In Nigeria, the road to a mental illness diagnosis is often fraught with shame, stigma and secrecy. People living with mental health conditions need to know that they are not alone and can get professional help.
For a significant part of her life, Hauwa Ojeifo had struggled with extreme mood and energy swings, which, coupled with trauma from sexual and emotional abuse, severely interfered with her quality of life. In February 2016, she was on the verge of taking her own life, but she shared her suicidal thoughts with a friend who encouraged her to see a psychiatrist.
The road to Hauwa’s diagnosis was long, hard, and fraught with the shame, stigma, and secrecy that is often associated with accessing mental healthcare in Nigeria. It is for this reason that She Writes Woman, a non-profit organisation working to give mental health a voice in Nigeria, was born. Part of their mission is to create safe spaces for people to access support that is free of shame and judgement, as well as create better lives for Nigerians by improving the way they think, feel, and behave.
In Nigeria, there is poor awareness about mental health and the topic is not often spoken about, as mental health conditions are often associated with substance abuse or possession of evil spirits (in the local parlance, the activities of ‘village people’). This 2019 survey on ‘Mental Health in Nigeria’ assessed the perception, as well as attitudes of Nigerians to mental illness, and one of the key findings from respondents was, “Mental health is people going mad.”
Nothing about us without us
She Writes Woman is a mental health and disability rights advocacy organisation involved in legislative advocacy, as well as mental health policy and reform across different sectors of the economy and in the political space. At the heart of their advocacy work is the mantra, “Nothing about us without us.” This is the idea that no policy should be decided by any representative without the full and direct participation of members of the group(s) affected by that policy.
In this capacity, Hauwa, who has since been diagnosed with bipolar disorder and PTSD, with mild psychosis and is now receiving treatment, testified before the National Assembly Committee on Health regarding the Mental Health Bill of 2019. Her testimony highlighted deficiencies in the language and the fact that the human rights aspects of the legal process were largely disregarded. The bill was stepped down and sent back for revision. The revised Mental and Substance Abuse Bill, 2019 passed for second reading in 2019, having been sponsored by Senator Ibrahim Oloriegbe, Chair of the Senate Committee on Health. Despite the deficiencies in the bill, it will still be a major improvement on the existing mental health legislation which is guided by the Lunacy Act of 1958.
This was the first time someone with a diagnosed mental health condition would testify before the House. It was made possible because the organisation also runs an advocacy program where people with lived experiences are trained to advocate for their rights and co-create solutions to their problems.
Provision of mental health services and safe place clinics
“Reaching out to She Writes Woman was a life-changing decision for me. They have been there every step of the way and I’ve had to call…at odd hours when I just wanted to talk to someone who understood what I was going through…” Uzezi, 30.
She Writes Woman also provides mental health services through a 24-hour toll-free helpline which is operational every day of the week and is manned by six therapists and four counsellors; each with different areas of specialisation. From Kaduna to Lagos, Abuja to Enugu, the helpline serves as a lifeline for thousands of Nigerians who need professional help or just need someone to talk to.
Miracle Ihuoma, a licensed psychologist, and the lead counsellor, said that from the get-go, callers are reassured of confidentiality and made to understand that they are in a safe, no judgement zone. “We make sure that the caller is in a comfortable enough environment to talk. When a caller is extremely distraught, we use relaxation techniques, and we reassure them,” Martina Ibe, an addiction and psychotherapy expert added.
The She Writes Woman team members are well aware that mental health issues are on a spectrum, therefore solutions and interventions are never a one size fits all. The first step counsellors take is to provide psychological first aid to callers, then based on needs assessment, the caller is either referred to the in-house therapists, or provided with specific tools which are designed to help the caller handle their situation.
The toll-free call centre — and the therapists attached to it — are funded by a grant from Airtel Nigeria. Funding partnerships with World Health Organization (WHO), Africa Women’s Development Fund and a host of others help to ensure the sustainability of the organisation’s programmes.
Beyond the numbers to the people
When the helpline was launched in 2017, the call centre received a maximum of 100 calls in a month; five years later, an average of 200 calls are received per day. “This year alone, we’ve gotten up to 20,000 hours of phone calls logged on the toll-free helpline,” Faiz Aliyu, COO at She Writes Woman, said.
Across the different channels on which She Writes Woman operates, a community of 45,000 people are served, including the volunteers. For Nusaybah Abdulfatah, her exposure to the resources and services provided by the organisation has helped her recognise unhealthy habits and patterns. “I was able to realise that I had a tendency to use emotional eating as a coping mechanism and recognising that this wasn’t healthy behaviour helped me learn my triggers. Now, I’m more committed to a healthy lifestyle. I know that when I’m struggling, I can always reach out for support in a safe environment. I also have access to a lot of self-care tools.”
She Writes Woman takes full advantage of the anonymity and accessibility that technology often provides. From the toll-free helpline to Safe Place Support Groups on Facebook; She Writes Woman provides a sense of community. This is very critical because one of the biggest problems in the mental health space is isolation, which is often fuelled by shame. When people realise that they are not alone in their struggle and that there are professionals who really care and are ready to help, they are less likely to feel shame and more inclined to accept help.
A movement of the people for the people
She Writes Woman’s describes itself as a “A movement OF people with mental health conditions FOR people with mental health conditions.” This is the foundation on which the Safe Place Community Clinics is built. Aliyu gave an overview of how the clinics operate, “These clinics are run by advocates who are trained in rights-respecting advocacy strategies, psychological aid, and first grade interventions; so that they have a thorough understanding of mental health policy and rights respecting mental health frameworks, which they can then use to educate their communities.” The clinics transitioned to fully online operations in 2020, in partnership with Meta.
What can be done better?
The physical Community Clinics were operational in the Southeast, Southwest, North Central, and Northwest geopolitical zones of Nigeria. Funding limitations and language barriers were some of the reasons the Northeast and South South zones couldn’t benefit from this service.
Dropped calls are very frustrating, however, for the helpline counsellors, poor reception caused by spotty network connections can severely interfere with the effectiveness of any interventions. Ongoing conversations are required with network providers to improve the service quality of the helpline.
Counsellors and therapists have challenges too, and they have to put their own needs on the back burner, so they can help their clients. To prevent burnout, She Writes Woman ensures that each therapist and counsellor has breaks. Weekly check-ins, monthly and quarterly mental health assessments are other measures put in place to make sure that, ‘charity begins at home.’
The WHO Special Initiative for Mental Health (2019–2023) centres on scaling-up mental health care as part of universal health coverage, leaving no one behind. What does this mean for mental health services in Nigeria? In the first instance, the National Primary Healthcare Development Agency (NPHCDA) needs to actively partner with organisations like She Writes Woman to train primary healthcare workers in the practice and provision of mental health services at Primary Health Care (PHC) level. This will go a long way in removing the stigma and human rights violations that are often associated with mental health conditions in rural communities. However, to integrate mental health care effectively into primary healthcare, will require legislative backing that would enable the required human resource capacity development and most critically, the requisite funding.