The joy of Mr Johnson knew no bounds when his wife Betty gave birth to their first baby, three years ago. It was prayer answered as they had waited on God for the miracle of conception two years into their marriage. The naming ceremony some eight days after by some friends, neighbours and church members was well attended in their modest home at Mpape, a suburb of Abuja, Federal Capital Territory.
The baby and mother were doing very well until two weeks after when Johnson, a taxi driver, came back home to meet a different woman. His wife was behaving abnormally: very irritable, aggressive. Her mood swings from complete taciturn to shouting and use of abusive language. The baby in her cot lay crying, unattended to.
Johnson who is usually welcomed home with a hug by his wife was confused. A very religious person, the first thing that came to his mind was that the enemy is at work. His wife has been “attacked”, an “evil arrow” has been fired at her. Johnson called his pastor who requested that he brought his wife to the church not far from their home for special deliverance prayer.
Thus began Betty’s two-year sojourn in the church where she was chained and prayed for every day to exorcise the demon. Unknown to her husband and the pastor, the woman was suffering from post-natal depression which may happen to new mothers. What she needed was care and counseling by qualified medics in a hospital not “deliverance”.
It was in that state that the officials of Gede Foundation, on a community outreach and sensitization on mental health met Betty. Established in 2002 by Dr. Jennifer Douglas-Abubakar ,a journalist and lawyer, Gede Foundation is a non-governmental organisation with the objective of providing services for “under served and highly stigmatized populations”.
It was the first non-governmental organization in Nigeria to provide a one-stop shop for high quality treatment, care and counseling in HIV/AIDS, including training, advocacy and research. After successfully tackling HIV/AIDS stigmatization for 12 years (2003-2014) Gede Foundation shifted focus to mental health which from a joint research conducted in partnership with Institute of Human Virology, found out that there is a prevalence of depression, alcohol use and suicide among HIV population in Nigeria. This research finding gave birth to the numerous projects which Gede Foundation is doing on mental health in Nigeria.
Mr. Godwin Etim, director, Partnership Management and Resource Mobilisation, Gede Foundation said that it was while they were at Mpape community in Abuja for mental health advocacy that the case of a woman chained in a church was brought to their notice.
“While we were there somebody gave us a hint that there is a woman that has been chained and kept in a church for nearly two years. We went there and met the woman in a very bad state: chained to a pole, dirty, emaciated and incoherent. We met the pastor who told us that they have been praying for her and believing God for miracle healing since her husband brought her two years ago. We asked if we could get a doctor to examine her and he said we should tell the husband . A call was put to him and he came to the church. He said the woman was violent and did not want her to kill him and the baby hence he brought her to the church, but we can go ahead,” Etim said, adfing that the doctor examined her, placed her on medication and within two months she had started speaking normally.
“By the fifth month she was completely well and left the church to her house and back to her tailoring shop. This is the woman they said was mad for two years. She joined our Mental Health Support group and within a short time she became the leader of the group,” Etim narrated.
Anita Ikwue, a 23-year undergraduate of National Open University Abuja has a similar story. She lost her father when she was four. Things were difficult as the family could not cope in the absence of the bread winner. Anita’s mother’s first attempt to remarry ended abruptly as the man died during a brief illness.
“He was very caring. Even though he was not my biological father, I saw in him a good and kind father. To lose him so soon was traumatic for me,” Anita said.
Her mother eventually remarried when Anita was eight, but she suffered abuse in the hands of the step-father that at the age of 10 she became depressed. In 2015 at age 17, now a student of Philosophy at Benue State University Makurdi, Anita’s mental illness became obvious that she was rushed to a psychiatric hospital. She was moved from there by her relations to different churches and shrines in search of a cure.
“At one of the shrines, a man old enough to be my grandfather bathed me naked in order to wash away the alleged evil spirit in me, my hair was shaved, they burnt some substances and forced me to sniff it,” Anita narrated.
Because of stigmatization, Anita could not continue her studies at Benue State University. Gede Foundation heard her story and picked her up, rehabilitated her through counseling and care and trained her as a Gede Foundation Champion to share her experience of mental health issues among communities both physical and online.
Gede Foundation’s Board led by Dr. Jennifer Douglas-Abubukar has also provided much funding to drive awareness and remove stigma associated with mental health.
According to Dr. Douglas-Abubakar, NGOs in mental health face lots of challenges in Nigeria. Notable among them is the lack of mental health Bill which could have provided strategic framework for all players to be guided in implementation.
“The mental health Policy (which is not yet an Act ) is not backed with implementation guidelines and sufficient legal provisions,” Dr.Douglas-Abubakar explained.
According to her, stakeholders, NGOs, Civil Society organizations, clinicians and academic institutions have made some milestones in engaging with the legislature and the mental Health Bill is awaiting the third and final reading at the National Assembly. “There is hope that this would be achieved in 2021”, she said.
Stigma and discrimination resulting from lack of knowledge and right information from both healthcare workers and the user groups is another challenge facing NGOs in mental health, according to Douglas-Abubakar.
“Mental health specialists in Nigeria are very few and services are inadequate and this has burdened patient-clinician ratio for quality service,” she said, adding that healthcare workers especially at the Primary Healthcare facilities are not trained on mental health services provision even though this is supposed to be part of their mandate.
NGOs have to deal with these and many other challenges in order to make reasonable impacts in mental health services delivery in Nigeria.
Dr. Douglas-Abubakar said that Gede Foundation has begun the training of healthcare workers on Mental Health Action Program (mhGAP)—WHO’s mental health programme for non-specialists in low and medium income communities.
“In August 2020, Gede trained 160 clinicians including nurses, Cummunity Health Extension Workers(CHEW), doctors, psychiatric nurses, psychologists and psychiatrists on the validated and approved five modules for community mental health and development programmes in Plateau, Nasarawa states and the Federal Capital Territory”, she explained.
Stakeholders and clinicians on mental health are in unison that to tackle mental illness in Nigeria government should provide workable policies and infrastructure for mental health services, promote community mental health programmes where uptake of services are community-based and create an enabling environment for NGOs to implement mental health services. These programmes include sensitization, mobilization and psycho-education at the primary health facilities.
Despite the efforts of Gede Foundation and other NGOs to tackle the rising incidence of mental health in Nigeria, not much has been done at the level of government to address frontally the issue. Every day we hear or read about suicide, homicide cases in the family and communities yet these have been greeted with inertia by the government.
“Mental health should be recognized from the policy level as an essential health service such as Malaria, Obesity, HIV/AIDS, says Mr. Joseph Odogwu, managing director, Gede Foundation.
“That people are wearing clothes and appear normal on the surface does not mean they are alright. We need to curb the scourge of mental health through concerted actions by the government, international donor agencies and non-profits like Gede Foundation before we are all consumed”, Odogwu said.