HEALTH

Stigma of Mental Illness in Nigeria: Time for Change——Dr Sunday Neru, Consultant Psychiatrist, Luton, UK.Dr Ifeoma Anwunah-Okoye, Consulting Psychiatrist, NJ, USA.Dr Biodun Ogungbo, Neurosurgeon. Abuja, Nigeria.

There is an explosion of mental illness all over the world due to the pandemic and the lockdown. Many people, especially the vulnerable, are stuck in limbo at home with little to do. Many people in abusive relationships are stuck with their abusers and undergoing a hellish time. This has increased anxiety and fears and the inevitable mental health deterioration leading to depression and sometimes death.


Life in Nigeria is an emotional roller-coaster and many people are barely hanging on. Nothing seems to work in Nigeria or work the way they are meant to work. The abnormal has been normalised in Nigeria such that sane people constantly question their own sanity. The slide from sanity to insanity is smooth and easy.

How can you keep it together, in the face of poverty, dejection, rejection and a hoard of bad news cascading down heads daily?

Case 1: I had gone to a store with my family and I saw a lady with black soot all over her face and arms, standing outside on one spot for a long time without moving and not uttering a word. I asked the owners of the store who the lady was and how long she had been standing there without moving.

They all laughed at me in surprise, as though, I should have known who she was. One of them replied “Oh you don’t know? She is the agent.” Then I asked, “What agent? Agent of what?”, and she replied, “Agent of the devil”. She stated the lady came by occasionally to take their things and food items by force. They would allow her to take the items, and she keeps coming back on a routinely basis.

Agent of the devil?

After hearing this, we were dismayed, but at the same time not surprised at the cultures with many superstitions, misconceptions, and stigma towards people with mental illness. If people with mental illnesses are referred to as agents of the devil, or mysterious aliens, and not human beings, how can people start to improve the mental health of the community? How can individuals and families with mental illnesses be helped and cared for if they are not seen as humans?

How can they have voices if they are not allowed to identify who they are by themselves?

The good thing is that mental health is slowly being embraced and recognized. However, to change a community’s perception and policies related to mental health and mental illness, we must start by addressing these types of misconceptions to reduce the stigma associated with mental illnesses.

We have a question for you!

What do you know about mental illness? What do you think about sufferers? Are they agents of the devil? People to be shunned and avoided?

Okay, let us leave you to wrestle with that for a moment and talk about the treatment of mental health sufferers in Nigeria.

Poverty of care in Nigeria

People who have suffered mental stress and breakdowns are poorly diagnosed and poorly managed in Nigeria. According to Lancet (Global Health) Nigeria currently faces a global human rights emergency in mental health. Underpinned by poor societal attitudes towards mental illness and inadequate resources, facilities, and mental health staff, figures suggest that approximately 80% of individuals with serious mental health needs in Nigeria cannot access care.

With fewer than 300 psychiatrists for a population of more than 200 million, most of whom are based in urban areas, caring for people with mental illness is typically left to family members. Families mean well but they are not equipped to handle mental illness, and many make terrible mistakes.

They send mental health sufferers out of the home. They throw them out due to stigma and society pressure. Stigma and misunderstanding about mental health conditions, including the misperception that they are caused by evil spirits or supernatural forces, often prompt relatives to take their loved ones to religious or traditional healing places.

Case 2: Miss A, a 22-year-old woman who had a mental health crisis following the death of her mother and who had been detained in a church in Abeokuta for five months at the time of a March 2019 interview, said: “When my father brought me, I didn’t know that he would leave me here. I was not happy, but I don’t have a choice.”

Forceful detention, chaining, and violent treatment are pervasive in many settings, including state hospitals, rehabilitation centers, traditional healing centers, and both Christian and Islamic faith-based facilities. As reported by Human Right watch in 2019, “People with mental health conditions find themselves in chains in various places in Nigeria, subject to years of unimaginable hardship and abuse.”

Human rights and dignity of life.

A nun in charge during a Human Rights Watch visit to a state-owned rehabilitation center in southeastern Nigeria said they chain people to their beds “so they do not run away.” The nun defended chaining a woman who had HIV “to stop her from going around the men.”

Human Rights Watch found another woman at the same institution chained naked to her bed.  People who are chained are forced to live in unsanitary conditions. Many must eat, urinate, defecate, and sleep in the same place, usually within the same space where they are confined.

Break the chains!

The Nigerian government should ban chaining and urgently investigate chaining in state-owned rehabilitation centers, psychiatric hospitals, and faith-based and traditional healing centers in all 36 states and the Federal Capital Territory.

The government should also prioritize the development of quality, accessible, and affordable community-based mental health services.

Will you join us?

To improve the lives of people with mental illness. Will you show more empathy and understanding? Will you raise your voice and ask the government to ban chaining in mental health institutions? Will you intervene and help stop cruelty to patients in these homes?

The time is now, and we need you to ACT!

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