Mental Health has barely had its 15 minutes of fame when discussing poignant Nigerian issues. Apart from a vague glance at it now and then, little has been done to control the narrative. Mental disorders in Nigeria is usually invoked to discredit people suffering from it or to ease culpability of certain acts. It is still stigmatized and the ailing are pushed to the sidewalks. Nigeria knows this as well, and this is why she formulated the National Policy for Mental Health Services Delivery in 1991. The action plans in the policies were clear in both situations—but nobody acted on it.

 

As a hereditary condition that can manifest in different ways, schizophrenia might be the most extreme form of mental illness. Hallucination, psychosis, disorganized thoughts, paranoia, delusions are words that may have lost weight from being thrown around in conversations. But when a loved one starts to hear voices, believing the thoughts in their heads leak through the nose so much they have to plug it with an open palm, or when a cousin decides to pack light and leave her five-year old son and a confused husband because her instinct told her to—it becomes difficult to fathom as family members. It becomes even more difficult to handle.

 

These conditions leave no prisoners, as the family members also get a brunt of it because they are the first and last lines of defense. Self-awareness is not common to people diagnosed with schizophrenia, and most times it is up to family members to figure out that something has changed within their loved one. The responsibility quickly shifts to them to offer much needed help. Help that is outrightly denied and rejected a lot of the times—compounding paranoia in the ailing, shifting relationship dynamics and snowballing into complex family issues.

 

Most times when we face these issues, we don’t tackle them with medicine alone We match it afoot with long prayers on mountains, vows of secrecy and shady Imams that offer drinks in small calabashes. If you drank from it, you will be cured, they’ll say. The content of the bowl most times are drunk, but something rarely happens.

 

Mental Health speaks to an acute awareness of the mind as an organ, and explores ways in which it can be nursed to health. The journey has been tumultuous all over the world, Psychiatry itself has faced a disturbing history over the years. Our inability to reconcile the concept of consciousness and how it relates to our body has left ample room for conjectures that have been adopted as truths. In the past, handlers did not hesitate to chain the mentally ill, homosexuality was considered a mental illness till the 1970s, lobotomies became commonplace procedures and the mental institutions doubled as prisons with no regard for human dignity.

 

 

It is slowly shifting, but this narrative still compels a bigger portion of the story. Nigeria, for example has about 40,000 doctors for a population of 200 million. Among these physicians, only about 200 psychiatrists practice. Meaning for every one psychiatrist, we have one million Nigerians. The number of people that suffer from mental illness cannot exactly be ascertained since most haven’t been officially diagnosed. Yet, the World Bank estimates that over 20% of Nigerians show symptoms of chronic depression. Alarming figures, but they should not be as surprising as Nigeria has a suicide rate of 17.3 per 100,000 people, ranking 15^th in the world.

 

Although widespread, depression is hardly examined closely within our environment. Sadness is an emotion, but an overwhelming amount of it is an illness. Depression is usually accompanied by lethargy, mood swings, a dire need to connect whilst surrounded by people, suicidal thoughts—amongst others. LeeAnn Tucker, who tested out a Neurostar-developed TMS helmet (electroshock therapy) that sends waves touted to cure depression said “The suicidal thoughts were so severe that I never told anyone, not my doctor, not my husband. Because when you tell someone, then they’ll try to save you.” Her perspective is proof that knowing a person dealing with depression and trying to cheer them up is generally a great gesture, but might not be the best option. The same way we do not look to friends and loved ones to prescribe antibiotics for that skin reaction, our attempts at succor is akin to throwing darts in the dark. There is a faint probability that you might hit bullseye but, where is the target?

 

Since the science of Psychiatry is an evolving one (all sciences are evolving but some, newer than others), we do not know what actually causes mental illness. The first time we had concrete proof that a physical ailment could cause some form of psychosis occurred in 1897. At the time, there was an overwhelming number of people committed into asylums. This also happened to coincide with a wide outbreak of syphilis and neurologist, Richard Von Kraft-Ebing decided to infect some of the committed patients with the disease—since syphilis can only be contracted once. They were injected, but did not manifest any symptoms associated with syphilis. It was then discovered that the influx of new asylum patients was tied to the STD.

 

Now, the conversation has shifted towards our immune system, as some scientists believe that there might be a connection between the two. Patients have been cured of psychosis after bone marrow transplants and drugs targeted at the immune system have been recorded to abate schizophrenia. There is no certainty to the science of this, but it is worth considering as our knowledge of these conditions continue to evolve.

 

Diagnosis that can be classified as mental illness ranges from depression, bipolar disorders to schizophrenia, adjustment, self-esteem issues, post-traumatic stress disorder, addiction etc. Psychiatry Hospitals in Nigeria overflow with people living with these conditions whilst receiving subhuman medical care. They complain of less than perfunctory cooking and degrees of neglect, even after paying. An undercover piece by Fisayo Soyombo tells stories of the chicanery going on within the four walls of Yaba Psychiatric Hospital, the most popular mental institution in the country.

 

Whilst psychiatrists might be the frontline for tackling these issues, psychotherapists/psychologists are also qualified to help. Although they can’t prescribe medication to patients, they have the training to help people manage their conditions better.  Sometime last year, I was so overwhelmed by matters of the heart that I found myself googling ‘Therapist near Lekki’ so that I could speak to someone. I realized that it costs between 25,000 naira ($64) to 35,000 naira ($89) for a single session (which roughly lasts an hour). Tele-therapy (over the phone) costs less, going between 10,000 naira ($25) to 15,000 naira ($38) for a session.

 

It might seem out of place to quantify sanity as a function of finances, but for a country like Nigeria where most things are viewed through an economic lens, this is not far-fetched at all. The Federal Government recently raised the minimum wage from 18,000 naira to 33,000 naira– still below the estimated living wage of the average Nigerian which is pegged at 42,000 naira a month. This wage is only limited to federal workers, and it was reported that roughly about 368,000 benefitted from it, leaving some 80 million Nigerians who are unemployed, uneducated and unskilled to fend for themselves. A Nigerian that earns minimum wage can barely afford one session with a therapist. Let alone the drugs prescribed by psychiatrists.

 

This is important because mental illness, naturally, is the most time-consuming arm of medicine because patients’ needs seem arbitrary yet, are extremely valid. Progress comes in bits during therapy and it cannot be rushed. Attention and care are vital for the ailing because, for proper treatment to be administered, four critical elements need to be put into consideration: ‌ pharmacology (drugs & treatment), ‌individual‌ ‌resilience‌ ‌training, ‌family‌ ‌psychoeducation‌ ‌and‌ ‌supported‌ ‌employment. When put in perspective, Nigeria has a lot of work to do—especially in providing the infrastructure to meet the needs of the troubled.

 

This is not complete without stopping the brain drain of physicians (psychiatrists, for emphasis in this context) leaving for better opportunities. Engaging in widespread awareness campaigns, creating an environment of dignity in mental hospitals and ensuring that treatment is affordable countrywide. But that is not all, perceptions surrounding these illnesses also demand to be addressed.

 

‌Seeing this disconnect, certain personalities have taken it upon themselves to level the playing ground a bit. Organizations like NEEM foundation, Love, Peace and Mental Health Foundation (LPM), She Writes Woman (SWW), Mentally Aware Nigeria Inititative (which has a suicide/distress hotline). One interesting initiative from Ndidi, a Private Healthcare establishment is Obodo (Instagram @Obo.do). Obodo, which is Igbo for community helps facilitate support groups for people in Lagos who might be dealing with these issues. The support groups, which are free, convene to address numerous issues like body image, divorces, depression, adjustment etc. Ndidi also offers packaged psychotherapy plans discounted for students and Corps Members. Which is how I believe mental health should be permeated to the public, in bite sizes.

 

But Support groups are not equivalent to actual therapy. In conversation with a Psychotherapist, she told me they are great for your mental health hygiene. They provide the needed insight that nobody is ever alone going through their problems. But they do not offer the personal engagement required to make proper diagnosis and kickstart recovery.

 

 

The stigma that comes with mental health has been cultivated over years, even in our subconscious. Consequences that accompany wicked deeds in Nollywood movies (Yoruba & Igbo) was a fit of madness. But this is only a case of art imitating life. Láti kà, meaning to confess is a newsworthy event in Nigerian communities. Where ladies, and sometimes men run into public spaces and take culpability for seemingly diabolic crimes within the environment. Such events are met with disgust from curious eyes and usually ends with the person ostracized from the community and in extreme cases, jungle justice meted out. Rarely has it been suggested that such delirium is natural with schizophrenia.

 

Public perception of mental illness is also strongly linked to violence, which has strengthened widespread stigma. However, research has revealed that mental disorders are not sufficient causes for harmful outbursts and that they are far more likely to be victims than perpetrators. The numbers reduce drastically when these people are shown attention and treated. However, the World Bank reported that only 10% of mentally ill Nigerians actually receive help.

 

After the creation of the Mental Health Policies in 1991, little was done in terms of cementing the idea and not just leaving it as a well-articulated document. Senators Ibiabuye Martyns-Yellowe of Rivers State and Dalhatu Tafida of Kaduna State attempted to usher in the Mental Health Act in 2003 but it fell through in April, 2019. The bill was later reintroduced in 2013, but it has since been seven years and the rights of people with mental health disorders is yet to be protected by law.

 

“Many are mad, few are roaming” is a lighthearted quote to highlight strange behavior among humans. But the reality is that, countless Nigerians are suffering varying degrees of mental illnesses. And instead of being cared for, they simply patrol the street, asserting themselves as backdrops in the Nigerian landscape– which is mind-boggling. There is nothing lighthearted about a thousand-yard stare. The body can get sick, why not the mind?