Changing society’s assumptions about mental disorders

October 29, 2018 07:00 am | Updated 10:52 am IST

Representational image.

Representational image.

"Leave me alone, let me die!" yells Hawah Abubakar*, a dozen pills in her hand, as she struggles to free herself from the clutches of a classmate. "I’m tired of this life." Tears roll down her cheeks. A student in her early twenties, Abubakar's wish is to sleep away her ordeals and never wake up. Perhaps if she dies, she says, she’ll cease to be an object of scorn. 

Abubakar has a mental disorder. Sometimes she loses control, closing her eyes and clenching her fists, making sudden, unpredictable moves and destroying things around her. She once attempted to jump from a two-storey building in the middle of a classroom lecture – it took half a dozen men to stop her. When she finally calms down and others tell her about her actions, she remembers nothing. In northern Nigeria, where she lives, people believe that she is possessed.  

But this time Abubakar isn’t out of her mind. She says her intention to commit suicide is genuine. "Every man who asks me out jilts me as soon as he finds out about my condition. No man wants to marry a girl like me," she sobs, adding that her friends and classmates have begun to avoid her, afraid her insanity might visit her unexpectedly and make them victims of her violent displays.  

People with mental disorders actually have two conditions to cure: their ailment, and society’s misconceptions about it – also known as stigmatisation. 

According to Aishatu Yushau Armiyau, a lecturer at the Department of Psychiatry, Jos University Teaching Hospital, stigmatisation deprives mental illness victims of their human dignity and participation in society, by undermining social support and compromising opportunities for treatment. She notes that stigmatisation is due to "misconception, prejudicial stereotypes, and negative public (and professional) attitudes about mental illness," owing to the assumption that "persons with psychotic disorders are unpredictable and incapable of being managed, even by the best efforts of the health system." 

Stigmatisation cuts across social class and demographics. Educated and non-educated people, laymen and even health professionals have been guilty of attaching stigma to persons with mental disorders. Such discrimination is particularly widespread in Nigeria. A study published in the South African Journal of Psychiatry in 2010 revealed that 52 percent of respondents believed that witches were responsible for mental illness, 44.2 percent held that it is due to demon possession, and close to one-third felt that it is a consequence of divine punishment. 

Meanwhile, in 2013, a survey of nursing professionals conducted by researchers from the University of Ibadan showed that 26 percent preferred to distance themselves from mentally ill persons. 

The World Health Organization (WHO) observed that mentally disabled people are often excluded from community life, denied basic rights such as shelter, food and clothing, and are discriminated against in the fields of employment, education and housing. Many are denied the right to vote, marry and have children. "As a consequence," WHO says, "many people with mental disabilities are living in extreme poverty which in turn, affects their ability to gain access to appropriate care, integrate into society and recover from their illness." 

While WHO says that mental health policies and laws are critical to improving conditions, they point out that these are "absent or inadequate in most countries of the world." In Nigeria, where the health budget dedicates only three percent to mental health, the sole available mental health care document is of colonial origin and includes obsolete laws, such as one providing for the imprisonment of suicide survivors.  

In 2003, a Mental Health Act bill was introduced in the National Assembly that would protect the rights of people with mental disorders, ensure equal access to treatment, and discourage stigma. It was withdrawn in 2009. In 2013, the bill was re-introduced, and has been hovering in the House ever since, yet to be passed into law.  

In the meantime, a handful of nonprofit organisations, such as the Mentally Aware Nigeria Initiative (MANI), provide support for people with mental illness and conduct awareness campaigns that have educated thousand of Nigerians. 

While urging Nigerians to challenge the "taboo, stigma and misconceptions about mental health among the general population," MANI also appeals to the government and other decision-makers to provide necessary legislation, policies and budget allocation to boost mental health services in the country, particularly to ensure mental health first aid and suicide prevention services.  

Also advocating for stronger and more up-to-date policies is the Abuja-based Smart Suicide Prevention Initiative (SSPI), established in 2013. It focuses on preventing suicide by raising awareness, provides resources to those affected by suicide, and advocates for policies that will save lives. SSPI uses a variety of media to get its message across – for example, it produces a TV show, "Whispers of the Hurting," to encourage discussion on the subject of suicide. 

The Lagos-based Mental Health Foundation has been operating in Lagos for the past 10 years, bringing together psychiatrists, clinical psychologists and dynamic young volunteers who coach and inspire the numerous depressed and stigmatised people in Nigeria. 

All of these initiatives work with minimal funding and little government policy to guide them. But that hasn’t prevented them from trying to bring about deeper awareness of mental health and help those who suffer.

* Not her real name

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