Stories and podcasts WBW Stories Mismanagement of Mental Health in Nigeria My only understanding of mental illness a child was what was generally referred to as 'Madness'. In Nigeria, such madness is defined as when one goes out of control and roams about the streets stark naked, half-naked, or clothed in rags and the catalyst – at least, before now – was that this hysteria came as a result of drug abuse, God-divined punishment for one's offenses, or a spiritual attack from an enemy. It was not until I was involved in a fatal accident in 2009 and was left to grapple with the ramifications of it that I began view mental health in a different light. I was treated for my physical injuries, but given that mental health is not really considered a priority in Nigeria until one fits the aforementioned archetype, no attention was paid to my emotional or mental wellbeing. Not long after the accident, I discovered on my own that I developed post-traumatic stress disorder (PTSD), a condition incurred as a result of abrupt or on-going trauma that creates a hyper vigilance in the survivor to risk, danger, and distress. I started avoiding anything that reminded me of the accident – especially boarding similar cars or riding in them – and did everything I could to avoid sitting in the exact position I was in when the accident happened. I even stopped listening to the music that was playing in the car at the time of the accident, and my heart would beat twice as fast if I was sitting in a car and the speed suddenly increased. It was my journey towards helping myself overcome my disorder that gave me a better understanding of mental illness, and opened my eyes to the failures of both health systems and community to curtail this suffering in those living with it. Through my personal observations and findings, I've discerned that the major mental disorders experienced by Nigerians (amongst others), in the order of the frequency at which they occur seem to be: Depression, Schizophrenia, Anxiety disorders, and issues around substance abuse and addiction. Though several factors such as financial problems, poor relationships with family and friends, unemployment, and grief are commonly linked to depression in Nigeria, little or no attention is paid to more subtle indicators of poor mental health, particularly in those whose unhappiness seems uncharacteristic and therefore, something that should be ‘snapped out of’ soon. Pity is not a treatment for mental illness, but few people know how else to act when someone in their community is suffering. Even when mental illness becomes chronic, the majority of people are often not enlightened about actions to take or do not know when to seek medical help. Instead, they may resort to prayers or seek spiritual help from a pastor, reverend, chief priest, or other traditional healers, which may bring some degree of comfort, but is in no way a treatment of the real issues at hand. In my community, someone who might – for example – become schizophrenic would likely be hidden by their family due to shame. They would keep this condition, which is entirely manageable with the correct medication and treatment plan, a secret for fear of being shunned by others. This is a mercenary act on the face of it, but is also seen as a form of protection for the person living with schizophrenia, because it ensures that food and clothing remains available to them despite their illness. In Nigeria, living up to general community expectations is of great importance, so the family of someone living with schizophrenia might go to extreme lengths to conceal the reality within their home. But, as is often the way with secrets, the truth eventually is leaked. I was personally unaware of the stigma mental illness really carried until I heard a story about a colleague of mine, who had a family member who outright refused to marry her fiancé upon learning that there was once a member of his family who had been diagnosed with schizophrenia. When mental illness becomes chronic, most families leave the patients in figurative and even literal chains (for fear that they might lose control) at prayer houses, in the hopes that a miracle will occur. In some other cases, patients might refuse medical care, denying their condition to avoid marginalization. In the early 1990s, only 23% of member states of the African Region of the World Health Organization (WHO) were reported to have mental health legislation. Countries in the African region have about 12,000 psychiatric nurses for about 630 million population. Nigeria, a country with about 174 million population, has just 130 psychiatrists across the whole country. WHO estimates that about 20 million Nigerians suffer from mental illness and only about 3% of the government budget goes to mental health, though a mental health expert in Nigeria, Dr Emmanuel Owoyemi, the founder of the Mental Health Foundation, was quoted as estimating that 64 million people in Nigeria suffer from one form of mental illness or other. Accordingly, it makes sense that family- and community-driven responses to mental illness are so prevalent despite their harms. For many, there is simply no other resource to manage mental health, and no clear understanding of symptoms, diagnosis, and management of mental illness. Efforts should be made to ensure that people are well enlightened on mental health and all it encompasses, with the Government investing more in public awareness and mental health infrastructure. It has been years since the bill which protects the rights of persons with mental disorders and ensures equal access to treatment and care, discourages stigma and discrimination, was introduced, but it is yet to be passed into law. The time for respectful mental health care is now, and we must act. About the Author.