Nigeria has made significant advances in health policies development and legislation aimed at achieving health for all, but challenges remain for mental health services. An initiative is addressing the country’s monumental mental healthcare challenges by deploying a multi-pronged approach that includes conventional online and unique offline interventions. But challenges remain.
Studies have shown that mental health, like physical health, is essential to overall well being, yet stakeholders argue it is often overlooked in Nigeria due to poor societal attitudes towards mental illness and limited resources.
Nigeria’s mental health budget is mainly financed through less than 4% of the central government health budget, with over 90% going to neuropsychiatric hospitals. Due to worsening economic inequalities and cash crunch, many Nigerians cannot afford basic mental health care, including counselling.
The Association of Psychiatrists in Nigeria reported that there are only 250 psychiatrists for a population of more than 200 million people, with most psychiatrists based in urban areas. Poor knowledge of mental disorders at the primary health-care level means that caring for people with mental illness is typically left to family members.
“Training on mental health is within the range of NGN200,000 to NGN600,000 for two to three months. It is quite easy to access treatment, because lots of facilities are springing up,” said Josephine Ebhoomhan, psychologist and volunteer with My Care Buddy. “I know about three facilities that are for counselling, and they are not even psychiatric homes. But because of rigorous training and stress to get certification, coupled with the fact that mental health is still not well known, the cost of treating people is high.”
Despite the challenges, Mentally Aware Nigeria Initiative (MANi) has implemented programs that provide mental health first aid and suicide intervention at no cost.
Executive Director MANi, Abiodun Oguntola, noted that the cost of mental health treatment or services is high in Nigeria and it is not just the cost, “the service is limited and the number of professionals in the line is not proportionate with those in need of the services.”
Going virtual
Virtual counselling is a key feature of MANi’s mental health first aid offerings. The initiative engages volunteers who counsel people with mental health issues that they would like to talk about. The initiative told healthnews.ng that its volunteer counsellors are trained professionals and students in the field who work pro bono to ensure clients receive the best service.
Counselling is done virtually, and when calls are received, an assessment is immediately done, and the case is assigned to a counsellor, who then meets with the client to determine their state of health and the next line of action. Emergency cases and symptoms that require more than counselling are referred to appropriate health institutions for further care.
“We engage volunteers, some are professionals in the field and some are students in the field, they counsel people who reach out to us and not just on depression but on any mental health issue they would like to talk about. Our volunteer counsellors are trained individuals and they work pro bono, they are amazing people who give their best to ensure our clients get the best service. Counselling is done virtually,” said Oguntola.
Sensitization approach
Aside from the interventional virtual counselling approach, there are also in-person offerings, some of which are also geared towards prevention via sensitization and community building.
MANi said it has a community of volunteers that are trained to sensitise people on mental health via conversation cafes, fireside chat, and mental health talks. These conversation cafes are held in 18 states across the country.
MANi added that it runs offline mental health awareness and sensitisation in schools, communities, and organisations, and online enlightenment.
In the last four years, MANi said it has provided direct support to over 40,000 people with eight out of ten being between the ages of 10 and 25. One of the channels through which the services are being offered are conversation cafes which are held across 18 states. The cafes reportedly educate more than 1,000 young people every month on mental health and mental health conditions.
MANi added that it is also helping to solve the manpower challenge of mental healthcare in Nigeria by helping to train over 5,000 employees and over 30,000 students, parents, and teachers on mental health.
Adeola*, a beneficiary said “I think it is very good for a free service. You can see the dedication that is being put into prioritising people’s mental health and the help to improve the quality of their life. It was great to have someone I could talk to.”
Commending one of the volunteer counsellors, Chisom*, another beneficiary said “Lola* is really amazing. I came in here seeking solutions to a symptom, and ended up getting the problem solved.”
“I must commend everyone at MANI, I had a wonderful experience during my scheduled sessions and my counsellor was very polite and understanding, she also kept things quite professional. It was lovely and a very much needed positive session,” noted another beneficiary.
Beneficiaries admit that they might not have been able to afford the services if they had to pay.
Bottlenecks meet optimism
While MANi has received many positive reviews from beneficiaries, several drawbacks exist, especially for the free service. One of such is clients’ inability to respect professional boundaries.
Oguntola noted that some clients are getting used to their counsellors and are developing an interest in dating them rather than talking about their issues. Also, some clients expose MANi volunteers’ details online or give out their details without consent.
There is also the challenge of funding. MANi described mental health awareness and care as requiring a lot of funds, especially for logistics purposes. This challenge becomes more cumbersome considering it directly incurs the cost for running such programmes.
MANi said it raises funding in-house to keep operations running, and funding received from donors is project-specific, such as its mental health programme in four universities across three states.
Eboohman of My Care Buddy also bemoaned how those seeking mental health care take it for granted. She noted that due to ignorance, affected individuals don’t know when to seek help and when they get help for free, often don’t take it seriously.
“One can overcome and deal with mental health by knowing how we operate, how we deal with issues, using self-knowledge to know when something is off and it is beginning to weigh you down, then see a counsellor. But when it is beginning to affect external factors, like the activities you do every day, friends and family. Then it is time to see a psychiatrist.
“I volunteer for three different mental health groups who provide free service, most people don’t take the free sessions seriously.
“We need to start creating awareness among family’s organisations, churches, and groups etc. so that people will take their mental health seriously,” she concluded.
*Names of beneficiaries have been changed to protect their identity and counsellor’s last name cannot be provided for confidentiality.
This story has been supported by Nigeria Health Watch through the Solutions Journalism Network, a nonprofit organisation dedicated to rigorous and compelling reporting about responses to social problems, solutionsjournalism.org