NEW YORK, New York — Around the world, mental health stigma is spreading a vicious circle of poverty. In Nigeria, an estimated 80% of people with serious mental health problems cannot receive care due to a combination of stigma and lack of resources. Although mental health problems can stem from complex sets of individual factors, poverty is both a cause and a consequence of poor mental health. The most recent reports from 2018 indicate that almost 31% of Nigerians, or about 66 million people, live on $2.15 a day. Amaudo Itumbauzo, a Nigeria-based nonprofit, and Amaudo UK, a charity set up to support preparatory work overseas, aim to improve mental health care in Nigeria.
Stigma and misconceptions about mental health in Nigeria
Stigma and taboos impact mental health in Nigeria. A study by Modupeoluwa Omotunde Soroye and others, published in 2021, found that many communities in Nigeria attribute depression, schizophrenia and other mental illnesses to demonic possessions, curses from witches and punishments from God for “harmful acts”. Mental health is a taboo subject in some communities and some families even prohibit parents from marrying anyone with a history of mental illness in their family.
Mental health awareness in Nigeria is low and in some corners of Nigeria people with mental illness are chained and beaten as a means of spiritual treatment. After receiving diagnoses from “unscrupulous mental health professionals,” spouses sometimes take it upon themselves to dispel evil spirits by physically beating them. With these stigmas and misconceptions in general, people who need help are not only denied treatment, but they also face violence and remain in the care of family members who consider the state of the person as ashamed.
Lack of resources
Although Nigeria reports the highest number of cases of depression in Africa and ranks “15th in the world for the frequency of suicides”, the country of more than 200 million people employs fewer than 150 psychiatrists, according to Al Jazeera in 2019 Moreover, around 90% of Nigerian doctors want to find work abroad and only eight facilities are available to both train psychiatrists and treat patients, a study by Yusuf Hassan Wada and others say.
Aside from the stigma surrounding mental illness and its links to spirituality, as well as the widespread belief that those who suffer can “get away with it if they try hard enough”, there just aren’t enough opportunities job opportunities for psychiatrists because psychiatry is not a field many actively believe in.
Without recognizing and addressing the underlying stigma surrounding psychiatric disorders, for people with mental illnesses, treatment and care will remain scarce, leaving increasing numbers of Nigerians highly vulnerable to poverty.
Amaudo Strategy and Impact
The study by Soroye and others stresses the importance of community psychiatry and its proper implementation to help those who need it most in Nigeria, noting that it should “focus on detection, prevention, early treatment and rehabilitation of patients”. Additionally, for a comprehensive response, there is a need to address the stigma negatively associated with psychiatric and mental health disorders by educating community members and correcting common myths. Amaudo does just that.
Nigeria-based non-profit organization Amaudo Itumbauzo and charity Amaudo UK aim to provide vulnerable people with serious mental illnesses with a safe haven while raising awareness of mental health in local communities.
The Borgen Project spoke with Kate Lumley, CEO of Amaudo UK and niece of Amaudo Itumbauzo founder, Rosalind Colwill, as well as Reverend Kenneth Nwaubani, Director of Amaudo in Nigeria, about how the organization provides mental health care in Nigeria.
Okopedi Rehabilitation Center
Amaudo Okopedi is a rehabilitation center in Nigeria for people with serious mental illnesses. Residents are supported by a team of 25 support staff, including medical professionals and psychiatrists, who “live, work, eat and socialize together”. Okopedi’s primary goal is to relocate residents to a supportive home environment, which is why part of the rehab process includes “counseling, medication, training, and family tracing,” the website says. of Amaudo.
Speaking of Amaudo’s approach to Okopedi, Reverend Nwaubani said much of the approach was inspired by “African community life”. Nwaubani told The Borgen Project, “At Amaudo, staff and residents, who are undergoing mental health rehabilitation, will work, eat, worship and play together. This system provides love, care and support to those (who have experienced stigma, abandonment and neglect from) family and society. »
Not only does this approach provide support for residents, but Lumley also noted that the “everyday rhythms” of Amaudo’s environment are particularly nurturing because they provide structure and positive space for residents. Lumley says, “Everyone is expected to pitch in as much as they can for the benefit of the community, whether it’s helping out on the farm, in the kitchen, or keeping the compound clean and tidy.
Through the vocational training unit and small loans offered by the self-help group (as part of the CMHP), patients receive support and the opportunity to learn a trade and earn an income independently. A patient named Annah uses the profits she makes from her shop through support from the self-help group to send her children to school.
Residents tend to stay in Okopedi for an average of one year, according to Reverend Nwaubani. Prior to relocation, Amaudo expects residents to have an overview of their illness, be willing to take medication, take care of themselves with minimal support, and participate in community activities such as cleaning of the enclosure, agricultural work and leisure.
Amaudo staff also prioritize the importance of home visits and the value of supporting family members in understanding patients’ mental health and needs.
Fighting stigma and taboos
In addition to offering practical support for people with serious mental illnesses, Amaudo offers mental health programs and support to local communities and families to address mental health stigma.
Through the Amaudo Community Psychiatric Program, which aims to address the causes of homelessness among people with mental illnesses, Amaudo provides accessible and affordable care and treatment. According to Reverend Nwaubani, the program was born with two objectives:
- To provide ongoing mental health care to the growing number of people with mental illness and homelessness who are reunited with their families.
- To provide accessible and affordable care to people with mental illness in their communities to reduce the number of those whose conditions have become chronic due to lack of care or poor care provided by religious healers and witch doctors.
The community psychiatric program was initially created in collaboration between Amaudo and the government of Abia State, the first state to adopt the program. The state government provided “skilled labor like psychiatric nurses” and local governments provided clinical spaces while Amaudo provided supervision and “psychotropic drugs through a fund. renewable for medicines”.
“This system has remained active since 1996 despite many challenges and has helped to reduce the
mental health treatment gap in southeastern Nigeria. It looks very much like it did when it started, although it now covers four states,” says Nwaubani.
To combat stigma, Amaudo also hosts a weekly radio show that raises awareness about mental health, sometimes featuring guest speakers and British sponsors. The show airs every Monday at 11:30 a.m. NGN time and can be streamed through the BCA/TV app.
Future goals and support
Amaudo secured funding to build a residential block for nursing students who, according to Lumley, “until now had to sleep on the floor”. During the visits, nursing students learn about mental health as a mandatory component of their general nursing requirements.
“This new block will allow Amaudo to continue to play a key role in training the next generation of nurses to understand mental health issues and there are plans to use the block for other groups of people to train, such as community leaders, journalists and church representatives. says Lumley.
Given the inflation linked to the pandemic, Amaudo benefits greatly from financial support and has several appeals for donations in progress. For example, Reverend Nwaubani spoke of the increased cost of rehabilitation and fundraising for a new truck since the costs of repairing the organization’s only truck are unaffordable.
Thanks to the critical work of organizations like Amaudo, mental health care in Nigeria can improve.
Photo: Wikimedia Commons