Stigma, mental health literacy and the nigerian youth
According to the World Health Organization, mental and behavioural disorders rank 5th on the burden of diseases ladder globally. To put this in more vivid figures, around 13% of people worldwide suffer from these disorders. If we look closer to Nigeria, the figures are even more alarming. An estimated 20-30% of the Nigerian population (1 out of 4 people) suffer from mental disorders, ranging from neurotic conditions like anxiety disorders, to the more debilitating psychotic and organic mental disorders. As disturbing as those figures are, one is even more perturbed to realise that most of these disorders are more incident and prevalent in the younger population. For instance, depression, the commonest mental health disorder, has a peak incidence under 45 years of age while schizophrenia is under 30 years.¹ This makes the youths, the proletariat of the nation and the hope of its future, the major target of the menace of these often disabling and debilitating conditions.
Because of the early onset of some mental disorders, a high percentage of the Nigerian youths affected have their education and careers nipped in the bud. The youths are the Aunt Sally of mental disorders because the age group is very critical in the psychological development of human beings. Several models have tried to describe the aetiology of mental disorders but according to the biopsychosocial model, three factors, dating from conception are involved. Biological factors include prenatal brain injury, birth asphyxia, substance use, genetic predisposition and others. Psychological risk factors are those qualities that make people vulnerable to mental illnesses and they include poor self-esteem, personality disorders and personal coping strategies to life stressors. Chief of the social risk factors are poverty, maternal deprivation and lack of social support. Furthermore, the risk factors can be grouped into three, based on causality. Predisposing factors are events that occur early in life, while precipitating factors are the last straw that breaks the camel's back, triggering an episode of mental illness. Maintaining factors are those that make it difficult for them to gain insight to their situation. However, for an event to be considered significant in causality, it must have temporal association and prove of biological plausibility. Accordingly, not all who experience eventful life situations develop mental illness.
With the myriads of physical and emotional stressors that characterize adolescence and early adulthood, it is not surprising that the incidence of mental disorders is higher in the age group. To name just a few, some of the stressors include relationship break ups, financial difficulties, poor academic performance, sexual assaults and psychoactive substance use. Early in 2020, a University of Benin student was raped to death while reading in her church premises at night. Following that incident, several youths, mostly females, came out to report how they have secretly struggled with depression and PTSD from the trauma of unreported sexual assaults.
Nevertheless, as common as these conditions are in Nigeria, especially among the youths who are the bedrock of the nation's economy, the attitude of the general populace to mental disorders is bewilderingly appalling. Studies done in recent times show that the awareness of mental disorders, causes and management is still extremely low. In a low-income nation like Nigeria, where in many cultures, mental disorders are attributed to repercussions of evils perpetrated by the sufferers, the figures are even worse. As a result, people with history of mental illness face a lot of hatred, stigma and discrimination.
Realising that without mental health, the WHO's definition of health is incomplete, and to raise awareness of the public to this pertinent but seemingly neglected aspect of health care delivery, Jorm et al coined the term mental health literacy (MHL) in 1997. They used it to describe “knowledge and beliefs about mental disorders which aid their recognition, management or prevention”. This definition accentuates and highlights the role of health seeking behaviours and attitudes of the general population to the prevention and management of mental and behavioural disorders. Hence, improvement of the MHL of the general population is a major victory in the fight against barriers to effective mental health care.
At the top of the list of those major barriers to effective mental health coverage in Nigeria are stigma and discrimination. Stigma is when an individual is viewed in a negative way because of his mental illness. Discrimination is when an individual is treated in a negative way because of his mental illness. In Nigeria, people with mental disorders experience a double burden of illness: first, the burden of having to endure a debilitating condition and secondly the burden of having to face up to the social prejudice from society. Overwhelmed by shame from stigmatization, the people affected generally shy away from seeking appropriate medical care, preferring to keep suffering in silence. This ignites a vicious cycle which eventually results in the individual's condition getting progressively worse. Even the small percentage who seek medical help encounter great difficulties with rehabilitation in a socially intolerant society. Thus, most of them experience relapses and impediments in recovery as a result of inadequate social support.
In view of the aforementioned, Nigeria face an uphill task in her fight against social stigma and discrimination against people with mental disorders. The 2006 WHO-AIMS report on mental health in Nigeria revealed some perturbing facts. It divulged to the limelight the gross underfunding of the mental health sub-sector, lack of implementation of policies to protect people suffering from mental illness from discrimination, lack of health promotion against stigma and discrimination and gross under staffing of mental health facilities. In fact, Nigeria has less than 200 trained psychiatrists to serve about 200 million population. That is 1 psychiatrist per million population!
Consequently, we see the results of the nonchalance in the nation's handling of mental health services delivery every day on the average Nigerian streets. Because symptoms of mental and behavioural disorders are not recognised and treated early at the acute phase, they often progressively worsen. Left to fend for themselves, the people affected become vagrants, roaming the streets in bedraggled clothes and begging for survival. As a result, they are prone to sexual assaults, violence, physical injuries and eventually death arising either from complications of a neglected medical condition or their mental illness.
The way forward is first the implementation of the 2016 National Mental Health Policy. The preventive provisions of the policy will protect the youths, especially the girl child from sexual exploitation and other abuses. It will also better protect the legal rights of people with mental issues against stigma and discrimination. The Lunacy Act of 1958 is antiquated and is no longer in tune with the International Human Rights Act. Second, the Nigerian Drug Law Enforcement Agency and other law enforcement agencies should ensure a society relatively free from illicit drug abuse. Third, the government should create a conducive environment for the Nigerian youths to live and thrive. Where there is a conducive environment and effective counseling services and programmes for the youths, their mental health literacy will vastly improve. Fourth, there should be training of more experts and better financing for the mental health unit of the health sector. Additionally, the government should create rehabilitation centres for the vagrants on the streets to protect them from abuse, stigma and exploitation. Lastly, there should be provision of effective mental health promotion services both locally and on the media to improve the mental health literacy of the general population and change their attitudes to mental illnesses.