(Three Nigerian non-governmental organizations engaging in advocacy on mental-health issues in different States offer their perspectives.)
ANPPCAN, ENUGU
The African Network for the Prevention and Protection Against Child Abuse and Neglect (ANPPCAN) was founded in 1986. It is focused on protecting the rights of children including survival, protection, development and participation, all with the aim of ensuring that they emerge wholesome individuals, unencumbered by traumatic experiences. ANPPCAN looks after children who have experienced abuse and works for their mental health. Clinical Psychologist and Programme Director of teh organisation Elekwachi Chimezie spoke to PLAC BEAM. Chimezie is also Centre Manager for the International Federation for Psychotherapy, Enugu.
Elekwachi Chimezie, Programme DIrector ANPPCAN
On mental health bill and advocacy:
“The Bill focuses on ensuring that people have better access to mental health care and makes government responsible in terms of providing mental health access. Most importantly, it will address the issues of human rights abuse in the sector, you know it’s been a major issue for people to realise that mental illness is like every other form of poor health. Providing a law that will enable people to have improved protection both in the workplace and society, will improve on the work that we do.”
On operating environment for NGOs working on mental health:
“Apart from few global funding, for example Grand Challenges of Canada, DFID that I know, there aren’t a number of opportunities or funding focused on providing mental health services for those who are in need of it.”
Unique experiences:
“In 2015, we published an article called, ‘Brain Fag: New Perspectives’. Brain fag is a mental health condition that was first diagnosed by Raymond Prince in Nigeria and became a diagnostic criterion. But after brain fag was removed from the category of mental illness. It was no longer referred to as a mental health diagnostic criterion. My senior colleague and I, Professor Peter Ebigbo, wrote an article on the new perspectives about brain fag. We said that brain fag is a form of mental illness that goes in line with, in some cases, depending on the personality of the individual, anxiety. In other situations, it can come in the form of depression. What is most important is that the clinician understands the dynamics of our culture to be able to diagnose this condition correctly. We identified that there are issues of misdiagnoses that usually occur because people aren’t really culturally aware about the cultural dispositions that make the African different from the Western person. So, we wrote this article and also said that brain fag was usually seen among students though can occur outside of student community.”
On causes of mental health problems:
“When you talk about the insurgency, the issue of banditry, robbery, kidnapping, these have been major factors of unrest among people. When you look at the socio-economic situation, especially for young persons who do not have access to health care, no social protection, you realise that young people are uniquely affected by mental health problems.
“The National Violence Against Children Survey of 2015 estimated that about 60% of our children experience violence and you know that violence has a direct impact on mental health. Also, women who have experienced domestic violence can develop mental health problems. In fact, studies have shown that about 35% of our women have experienced domestic violence and sadly less than 55% of them have access to supportive services.”
On protecting mental health and wellbeing:
“Basically, it is about being positive. We have to look out for things that make us look towards life with positivity. Also, you know that it is not what happens that matters, it is how you look at it that makes a difference. We must be able to look critically at positive things that happen around us and be very intentional about identifying the positive things that happen to us. People in every day conversation say, ‘Yesterday is history, tomorrow is a mystery and today is a gift and that’s why it is called present’. We need to be able to realise that what we have today is hope.
“We have to remember that our communal lifestyle is always and has always been a very good one. Even the Western world is learning about communal approaches to social wellbeing and togetherness. So, we need to look at how things are happening with us by looking at communal lifestyle and bringing up all those communal things that make us find ways of surviving. “
What the government could do:
Mental health is the most neglected sector. More should be allocated to mental health. The students that are now in the university, should be encouraged. Those that are going to be doctors should be encouraged in the field of psychiatry and psychotherapy. We need to have more psychiatrists, psychologists and psychotherapists because they are not much. If there is need, they should be sponsored as well so that those that are interested can have the means to that kind of education. Our rehabilitation centres need help. They need more workers, beds, funds. There needs to be programmes for creating awareness for mental health issues. Even the policies we have need to be checked and revised.
CHARIS HEALTH CARE & COMMUNITY SUPPORT INITIATIVE, JOS
Henry Ojenya, Programmes Manager, Charis Healthcare
Charis Health Care is a community-based and faith-based organisation in Jos that provides care to people that are experiencing psychological problems. They provide mental health services for individuals, families and communities. The organization has recovery groups and programmes that provide life-skills training and support. Programmes manager Henry Ojenya speaks on the Nigerian situation.
On mental health bill and advocacy:
“The Mental Health Bill came out of the Lunacy ordinance of 1916, but the name is called the Lunacy Act of 1958. We have seen how this Bill has gone through reforms and a lot of other activities around it, how it will be enacted and implemented from 2003 when the House of Assembly raised the issue again, to 2019 and then 2020. This Bill has gone through a lot of reform, yet it still carries some stigmatising words and names that makes it difficult for us to carry on with our work especially around advocacy for improved mental health services.
“Treatment is only available in the tertiary institutions like the federal neuropsychiatric hospitals. So, we need our legislations to be centred around mental health issues being faced in Nigeria, the establishment of institutionalized facilities that could provide evidence-based care and how to support people working in the field of mental health care.
“People are experiencing trauma in communities, individuals trying to overcome mental health challenges so, people should be able to access basic care. There is no humane or medical approach from our Lunacy Act for people experiencing mental health problems. This law will definitely create a more enabling environment and will ensure that more people have access to mental health care knowing that there is a law protecting them from human rights abuses.”
On operating environment for NGOs working on mental health:
“The operating environment seems not to be conducive. NGOs work out of passion but sometimes we get to a point where we are stuck. Let’s take even one aspect of the mental health, for instance, which is drug use. There is an epidemic of drug problems in Nigeria. When we go to the community to provide care for individuals with drug use problems, sometimes we have government agencies like NDLEA come to raid or even arrest professionals and health care workers in those communities. If there is an awareness of mental health generally, people will know that substance abuse, drug dependency is also a mental health problem and needs medical approaches. Criminalizing drug users rather than sending them for treatment is not a better approach. Drug arrest should be really done towards people selling these drugs not people using it. People using and depending on the drugs should be sent for treatment. You expect a community responsiveness but, if it is not livelihood, community empowerment, environmental issues, you don’t get support, funding or community backing. So, the environment is not really conducive in terms of funding, supportiveness from communities, supportiveness from institutions, stigma and sustainability.”
Unique experiences:
“Recently, we had to provide trauma care for young children aged 9 to 12 years old who were molested by a foreigner. Over nine of them were molested. I won’t mention names for confidentiality reasons. This happened since May and no form of intervention was provided for them. The only thing done for them was that they were taken to a primary health care centre and there was no reproductive check-up for them or trauma care or protective service. We had to look at legal services that could address the issue because it involved a foreigner. Our police system was compromised.
“Another experience we had was of a client that was arrested for using drugs. He was taking cannabis without causing problems in his space. He had no problem with his neighbour or anyone, but they knew he smoked cannabis. Someone’s car got stolen in the neighbourhood and of course, every finger was pointed at him. Substance use we know most times is as a result of mental health problems. This client was taking substances to cope with the stresses he was experiencing; he could not sleep at night or cope with academics. He was detained; no attorney to fight for his case so, he was imprisoned. When we didn’t see our client come into the facility for so long, we had to look for him and hire a lawyer to fight his case.
“There was another case of a young man who was abandoned in the street, eating from a bin. A religious organisation told his family that if they had anything to do with him, all of them in the family would come down with mental health problems. The young man was abandoned, and we knew that the family could support him to get help. His situation got worse until we found him. Prior to this, he was coming to us for counselling. When we found him, we took him to a facility because we provide outpatient care, we looked for funding for him which was difficult. Today, he is doing well and even learning a skill. The highlight for me or my work is the fact that you see a young person come in with say a drug or mental health problem struggling to cope and then over months, you see them smiling out. People not talking to you, paranoid and suicidal, after some months of treatment, medication, counselling, support, you see them connecting back with family. It’s amazing.”
Protecting mental health and well being:
“In our organisation, there is something we call PEGMATE, which we advocate for protecting your mental health. The acronym is explained below.
- P – Physical Exercise – Keep yourself active each day. Try push-ups, skipping, jogging, dancing, go for a stretch walk or run the stirs. If you can’t step out of your house. Exercise reduces anxiety and depression.
- E – Eat right – Remember to drink a lot of water.
- G – Get good sleep. Ensure you get 5 to 7 hours of quality sleep.
- M – Maintain Healthy Relationships. Connect with friends, family and acquaintances.
- A – Avoid the use of psychoactive substances.
- T – Talk to a professional. Discuss your vulnerability in a safe place. Share your feelings, negative thoughts and behaviours. Visit a counsellor.
- E – Engage your mind in creative activities. Paint, draw, knit something. Travel, grow a plant, read a book, bake, design a card. Find time for your hobby.
“It’s good to watch the news but it is more important to protect our mental health, so sometimes, change the channel. As much as possible, avoid psychoactive substances, alcohol, tobacco, opioids, tramadol, that could trigger mental health issues. If we find a way to ease the stresses that we face, then it’s possible that we can live a life that is free of mental health problems in Nigeria. “
What the government could do:
“We need the government to support NGOs, faith-based organisations, community-based organisations, treatment centres, so that we would have people coming into the facilities for mental health check-up. If we can have this inclusiveness of mental health treatment in the National Health Scheme, the NHIS, then it makes it easier, so people know that they need to do mental health check-up the way they go to the hospital for check-up.
POSITIVE PATHWAYS INITIATIVE, KANO
Hajiya Rukayya Tofa, Founder Positive Pathways Initiative
Positive Pathways Initiative is a non-profit organisation dedicated to working for the protection, promotion, improvement of quality of life of people suffering from mental illnesses, especially depression and anxiety. They provide preventive and rehabilitative measures like mentoring, counselling, and empowerment. The founder, Hajiya Rukayya Tofa, gives her take from the family and victim perspective:
“What we are trying to do for now is mostly create awareness. What is really going on in the society is that there is a lot of stigma attached to mental illnesses, and people are afraid to come out and say, ‘Look I have a mental disorder or I am not feeling well, I am depressed.’ So, they are afraid to seek for medical attention. They are always thinking that people will term them as crazy.
“Even as families, you will see a person suffering from a mental health illness, but they are hiding it or will even lock the person up for a long time instead of seeking for help. Even when we visited one of the rehabilitation centres, some families if they take their loved ones there, they don’t even want the person to be discharged; they want him to stay there forever. So, even if they are healthy and can go back home, there is still that stigma. Integrating them back into the society is also a problem, both from their family and people in the community”.
On causes of mental health problems:
“Depression is one of the main causes of mental illness. Depression can be caused by genetic factors, serious illnesses, trauma, abuse, and age.”
On Protecting mental health and well-being:
“I will say rest and get enough sleep, eat a healthy diet, be confident and bond with your family. Like us here, a lot of men don’t even know what their women are going through, and the women are even afraid of telling their husbands what they are going through. So, it’s good to show your family love. Bond with them as there’s a lot of drug abuse cases and teenage suicide so you need to take care of your children properly. See the kind of people they are mingling with and also encourage them in their lives. Always make them confident and courageous. Whenever you feel you are depressed, you need to seek help. Go and see a doctor, go and see a psychiatrist. The brain is also part of your body. If you can go for physical check up on your physical health, you also need to see a psychiatrist because like I mentioned, you can hurt yourself or your loved ones. In fact, about one in every four people can be depressed or is already depressed according to statistics. As I said, people can be cured. Allow them to go back to their work, don’t look at them as lunatics. You need to respect them and also show them love.
What the government could do:
“I just hope that the government will do more about the policies to create awareness on these mental health issues. I also think more needs to be allocated to mental health sector because the funds that go to mental health are not that much and a lot needs to be done. One of the rehabilitation centres that we visited really needed more workers. They even complained that they needed more psychiatrists. It takes longer before they can get anything. They send reminders and it takes months before something is done.
“What we really intend to do is even going to villages to create more awareness. People normally go to see traditionalists or herbalists. They don’t associate their mental health as a disease or illness to go to the hospital. They feel like it’s a demon. Those people that don’t have the means to go to the hospital, we want to help them; take them to see a psychiatrist.”