Mental health is gathering momentum in Nigeria, albeit slowly but we are getting there. We are in a global pandemic that has triggered a looming mental health crisis due to factors surrounding it like economic downturn, social isolation, remote work, health challenges, grief and death. However, as we are providing interventions to cater for the mental health needs of people, there is a widening gap in access to this support due to systemic barriers that make therapy and treatment elitist. I want to examine the role of poverty in mental wellbeing and mental healthcare for underserved persons in Nigeria.
Poverty presents many barriers that hinder access to quality mental health from the prevention, health promotion and intervention levels. At the preventive level, people experience many challenges posed by poverty that creates inequalities between them and good mental health. These challenges include; lack of good food, risk of homelessness or poor living conditions, unaffordable healthcare for physical illness, and illiteracy. These are all factors that can trigger mental distress and also make it hard to comply with treatment mode recommended by the mental healthcare system.
On the health promotion level, according to the World health Organization (WHO), it looks at a focus on enabling people to have more control over improving their health through creation of supportive and healthy environments, strengthening community action and personal skills1.
On a treatment level, interventions currently provided in Nigeria do not level to the understanding of the people, or consider cultural diversities and other socioeconomic factors, which end up yielding poor results. Take for example, Nigeria, a country that is collectivistic culturally, any interventions that isolate and only focus on the individual may yield poor outcomes as opposed to interventions that view the individual as a part of their community. The African culture is popular for its ‘ubuntu’ approach where every individual is a part of a system that allows for communal and family togetherness. Do our mental healthcare systems consider this when designing and providing therapy or treatment that only offers the single individual support as if they are not a part of a larger whole?
The silence culture around mental health has thrived in our society because we make certain key decisions as a whole; in families, religious centres, communities, workplaces and all the other places that form our collectivistic nature. Then, it will only be appropriate that we begin to look at solutions that are tailored for our own culture, and not just an adoption; hook, line and sinker of approaches that cater for the needs of an individualistic culture.
Our mental health interventions are designed such that it works completely oblivious to the systemic barriers and lack of basic social needs that deteriorate mental health or skews access to care unfavourably.
In therapy, I meet a client who is depressed due to financial crisis, which has become quite common since this pandemic. How then do I create a treatment plan that uses cognitive behavioural therapy to teach the client coping mechanisms while the root cause stays persistent? And my bigger concern as a therapist is; why does my intervention have to be so limited in terms of providing support that practically addresses root causes, which will see my client experiencing a higher rate of symptom alleviation in therapy.
If you examine this, we are living in a quagmire of barriers that make sure that the common man does not access mental healthcare. That, the common man, does not enjoy the opportunities to maintain an optimal level of wellbeing.
According to Human Rights Careers, Social justice is “fairness as it manifests in the society; in healthcare, employment, housing, and more…. without discrimination, respecting and protecting every individual’s human rights2.” Mental healthcare requires an approach that ensures all other basic needs of help seekers are catered for. This is a better way to work as a mental healthcare provider, who doesn’t just send off a help seeker with some tips and pills to manage their mental health but also provides practical support to cater for other social needs.
If you are in the FCT and you need to speak with a counsellor for free, dial 112, no credit charges.
About the author: Aisha Bubah is a Psychologist and a social entrepreneur who is contributing towards a world where mental health is no longer stigmatised and care is available to everyone without systemic and structural barriers.
1World Health Organization. Health promotion. https://www.who.int/westernpacific/about/how-we-work/programmes/health-promotion Retrieved on 27th Jan., 2022