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Needed: Mental primary healthcare for a traumatised population

I have struggled with clinical depression at two different points in my life. The first time was in 2012, at a time when life was seemingly one unbroken sequence of unfortunate events – a family dispute, an unplanned pregnancy that turned out to be ectopic, job loss, eviction and rough sleeping, and ultimately the end of the relationship, which started my spiral. At the time, as a broke, homeless 22 year-old in Leeds, I was able to walk into hospital and ask for help – which came promptly and free of charge. I had no idea what clinical depression was, or that it could happen to people like me, but I got a diagnosis and free counselling appointments.

It turned out that I did not need medication to bring my depression under control. A change of habits and a change of environment from the UK to Nigeria did the trick. The second time I struggled with depression was when my dear friend and colleague Binta Bhadmus passed away in 2019. This time around, I received no professional diagnosis or help. In fact it was only because of my prior experience with the condition that I knew that the total loss of interest in everything; the inability to enjoy anything including sensory delights, and the constant feeling of immense tiredness and lack of motivation were textbook symptoms of clinical depression. Once again, I found ways to avoid medication by using my work and travel as powerful distractions to bring me out of a dark place. At the time, I remember thinking to myself “What happens to all the Nigerians facing mental health challenges who cannot use daredevil journalism and trips to Doha to escape from their own thoughts?”

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Nigerians are traumatised – Make no mistake

Statistically, your average 30 year-old Nigerian who has lived most or all of their life in Nigeria, is very likely to be suffering from a mental health problem. This person has spent much of their childhood associating “discipline” with extreme and gratuitous violence at the hands of authority figures who are among the world’s most prolific child abusers. As a young adult, the experience of abuse at the hands of authority figures has intensified, as the police and military can randomly select them to be kidnapped, raped, robbed and murdered. He or she is also accustomed to abusive relationships with family, clan groups and religious institutions.

Statistically, your average 30 year-old Nigerian who has lived most or all of their life in Nigeria, is very likely to be suffering from a mental health problem

This young Nigerian has witnessed several acts of extreme violence and cruelty, including watching human beings beaten and burned to death on the street, police officers kidnapping young women off the street and raping them in police stations using plastic bags as prophylactics, soldiers opening fire on hundreds of peaceful unarmed civilian protesters at Lekki Toll Plaza, soldiers maiming over 1,000 unarmed Shiite civilians in Kaduna State, youth corpers butchered and dismembered following the electoral loss of an ethno religious demagogue, and many, many more things.

This person lived the first 9 years of their life in absolute terror under the military jackboots of Ibrahim Babangida, Sani Abacha and Abdulsalam Abubakar. Following what was supposedly a 16-year reprieve which was itself dotted with hundreds of Ikeja Cantonment disasters, passenger airline crashes, road accident disasters, Odi Massacres, unreported civilian massacres in the Middle Belt, Reverend Kings, Otokoto Shrines and so many more unthinkably traumatising sights and events, they are now back squarely in Abacha territory. How can someone exposed to this level and magnitude of disaster not be negatively affected to a profound extent?

So why is mental health support so expensive and inaccessible?

The most immediate answer to this question is “Because there is a shortage of psychologists and psychiatrists” which is certainly true. With a doctor to patient ratio approaching 5,000 patients per doctor, Nigeria does not have close to enough regular doctors to look after prosaic physical ailments, much less specialised mental health physicians to look after mental health conditions. This however, assumes that there is only one way of tackling Nigeria’s growing mental health crisis.

Using my experience in 2019 as a reference point, I was able to get some free counselling from (amateur) volunteers from an organisation called Mentally AwareNG. This was not professional help, and it did not provide diagnostic or prescription services – but it did in fact, go a long way. My counsellor Anthony, was not a licensed psychologist, but – here’s the thing – he did not have to be. Merely having someone with a general knowledge of the field to talk to and receive advise from really did go a long way. Just like primary healthcare centres across Nigeria are not equipped to the extent of general hospitals or federal medical centres, I believe that a more grassroots-oriented model of mental healthcare is not only feasible, but absolutely necessary.

The situation where a young Nigerian who statistically does not earn more than N60,000/month will need to pay between N20,000 and N150,000 per session to access any form of professional therapy or counselling, is nothing short of ridiculous – is mental healthcare only for high income earners? Do regular Nigerians not have mental health challenges as well – even more so than high income earners? Is there a rule stating that mental healthcare must either be premium, top-end healthcare or altogether nonexistent?

I think this is a question that Nigeria and Nigerians will increasingly have to answer as we all get older.

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