Mental health campaigns tell us to take control of our journey. A few years ago, a woman I’ll call Grace did just that. When she walked into a psychiatric hospital in Nigeria to ask for care, she thought she was taking her future into her own hands. Later that day, Grace’s belongings were taken, and she was restrained on a bed by a guard who held her legs open while a psychiatric nurse searched her and found the phone she’d kept to reach her mother. As Grace tried to fight, the nurse and guard walked away, leaving her naked.
That day, they didn’t just take Grace’s phone. They took her dignity.
Grace’s story reflects a deeper crisis: Around the world, emotional distress is too often medicalized, institutionalized, and met with control instead of compassion.
More than 1 billion people experience mental health conditions — nearly as many as heart disease and diabetes combined. Collectively, these conditions cost the global economy about $5 trillion a year and rob humanity of 290 million years of healthy life. That’s as if the entire population of Nigeria, my home country and the sixth most populous in the world, lost the potential to fully work, study, or care for their families for a year.
Yet mental health is still treated as an afterthought. According to the McKinsey Health Institute, the world underfunds mental health care by $200-350 billion a year — a gap that will widen as development assistance shrinks. While mental health conditions represent 15% of the world’s health burden, services to address them only get 2% of government health spending. In many countries, even basic services such as crisis response are scarce, leaving millions with little help for recovery.
For women, the crisis runs deeper. The impact of depression alone, as measured in years of life affected, is more than a third higher for women than men. When trauma from sexual violence manifests as mental health conditions, women are shamed, blamed, and denied validation of their experience. They’re silenced by stigma and dismissed by systems built without their voices. The result is a double punishment: first for what they endured, then for how they respond to it.
Care rooted in respect
Closing the care gap isn’t just about funding — it’s about dignity. Dignity means making it safe for people to speak up. It means treating them as partners in their own recovery, with the power to exercise free and informed consent based on full information. And it means ensuring that if, legally, others must be engaged in their decision-making, they’re people who deeply understand their needs and potential, not just their symptoms.
These principles aren’t radical. After all, 164 countries signed the U.N. Convention on the Rights of Persons with Disabilities, which affirms the agency of people to make their own health care choices. Yet for millions, these rights remain theoretical. To make dignity the norm, not the exception, governments can act now in four ways.
1. Recognize rights. In 2023, Nigeria repealed the Lunacy Act of 1958, a law whose cruelty was baked into its title. The old law viewed people with mental health conditions as inherent threats, legitimizing involuntary confinement. The new Mental Health Act recognizes the rights of people to be treated in the least restrictive environment and outlaws discrimination in housing and employment.
2. Decriminalize suicide attempts. In 23 countries, attempting suicide is treated as grounds for punishment rather than a call for compassion. Pakistan, Ghana, and Kenya are among the growing list of countries that have recently repealed or replaced these punitive laws. When someone reaches a breaking point, they need support, not a prison sentence.
3. Make sure decisions are made with — not for — those who need help. Nigeria’s new law calls for committees of psychiatrists, medical social workers, faith leaders, and others to determine care for those perceived to be unable to make decisions independently. Those panels should also include the most vital perspective: that of individuals who have experienced mental health conditions themselves. Representation also has a model in Peru, which formalized supported decision-making, where people can appoint trusted advocates to help them get the treatment they want and need without surrendering control.
4. Invest in community-based care. Governments in upper- and lower-middle-income countries spend more than 70% of mental health budgets on institutional care, even though community-based services are often more accessible, effective, and humane. Every day, an estimated 23,000 people are admitted to mental hospitals — often against their will and sometimes at the sole behest of the provider who profits from their confinement. But people heal best in familiar environments, surrounded by loved ones and engaged in daily routines. By reallocating resources and partnering with civil society organizations, governments can bring care out from behind locked doors and into communities.
Around the world, organizations are proving that local care — not coercion — is the most effective medicine. StrongMinds, based in Uganda, provides group therapy for women with depression, an approach both scalable and personal. The mental health helpline at She Writes Woman, an organization I founded to provide services and champion rights, offers free, confidential support for all Nigerians. Project HOPE trains community health workers worldwide to deliver quality mental health care despite limited resources. And Neem Foundation’s Counselling on Wheels brings urgent therapy to conflict zones in northeast Nigeria.
Grace’s story didn’t end that day in the hospital. She eventually found care rooted in respect. Calling a helpline and joining a support group helped her regain her strength. Through She Writes Woman, Grace connected with others who understood her journey and found power in speaking up and advocating for her rights. And as she gained strength, so did her family — as is so often the case when women get the care they need.
Women like Grace, and the organizations that stand with them, remind us that recovery is exactly what we choose it to be. They show that the path to dignified care doesn’t require new miracles or massive budgets. It requires us to see people as whole, no matter the challenges they face.
About the author
Hauwa Ojeifo
Hauwa Ojeifo is a Nigeria-based mental health activist and founder of She Writes Woman, a nonprofit organization giving voice to mental health and ensuring that people with lived experiences are their own decision-makers.
