It was the late journalist and essayist, Dele Giwa who once wrote that Nigerians are 'unshockable'. But this piece of news Tuesday, May 12, 2020 that had flooded the social media was very shocking if not numbing. A 22 year lady, Ms Funmilola Adisa had drowned her 18-month old baby in a bucket full of water at her Gowon Estate residence in Lagos. She told the police that the baby which she got outside wedlock was an obstacle to her fulfilling her lifelong ambition of becoming a lawyer. There was no remorse, no iota of regret for her actions. This happened at the peak of the lockdown occasioned by the COVID-19 pandemic.
Elsewhere in Nnewi, Anambra State in Eastern Nigeria, a man identified as Emeka Ezimmadu last September reportedly killed his mother and two children with a machete. The timely intervention of neighbours and the local vigilante saved the lives of his wife and two other children who were treated for various degrees of body harm at the hospital.
While the community believed that Emeka, 40, was under the spell of an evil spirit, he must have indeed suffered a mental relapse resulting in such a despicable act of killing his own children and mother.
Mental and behavioral disorders affect people of all nationalities regardless of age, sex and financial status. Recounting his battle with depression for over two years in a social media post recently, a Nigerian business man Mr. Femi Fowora said: "people erroneously assume that because you are well- to- do you cannot suffer depression. My reality was different and for over two years I felt the full wrath of depression". Mr. Fowora thereafter announced the establishment of Otunba Olufemi Emmanuel Fowora Foundation with take-off grant of N500m to fight the scourge of mental illness in Nigeria.
In Nigeria, not much attention has been paid to mental health in official circles despite being endemic in both urban and rural communities. While there is a considerable level of policy and action as it relates to malaria, HIV/AIDS among other diseases, same cannot be said of mental illness. While millions suffer from different forms of mental illness but appear normal , those who visibly suffer mental illness are stigmatized and avoided even by family members. A Mental Health in Nigeria Survey conducted by Africa Polling Institute (API) in partnership EpiAfric in 2019 and published in January 2020, estimates that 20% - 30% of the Nigerian population are believed to suffer from mental health disorders. "The reason for this high figure has been attributed to economic hardship, negative environmental externalities and the rising cost of decent living in the country", the Report concluded.
Indeed mental illness in Nigeria was exacerbated during the lockdown as a result of the Covid-19 pandemic. The insurgence in the North East, North West and some parts of North Central leading to families and villagers being displaced from their ancestral homes and loss of means of income and livelihood have also been a major causative factor in the rise of incidence of mental disorder in Nigeria.
The lockdown also saw the rise in domestic violence and sexual abuse against women and children as family members were compelled to stay together for longer periods than they had been used to leading to arguments, frictions and misunderstanding.
With public health institutions completely overwhelmed by the Covid-19 pandemic and governments and corporate organisations diverting resources to curtail the spread, mental health issues were left unattended to. Even the Nigerian Police and other statutory agencies that would have handled the issue of domestic and sexual violence were not accessible as a result of the lockdown. Family members, afraid and traumatized, were at a loss on how to handle the behavioural disorders noticeable among one of their own. Most common among these mental disorders is depression. According to medical experts depression is characterized by sadness, withdrawn syndrome or loss of interest, low self-esteem, lack of appetite among other symptoms.
With dearth of mental health facilities and personnel in Nigeria even before the medical complications occasioned by Covid-19, many mental non-profit organisations in the country have risen to fill the lacuna. One of such is Gede Foundation with its headquarters at Federal Capital Territory Abuja. Founded in 2002 by Dr. Jennifer Douglas-Abubakar, Journalist, lawyer, Philanthropist, Gede Foundation was established "to cater for underserved and highly stigmatized population". After an extensive work spanning over 12 years on HIV/AIDS advocacy, counseling and care, Gede Foundation shifted focus to mental health which it identified as the next scourge especially among people living with HIV/AIDS.
Mr. Godwin Etim, Director, Partnership Management and Resource Mobilization, Gede Foundation said the non-profit organisation has done excessive work in areas of advocacy, counseling and care in recent months following the increase in mental disorder as a result of Covid-19 lockdown and insurgency in some parts of the country. According to him, Gede Foundation provided mental health support to frontline workers: doctors, nurses, laboratory attendants through online platform during Covid-19 lockdown to keep them in a stable frame of mind to attend to handle health emergencies. Besides, Etim said Gede Foundation engaged several communities to create awareness about mental health and reduce stigmatization of people suffering from mental illness using trained Mental Health Champions (survivors of mental health) in Mpape, Durumi, Mararaba and other suburbs of Abuja and in communities in Plateau, Benue and Nasarawa states. In partnership with Christian Blind Mission (CBM), United Kingdom, Gede Foundation embarked on Water, Sanitation and Hygiene (WASH) projects constructing boreholes and providing mental health and livelihood support under the North Central Transitional AID in Nigeria which will run from October 2019 – March 2023.
Mentally Aware Nigeria Initiative (MANI) is another non-governmental organisation making great impact in mental health advocacy, counseling and de-stigmatization in Nigeria. Reputed as the largest youth run and youth focused mental health organisation with over active 15,000 volunteers across Nigeria ,MANI is "a community of young people who are motivated to fight stigma and create an awareness for their mental health without fear of discrimination," according to information on its website. Dr Victor Ugo Co-founder of MANI and himself a survivor of mental health disorder while at the medical school, said in a recent interview that his organisation is daily inundated with calls by families of people suffering from one mental health disorder or the other needing help to manage them. He said through the monthly program Conversation Café, an enabling environment is provided for people to come together "to talk about mental health, participate in activities to improve their knowledge of mental health as well as build adequate coping mechanism."
Dr Ugo counsels those suffering from mental health to "find and join a community of people with similar experiences as even the smallest of community supporting you, can make your recovery journey just a little bit easier."
She Writes Woman (SWW)Foundation is another non-governmental organisation partnering with Women at Risk Foundation during the Covid-19 pandemic to provide broad based group and confidential counseling services as well as virtual support groups for victims of gender based violence. Founded in 2016 by Ms Hauwa Ojeifo, SWW is a "women-led movement of love, hope and support that gives mental health a voice in Nigeria." Ms Ojeifo won the Changemaker Award by Goalkeepers of the Bill and Melinda Gates Foundation in 2019 for the impact her organisation has made in mental health advocacy and counseling services among women who have suffered domestic violence and sexual abuse.
According to Dr. Jennifer Douglas-Abubakar, NGOs in mental health face lots of challenges in Nigeria. Notable among them is the lack of mental health Bill which could have provided strategic framework for all players to be guided in implementation. "The mental health Policy (which is not yet an ACT) is not backed with implementation guidelines and sufficient legal provisions," Dr.Douglas-Abubakar explained. According to her, stakeholders, NGOs, Civil Society organizations, Clinicians and academic institutions have made some milestones in engaging with the legislature and the mental Health Bill is awaiting the Third and final reading at the National Assembly. "There is hope that this would be achieved in 2021", she said.
Stigma and discrimination resulting from lack of knowledge and right information from both healthcare workers and the user groups is another challenge facing NGOs inn mental health according to Douglas-Abubakar. "Mental health specialists in Nigeria are very few and services are inadequate and this has burdened patient-clinician ratio for quality service," she said, adding that healthcare workers especially at the Primary Healthcare facilities are not trained on mental health services provision even though this is supposed to be part of their mandate.
NGOs have to deal with these and many other challenges in order to make reasonable impacts in mental health services delivery in Nigeria. Dr. Douglas-Abubakar said that Gede Foundation has begun the training of healthcare workers on Mental Health Action Program (mhGAP)—WHO's mental health programme for non-specialists in low and medium income communities. "In August 2020, Gede trained 160 clinicians including Nurses, CHEWS, Doctors, Psychiatric Nurses, Psychologists and Psychiatrists on the validated and approved five modules for community mental health and development programmes in Plateau, Nasarawa states and the Federal Capital Territory", she explained.
Stakeholders and clinicians on mental health are in unison that to tackle mental illness in Nigeria government should provide workable policies and infrastructure for mental health services, promote community mental health programmes where uptakes of services are community-based and create an enabling environment for NGOs to implement mental health services. These programmes include sensitization, mobilization and psycho-education at the primary health facilities. NGOs are efficient in conducting capacity building activities for healthcare workers and community members. Government should partner with such initiatives.
Besides, people with mental health challenge are still being stigmatized and discriminated against even by family members and friends making it difficult for them to access counseling and care in good time. There is urgent need to create more awareness and education on mental health in Nigeria for better understanding and empathy and hence end stigma. The huge negative impact of the Covid-19 pandemic on people's income, job, business and other means of livelihood is only pointing to one direction: mental health disorder is going to be on the increase as people battle for life and livelihood.
