By Violet Ikong
Myths and misconceptions about mental health abound in most African communities, with the widely held assumption that anybody who suffers from a mental health problem is insane or spiritually ill. As a result of stigma, most Africans would rather struggle with mental health issues in silence, than speak up or seek help.
“The African concept of mental illness has to do with seeing people vagrant on the street, eating from waste bins, looking dirty and unkempt,” said Etim Amaku, a psychiatrist at the federal neuro-psychiatric hospital in Calabar, Cross River State, in southern Nigeria.
The World Health Organization (WHO) estimates that one in four people in the world will be affected by mental or neurological disorders at some point in their lives. However, because of stigma and fear of discrimination, over two-thirds of those with a known mental disease never seek help from a health professional. About 5% of adults globally – 280 million people – suffer from depression. In Africa, most governments devote less than 1% of their budgets to mental health services, even though an estimated 100 million people on the continent are said to suffer from clinical depression, which is the most prevalent mental illness in the world.
But some individuals and organizations in Nigeria, Kenya, and Uganda are trying to make a difference in people’s lives by raising mental health awareness and offering intervention for people suffering from mental health challenges.
Safespace Nigeria responds to mental health challenges
Precious Eze is the founder of Safespace Nigeria (Safespace NG), an organization focused on mental health awareness efforts, advocacy, and providing support to young people in Nigeria.
Eze founded Safespace NG in 2020 to provide an opportunity for young people to express themselves, learn about mental illnesses, and how to manage their mental health. Located in Calabar, Cross River State, the organization gives those battling with mental health challenges an opportunity to ask questions, get free counseling services, and learn from the experiences of others.
Nigeria has the highest cases of depression in Africa, and ranks 15th in the world in the frequency of suicide. According to the WHO, one in every four Nigerians, or approximately 50 million people, suffers from a mental illness. However, Nigeria does not have enough mental health experts. “For a country with a population of over 200 million people, we have less than 200 psychiatrists,” said Amaku, who is a psychiatrist. The country currently has only eight neuro-psychiatric hospitals.
As a child, Eze, now 27, battled with mental health problems, including suicidal ideation on multiple occasions. “One of those days when I could not go through with killing myself because my younger brother came into the room and stopped me, I sat down and thought about all the people who had killed themselves. I realized that if I had gone ahead to kill myself, my parents would not have known why I did it or that I was struggling so much,” she said.
Eze decided to choose survival over suicide, and founded her organization. Through Safespace NG, she reaches out to young people across the country and encourages them not to turn to suicide as a solution to depression. Since 2020, Safespace NG has served over 1,000 young Nigerians through conferences, seminars, and outreach events. The events are held both virtually – closed WhatsApp groups and Zoom are commonly used for virtual meetings – and in person, with conferences and seminars held in Calabar. Free counseling services are also available both online and in person.
Mental health is misunderstood by the majority of Nigerians, Eze said, and her organization aims to dispel myths and appropriately educate people about it. “Even though some people are beginning to understand and appreciate mental health, there is still a sector of people, especially the older generation, who are completely ignorant about [it].”
One commonly held misconception is that mental illness is a spiritual problem, and this belief frequently leads to the exacerbation of what might begin as minor psychological troubles. “In our culture, we find it difficult to seek help at the initial stage where we notice we have challenges with our mental health. We believe in spirituality or cultural ways of getting help and fail to get medical health at the appropriate time,” said Amaku, the psychiatrist.
Stigmatization keeps people from seeking help. “The level of stigmatization in Nigeria seems to be worse as compared to other countries of the world because sometimes even family members and relatives of people who have mental health challenges face stigmatization by others. When a person desires to marry into a family with a member who has or has had a mental illness in the past, such a person is traditionally discouraged from proceeding with the marriage preparations. If you visit schools where a child has a seizure, you will notice that the school stigmatizes the child and may even urge the parents to remove the child from the school,” Amaku said.
Safespace NG has big plans. Eze hopes to take mental health awareness into rural communities where misconceptions are very high. “In some communities, children who suffer mental health illnesses are seen as being possessed. We want to create awareness in such communities to let them know that there are people who are willing to listen to them and that they can get help for whatever mental challenge they might be faced with. We also want to let them know that they are not alone,” she said.
The organization also plans to increase awareness among disabled people, especially those who are part of the deaf community, because according to Eze, there are not many mental health experts who understand sign language. “A deaf person will first have to explain their situation to someone who understands sign language for such a person to pass their message to a mental health expert – and this poses a challenge.”
And Safespace NG plans to create a support group network across the 36 states of Nigeria. Eze believes this will further give young people the courage to break their silence in situations where their mental health feels threatened. “Knowing that they have other people who are going through – or have gone through – similar situations will give them the courage to seek help and healing,” she said.
Youth forums in Kenya advance mental health awareness
In August 2017, Obed Momanyi took out a loan of KSh 1,500,000 from a local savings and credit co-operative society called SACCO, in Nairobi. He intended to put the money into a business, but instead he was scammed and lost all the money. He became seriously depressed. “I had suicidal thoughts, and for days I stayed indoors with my phone turned off, and I did not eat for some days,” he said.
His close friends were worried, but Momanyi would not admit to anyone that he was depressed. “Mental health discussions are not viewed positively by people around me, so I had to just tell them I was fine, even though it was a lie.”
George Imara, a 25-year-old local developer in Nairobi, Kenya, lost a female friend to depression-related suicide in 2013. He thought that if he had had more information about depression, he could have saved her life. “In her suicide note, she mentioned that I was one of the persons who gave her a reason to live longer through my words of encouragement to her. If I had good knowledge of mental health and depression, I probably would have done better to save her,” he said.
In Kenya, depression and anxiety disorders are the leading mental illnesses, with one in every 10 people suffering from a clinical mental health disorder. One out of four persons who seek healthcare in Kenya have a mental health condition. Globally, about 800,000 people die by suicide every year, and suicide is the leading cause of global death among 15-29 year olds.
After his friend’s death, Imara started learning more about mental health, and in 2015 he organized a mental health seminar in the town of Ruai, about 35 kilometers from Nairobi. He invited mental health experts to teach young people about mental illnesses, especially depression. Then in September 2016, he founded Mental Health Forum Kenya, which presents seminars about mental health to young people and connects them with mental health experts such as therapists, psychologists, and psychiatrists. They also link young people who are dealing with mental health issues with survivors so that they can be inspired by their stories.
When Imara heard about Obed Momanyi’s depression that was triggered by the scam he had endured, he offered counseling, which eventually proved effective. Imara first invited Momanyi to attend a mental health seminar in 2018, but he did not attend until 2021. According to Imara, reluctance to attend mental health seminars is common, since people are afraid others will think they are insane if they do. “Many people here come from a point of ignorance about mental health and associate it with something else such as madness, weakness, and witchcraft. They do not see it as something that can be diagnosed and treated clinically,” he said.
Momanyi finally decided to attend the 2021 conference in the company of three of his friends. He now speaks to his friends and family about the importance of mental health, and why they should seek treatment if they are experiencing mental health issues. “If more people in our communities can stop viewing mental health negatively and realize that it is normal to suffer mental health challenges, more people will learn to not be ashamed of attending mental health seminars and forums,” he said.
So far, Mental Health Forum Kenya has organized five seminars across three locations in Ruai. Over 350 young persons have attended these seminars, which are annual – although in 2020, the pandemic prevented the organization from holding one. Like Momonyi, those attending hope to reclaim their lives.
Mental Health Uganda gives hope to people with mental health challenges
In1997, a group of people suffering from mental illnesses in Uganda came together to form a peer group where they could talk about their problems and receive treatment. This peer group eventually evolved into what is currently known as Mental Health Uganda (MHU), an organization with 25,000 members across the country that primarily works with caregivers to ensure that people with mental health issues have access to the therapy they seek. MHU also operates a round-the-clock, toll-free number for individuals to call for free mental health counseling and referral services. And people with mental health concerns can also visit the organization’s office in Lungujja, Makamba Zone, Kampala.
Experts estimate that up to 35% of Ugandans suffer from a mental health disorder and 15% require treatment. The BBC reported in 2015 that, at that time, there were only 30 psychiatrists in Uganda, despite a population of over 35 million people; Mental Health Uganda reported in 2021 that the figure had risen to 43 psychiatrists. This puts Uganda among the list of countries with fewer than one psychiatrist per 100,000 people. The country is ranked among the top six countries in Africa for individuals with depressive disorders.
MHU advocates nationally for the rights of persons with mental health challenges, provides rehabilitation services for homeless people with mental health illnesses, and organizes training and interactions on mental health across the country. It trains village health teams and community health workers to connect persons with mental health issues in their areas with available services.
“We have also trained the child and family protection unit of the police force in Kampala on handling and understanding mental health. We did this because every case of mental health challenge reported to the police is first reported to their unit,” said Geraldine Kauma, from the MHU communications department.
She explained that mental health in Uganda is stigmatized, with treatment not prioritized by the government. Most Ugandans feel that mental health issues are spiritual, and they choose traditional methods of care for people with mental illnesses. According to experts, up to 80% of patients in Uganda’s mental health hospitals have previously been to a traditional healer.
But with increased awareness of the clinical basis of mental illnesses and options for treatment, people will be able to let go of myths and misconceptions, Kauma believes. And that is why MHU plans to continue its work to educate the public and improve access to mental health treatments for Ugandans who are suffering.