Nigeria’s Mental Health

Mental health is a global and public issue that requires serious attention in Nigeria. According to Prof. Taiwo Obindo, the president of the Association of Psychiatrists in Nigeria (APN), stated that over 60 million Nigerians suffer from mental health disorders. Despite the scale of the problem, there is a limited understanding of mental health in the country. This lack of awareness exacerbates the growing mental health crisis, particularly in conflict-affected areas. Religious and cultural beliefs, lack of experts on mental health and mental well-being, and lack of mental care infrastructure, especially for people in conflict zones, make life difficult for those facing mental health crises in the country.

The perception and attitudes of Nigerians toward people with mental health illness pose a significant challenge for victims of mental health diseases. The perception of mental illness that some Nigerians hold is that of people walking around in the streets naked with tattered clothes. However, eating disorders, anger issues, and depression are often not considered as part of mental health illnesses, leading to a lack of priority given to mental well-being. Religion also plays a significant role in shaping these perceptions. There is a widely held belief that mental illness is from supernatural causes such as evil spirits, voodoo or witchcraft. This spiritualisation of mental health can lead to stigmatisation, further isolating those affected. As a result, individuals may seek help from traditional healers or spiritual leaders, who often lack the qualifications to provide proper mental healthcare, worsening the situation for those in need.

Funding is a crucial part of improving mental health services in Nigeria. However, funding for mental health services is inadequate across the country.  Mental health infrastructure is funded by 3.3-4 per cent of the national health budget, leading to poor-quality treatment for patients and a shortage of mental health professionals. According to a news report, the number of medical professionals available to address mental health needs in Nigeria is insufficient.  The country has just eight neuropsychiatric hospitals and fewer than 15 state-run neuropsychiatric centres. In rural areas, the scarcity is even more severe, with psychiatrists almost non-existent, making it difficult for individuals in these regions to access quality mental healthcare. This also contributes to underreporting of the consequences of untreated mental health illnesses such as suicide.

Nigeria’s economic downturn has exacerbated the shortage of mental health professionals, fuelling a brain drain within the healthcare system.  As noted by the  President of the Association of Psychiatrists in Nigeria (APN), the country should have one psychiatrist per 10,000 people, but currently, there are fewer than 250 psychiatrists for Nigeria’s entire population. With the population projected to reach 400 million by 2050, this would mean one psychiatrist serving 864,000 people. Due to economic hardship, many psychiatrists immigrate to places like the United Kingdom (UK). Post covid, Nigeria’s brain drain has significantly increased, with over 100 Nigerian psychiatrists leaving the country in the last three years. The economic crisis has had a particularly severe impact on mental healthcare, with rising inflation and limited job opportunities in the health sector diminishing incentives for psychiatrists to remain in Nigeria. In contrast, foreign medical institutions actively recruit healthcare professionals and offer lucrative payments for their services., further encouraging the exodus of Nigeria’s mental health specialists.

Conflict zones pose a significant challenge for individuals suffering from mental health conditions in Nigeria. People in these areas are often exposed to traumatic experiences, leading to mental health disorders such as post-traumatic stress disorder (PTSD). Unfortunately, access to necessary mental healthcare is severely limited due to the destruction of health infrastructure caused by ongoing violence. For instance, in 2022, Nigeria recorded 43 incidents in which 37 health workers were kidnapped, 11 health supplies ransacked, and 11 health workers killed. When further broken down, 17 of these incidents happened in the Northeastern states of Borno and Yobe, which are worse hit by terrorism. This leads to a significant shortage of healthcare professionals in these zones due to insecurity, making it almost impossible for those experiencing mental health problems to get adequate treatment.

In addressing the challenge, former president, Muhammadu Buhari, in January 2023, signed the Mental Health Bill into law, replacing the lunacy act 1958. The new law offers some protection to people with mental health conditions, including the freedom to participate in their treatment plans. It bans the dehumanisation of people living with mental health conditions and aims to increase community-based coverage to promote access to mental health services. However, the law allows for involuntary treatment and coercion in other forms, contrary to international human rights laws and treaties. Nigeria’s healthcare system is still underdeveloped and lacks modern medical facilities, with its healthcare indicators being some of the worst in Africa. To tackle this problem, Nigeria approved the second National Strategic Health Development Plan (NSHD 2018-2022). The Nigerian Sovereign Investment Authority (NSIA), in partnership with the Federal Ministry of Health, signed a series of agreement to help modernise and expand healthcare services with the help of the private sector. Though these steps are commendable, there is still a long way to go before there will be any improvement in mental healthcare services for victims of mental illnesses.

Understanding a problem is vital in tackling it. The government must invest more in research on mental health and well-being. Public-private partnerships, along with collaboration with civil society organisations (CSOs) and non-governmental organisations (NGOs), should be leveraged to raise awareness and sensitise communities about mental health issues. There is a need for Nigerians to shift from superstitious beliefs about mental illness to a more evidence-based understanding of its nature and its impact on individuals and society.

Funding is critical to improving Nigeria’s mental health infrastructure and services. The government must significantly increase investment in this area. One gap in Nigeria’s mental health landscape is the lack of accessible hotline support for those struggling with mental illness. The government should incentivize the establishment of formal and informal hotline support systems to provide accessible and confidential resources for those in need.  In conflict zones, humanitarian aid should integrate mental health services for affected populations, including the provision of psychosocial support for those suffering from mental health conditions. This would help address the unique mental health challenges faced by individuals in conflict-affected areas.

Additionally, the government must tackle the root causes of the brain drain in the medical sector. By creating job opportunities and improving security, Nigeria can incentivise psychiatrists and other mental health professionals to remain in the country, helping to close the gap in mental healthcare provision and offer much-needed support to individuals experiencing mental health challenges.