Stories and podcasts WBW Stories Closing the Chasm: Cross-Cutting Mental Illness Management in Nigerian Institutions Neurotypical people are fascinated by mental illness. It is not hard to see why – it is romanticized, anaylzed, and scrutinized in our popular culture, media, and classrooms. We are haunted by the romance of a once-bright mind sputtering into some nonspecific madness; of a parent beholding their only daughter, one who had ranked within the top 10% of her class and represented a beam of hope for the family – of glory, aspiration, and unending potential – to suddenly degenerate into a reprobate, as she cries. In this narrative, the girl is afflicted by repeated hallucinations, anxiety, mood swings, or in some extreme cases defecates in her pants or walks down the street stark naked, unable to distinguish reality from fantasy and helplessly judged by people for actions over which she has no control. In such a narrative, this shame would presumably motivate any parent to take any number of desperate measures to find a way to support their child. Not all stories of mental illness are, in reality, so graphic. But even so, the capacity for African society to support people living with mental illness is not yet as expansive as it could be. Mere mention of mental illness in Nigeria instantly sends a mixture of shock and amusement through anybody subject to the conversation. The melodramatic fantasies we paint are of erratic, abnormal behaviours, people wearing rags as an outfit, an aggressive outlook, inclination to self-harm, a stark decline in mental and physical functionality, distorted perceptions of reality, or a person talking themselves. In this culture, mental illness is often misconstrued as a punishment from God, an ancestral curse, or an outcome of prolonged abuse from either childhood or a forced early marriage. Accordingly, the first remedy many seek when mental illness arises is to seek a spiritual intervention instead of medical assistance – often with huge economic repercussions. Mental illness is manifested in many ways, but is often recognized by the increase of abnormal thoughts, emotions, and behavior in relationships. Mental disorders include, but are not limited to: depression, bipolar affective disorder, schizophrenia, psychosis, and post-traumatic stress disorder. Globally, 450 million people and 64 million Nigerians suffer from some type of mental illness. Of the 800,000 yearly suicides from depression, 85% occur in developing countries with adolescents, 15-19 years, at the top of the list. The reasons for this are varied, the stigma against mental illness cannot be overstated as a contributor to these statistics. Stereotypes, negative professional perception of mental illness, and the presumption that people living with mental illness are violent all contribute to this reality. Mental illness may be catalysed by hereditary causes, substance abuse, trauma, or circumstantially (for example, through isolation). Management and treatment may be impinged by many factors, some of which include the delay in the identification of illness, lack of education about how to seek care, and fear of societal stigmatization. This may be complicated by non-use of appropriate modern medication or lack of engagement with mental health support services. Stigmatization and prolonged exposure to extreme stress remain two critical factors that, today, fuel the devastation caused by mental illness in Nigeria. Nigeria is woefully under-resourced insofar as mental health support goes. Mental health services need to be provided locally that are affordable, accessible, and respectful for all people, regardless of background. The Government must invest in promoting service uptake and ensure continuation of treatment by those who need it the most. There is an urgent need for mass recruitment of psychiatrists and psychologists, an aggressive campaign to raise the critical consciousness of the people by correcting harmful misconceptions about mental illness, with the intention of ending the stigmatization is fundamentally harming society. Extensive efforts need to be made to overcome ignorance and discrimination, and those living with mental illness are most vulnerable to their harm. Though mental health is not yet a stated priority of the Nigerian Government, we need not wait until an army of trained and resourced psychiatrists and psychologists are invested into. We can act today with a valuable resource we already have: religion. Religious institutions represent the single most effective link for cross-cutting collaboration with civic agencies capable of delivering community directed intervention to the health needs of diverse populations while harnessing the diversity of race, cultural and economic factors. Religious podiums can be used to encourage health seeking behaviours and compassion for the mentally ill, better parental care, social support, economic, and educational empowerment for every child – and especially girls – in their community. This is invaluable, especially during this critical economic recession period. Similarly, spiritual leaders through positive behavioural strategies are more likely to reduce the burden of depression by the delivery of heart-warming, motivational speeches. By attesting to the importance of respect and kindness, alongside demonstrations that educate family members on the prevention, management, and the promotion of positive communal attitudes, churches can demystify mental illness and create a holistic reorientation and dialogue as support for medical-based care is increasingly recognized as necessary by decision-makers. In order to achieve the United Nations Sustainable Development Goals (SDGs) around Improved Health and Wellbeing (SDG 3) and Gender Equality (SDG 5), the Nigerian Government should implement the 1999 Mental Health Policy Review Action Plans, scale up funding and training of care providers at existing mental health institutions, establish community-based mental support services at Primary Health Care settings that are stocked with free modern antipsychotic and mood stabilizing drugs, ensure specialist supervisory oversight of mental health practice, and include mental health education in school curricula. Until the Government is ready to assume leadership of this crucial human rights issue, churches can and should hold the space as champions for society’s most vulnerable people. About the Author.