoinette Nicolaou, a clinical psychologist based in Pretoria, South-Africa, said that in South Africa, there are more conversations happening around mental health, in the area of depression, anxiety, sexual orientation and gender identity. Nigeria is also experiencing a positive change in the mental health space; in 2019, She Writes Woman, a women-lead organization on the frontline of mental health support in Nigeria, launched the country’s first ever toll-free mental health helpline.
However, in spite of the increase in awareness and facilities providing support, there continues to be challenges that are impeding the advancement of mental health care across the continent.
Challenges in Mental Health:
Last year, the Nigerian Medical Association (NMA) reported that there are no more than 350 psychiatrists in the nation, serving a population of over 200 million people. Owoeye spoke passionately about the lack of psychiatrists in Nigeria stating: “At the Federal neuropsychiatric hospital at Yaba, we have been able to train over 100 consultant psychiatrists, but the unfortunate part of it is that people are not staying in Nigeria. When they finish the program they go out of the country in search of green pastures. They are not really committed to the course of Nigeria.”
However, Dr. Ayo Adebayo, a Nigerian psychiatrist who relocated to the United Kingdom four years ago, explained that the immigration of Nigeria’s psychiatric doctors is not because of a lack of commitment to Nigeria, but from unresolved issues bedeviling the system they have to practice in. “The first thing is the difference with the system,” says Adebayo. “There is a national health care system [in the UK], which ensures that everyone has access to healthcare. It is not free, you pay for it through your taxes, but at the point when you get the care, you are not charged any money. The second thing is with compensation, when you know there are countries where you will go and be better compensated for your work, why would you not go?”
He empathized with Nigeria’s loss of skilled personnel, and stated that a lot of Nigeria’s psychiatrists would likely stay in the country and carry on in their practice if the health care system was better.
For Amanda Iheme, a psychologist and founder of NDIDI, a private mental health practice in Lagos, Nigeria, another challenge for practitioners is finding useful materials to help patients. “With the clients that come to [me for] therapy, there is that challenge of finding helpful resources like articles, research, journals, that are tailored to supporting Nigerians specifically,” says Iheme.
In South Africa, the challenge lies with a government who has made no tangible effort to improve its mental health responses. Leon De Beer, Deputy Director at SA Federation for Mental Health (SAFMH) has this to say about the government’s inaction towards mental health: “Despite the 2017 Life Esidimeni tragedy, where 143 people died in psychiatrist facilities in Gauteng, a province of South Africa, the government has made no discernible effort to upscale its mental health response, and improve resourcing and implementation of mental health resources. Furthermore, our mental health policy lapsed in 2020, and we are only now hearing about efforts from the government to start reviewing [and] updating this, which is yet again, evidence of their sluggish attitude towards mental health.”
De Beer urged the South African government to begin to show that mental health matters to them, adding that for a start, the inadequate five percent budgeted for the health sector should be reconsidered.
On the issue of policies, Nigeria’s healthcare is still regulated by the Lunacy Act enacted in 1916, and entered into law in 1958—two years before Nigeria gained independence from colonial rule. For Hauwa Ojeifo, a mental health activist, founder of She Writes Woman, recipient of the Queens Young Leaders awards (2018) and an Obama Foundation Leader (2019), the fact that Nigeria is still operating under the Lunacy Act is the biggest point of contention when it comes to mental health in the country.
The Lunacy Act calls for the involuntary admission of patients into asylums after a medical practitioner and magistrate have determined that the individual in question is “lunatic” or “insane”. Iheme explains it simply: “[Essentially] a person is forcefully put in a psychiatrist hospital against their will.” Another issue with the 1958 law is the use of the word ‘lunacy’, which Adebayo says should be scrapped, as it is no longer an appropriate or accepted phrase in conversations pertaining to mental health.
In 2003, two Senators in Nigeria, Sen. Ibiapuye Martynes and Sen. Dalhatu Tafida introduced a new mental health bill to the country’s lawmakers at the National Assembly. However, the bill was withdrawn in April 2009. It was then re-introduced in 2013, but did not get enacted.
Another major challenge to mental health is stigmatization. Misconceptions and myths continue to abound regarding mental illness. There are the superstitious beliefs that those who suffer from mental illness are cursed or being punished for something they must have done, and there is also the belief that mental illness is unmanageable and incurable.
Speaking on stigmatization, Adebayo says: “There is this saying that people fear what they do not understand. There is a lot of misunderstanding when it comes to mental health issues, one of the reasons being, it is not something you can physically see a lot of the time, and when you can’t see it, it is so unusual and strange for many people.”
Owoeye opined that stigmatization has been a longstanding problem, especially in Africa. He says that it was not just those who suffered from mental illness that got stigmatized, but even the family and friends who care for them. According to him, education remains the only way out. “Creating awareness about mental health amongst the general populace would enable people to know that it is not different from some other medical conditions,” he says. “People will understand that it can be managed and it is not contagious.”
Access to treatment is another critical problem that needs to be addressed. In 2017, a UN report revealed that 75 percent of mentally ill South Africans do not have access to psychiatric or therapeutic care, and in Nigeria, only 10 percent of the mentally ill populace have such access.
Speaking on the issue of access, De Beer says: “It is extremely worrying that we still have discussions about people being unable to access basic mental health care services in this day and age. Such entitlements and rights are deeply enshrined in both national and international policies, legislation and treaties, such as the UN Convention on the Rights of Persons with Disabilities, to which South-Africa is a signatory.” He also lamented the state of public health institutions, which he described as “overburdened” and “thinly spread”.
When we think of access to mental health care we think of cost, believing that once cost is either subsidized by the government or discounted by private practices, people will come out to get the help they need. Iheme does not think this is entirely true, arguing that there are other factors that determine if a person goes after the help he/she needs. “Even if we make therapy cheaper or free, the chances of people coming in is still not guaranteed and this is because there is a lot more that goes into their decision to go look for help, says Iheme. “First of all, do they have an awareness of the problem, secondly, do they know it is okay to go and look for help? And finally, if they are going to be talking about their inner struggles do they know they can trust their therapist and doctors?”
These are just some of the many challenges encountered when it comes to mental health care in Africa. The question then is—is there a way forward, and what exactly would that look like?
Finding the Way Forward:
For Owoeye, progress starts with addressing two key areas: “Media platforms need to create opportunities and columns for mental health awareness and advocacy; it will go a long way to help us in the field,” he says. “By the time there is a proliferation of mental health knowledge and awareness, you will find everyone is equipped with the right information. Also, the [Nigerian] government needs to do more to encourage our specialized doctors and nurses to stay in the country.”
For Sola, a representative of MANI (Mentally Aware Initiative Nigeria), West-Africa’s biggest youth-run, non-governmental organization, a critical element in advancing the cause of mental health in Nigeria, is for the Nigerian government to repeal the 1958 Lunacy Act, and put in place a bill that is in line with the times.
Ojeifo agrees, adding that it is not just about passing another bill, but ensuring the bill passed, adheres to the International Human Rights tenets. “In drafting these new bills and regulations as it concerns mental health, lawmakers have to ensure they robustly consult with the people who live with mental health and psychosocial disabilities,” she explains. “We are the ones to tell them what the solutions look like, what our rights being protected looks like and what implantation looks like for us. Beyond that, they also have to adhere to the human rights of ensuring, protecting, promoting and safeguarding our human rights at every single point in time within this system.”
Nicolaou adds another step in mapping a way forward, and that is normalizing the act of seeking help for mental illness. “Mental illness is not something a person should be shamed for or feel ashamed of admitting, says Nicolaou. “Should a person find that they are not in a good emotional space, it is perfectly normal and healthy to reach out for help and guidance from a qualified professional”.
Africa as a continent faces a myriad of challenges, and a lot of these challenges differ from country to country. However, when it comes to the subject of mental health, the challenges faced are remarkably similar. It is encouraging to see how mental health advocates, professionals and organizations across the continent are working tirelessly to ensure that government policies are changed, and that there is a better understanding among the populace regarding mental health. With their level of passion and dedication, we can maintain hope that the changes required are not too far off.
For more mental health resources, make an appointment with your local health professionals or visit the MIND charity website.