LAGOS, Nigeria — When Victor Ugo was diagnosed with depression in his final year in medical school in 2014, he searched in vain for a community of young people going through the same thing. Frustrated by the lack of resources available, Ugo tapped six friends and started Mentally Aware Nigeria Initiative, or MANI, in Dec. 2015.
“We wanted to build a community where people were more accepting of their illnesses, more accepting of conversations surrounding mental health, more willing to discuss it in public so we can start trying to end the stigma,” Ugo, 28, told Devex.
While precise statistics are hard to come by, more than 7 million Nigerians suffer from depression, according to World Health Organization 2015 estimates. The same report estimates the West Africa nation has some 4.8 million people with anxiety disorders, the most of any country in Africa. Most get no professional treatment.
A culture of stigma and discrimination fueled by poor awareness has allowed misconceptions about mental illness to flourish. There is a widespread belief linking mental disorders to supernatural causes including witchcraft, demonic possession, and even punishment from gods or ancestors. Many turn to traditional healers, who have been known to subject patients to mistreatment such as beating on the head during exorcism, tethering by a rope, slapping, and chaining.
“Stigma is a big problem in Nigeria,” says Joyce Omoaregba, a senior consultant psychiatrist at the Federal Neuro-Psychiatric Hospital in southern Nigeria’s Benin City.
“It prevents people from coming to seek treatment; nobody wants to be seen entering a psychiatric hospital. Many who admit to be suffering any mental [disorders] may be evicted by landlords, lose their jobs or their spouse.”
MANI hopes to change this. The burgeoning, youth-led nonprofit has built strong advocacy using social media, especially Twitter. Every month it focuses on a particular mental illness or topic related to mental health. Using hashtags such as #IamMentallyAware, #EndStigma, #FightingAD (for anxiety disorder), #NotACharacterFlaw (for personality disorder), and now #FightingSchiz (for schizophrenia), MANI hopes to dispel stereotypes, promote acceptance among people battling mental illness, and raise mental health awareness.
So far, MANI has expanded into four states with a network of nearly 1,000 volunteers. It has provided group support for over 5,000 people living with a mental illness, including by reducing distressing situations, suicide intervention, and providing counselling sessions in barracks, hospitals, and churches.
Creating space for acceptance and conversation
Growing up in a home where both parents were nearly always absent, 25-year-old Maria* endured sexual abuse for much of her childhood. A decade later, Maria began to battle with a wave of lethargy, restlessness, loss of appetite, guilt, and insomnia.
A doctor in a foreign-owned hospital in Lagos recommended amitriptyline, an antidepressant that helped her sleep but did little to address her overall problems. When her wedding was called off in 2016, she attempted an overdose.
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Then in early March 2017, she stumbled on a post on Instagram from MANI asking people with mental health problems and suicidal tendencies to call them. She dialed the number and Ugo picked the call.
“He listened to me and he was never judgmental because he knew what I needed was to let it out and not leave it inside of me,” she said of Ugo. “He was honest in a very good way, always there. He told me about his struggles with depression, too. That was when I realized that I wasn’t alone.”
Ugo is glad that his team at MANI is gradually changing the narrative and helping people struggling with mental health issues.
“We’ve received 5,600 calls in less than 14 months since we opened the hotlines, with about 15-30 calls per day,” he says. MANI is now hoping to launch a mobile app next month, to connect mental health professionals to people in need. “It’s like an Uber for mental health,” he explained jokingly.
Without a national coordinating body or agency to oversee mental health care, or run anti-stigma and psychoeducation initiatives, more nonprofits like MANI are springing up to close the gap.
Hauwa Ojeifo, who was diagnosed with bipolar affective disorder and PTSD in Dec. 2015, started She Writes Woman two months after she attempted suicide in Feb. 2016.
Her struggles to seek treatment, open up to her family, and manage her situation propelled her to start a website where she could “speak so I could heal,” she says. Every post was a form of relief and gradually her reflections on recovery drew in many more women to reach out to her, saying they had the same issues or knew someone who did.
The nonprofit now operates a 24-hour helpline and organizes a women-only, anonymous monthly support group called “Safe Place” aimed at building “a tribe of people who understand you, don’t judge you, support you, embrace you, and hold you accountable in your mental health journey,” Ojeifo, 26, and a former research analyst at an investment bank, explained.
The results are trickling in. Ojeifo says they have worked directly with over 1,550 people via their helpline, Safe Place monthly support group, and occasional “hope visits” to vulnerable people in psychiatric hospitals, wards, and rehabilitation facilities.
“We have received over 500 calls from the helpline, about 20 percent of which were people with suicidal tendencies and about 98 percent expressing major depressive disorder symptoms,” she says. “Since the helpline chat service commenced in late April 2018, we have received about 6,152 messages and counting.”
Other suicide prevention hotlines have entered the fray. The Nigeria Suicide Hotlines managed by the Smart Suicide Prevention Initiative, reports that it has helped 2,567 people since launching two years ago. In March 2017, the Lagos University Teaching Hospital initiated the Suicide Research and Prevention Initiative and has had 82 calls, of which 40 were suicidal crisis calls. Though its hotline is small, the initiative has also coordinated at least 10 awareness-raising programs across the city.
Other programs have used the arts to address mental health. Project Get Naked, a nonprofit promoting mental health among young people, launched the #Save campaign last year to raise awareness using photography, music, visual arts, poetry, and fashion.
“[The] interesting thing about #SAVE campaign is that it has grown into a safe community for creative [people] to share, unburden, and educate themselves when it comes to mental health,” says founder SheiFunmi Nomia-Yusuf, who himself has bipolar disorder and depression.
The obstacles ahead
Despite the achievements made by these nonprofits and initiatives, many challenges continue to deter rapid progress.
Nigeria has been struggling to formulate a modern mental health legislation, allowing an old Lunacy Act of 1958 to persist. Since 2003, federal lawmakers have been grappling to push for a modern legislation with little success. The corollary is an ever-expanding gap in terms of treatment, patient protection, financing, human resources, and mental health services available to the population.
Making matters worse, mental health care is grossly neglected and underresourced. Around 3.3 percent of the national health budget goes to mental health, and there are fewer than 150 psychiatrists — approximately one psychiatrist per 1 million people — serving Nigeria’s estimated 180 million population. And other professionals including clinical psychologists, social workers, neurophysiotherapists, and occupational therapists are few and far between.
“We need a law that will cater for the rights of people with mental illness,” says Omoaregba, who doubles as the secretary-general of the Association of Psychiatrists in Nigeria. APN is working with other professional associations and NGOs to review the National Mental Health Bill being considered at the senate.
Still, these drawbacks do not detract from the growing sense of awareness in the country.
Every time Maria remembers the past, she breaks into laughter — allowing her smile to linger longer than usual. She will be getting married next year, and seems to be on a clear path to recovery. She now talks to people about mental health issues openly, and has also built a small community of friends with whom she discusses mental health issues.
“I am not totally better but I can say that I am 80 percent better than I was two years ago. Whenever I relapse I have the strength to fight it,” she says. “If we can try to be a shoulder that another person can lean on and feel safe without the fear of judgment, everything will be fine.”
*Name has been changed to protect identity.
Updated September 7, 2018: This piece has been updated to clarify that the photo of the Federal Neuro-Psychiatric Hospital is in the northeastern Nigerian city of Maiduguri.