Nigeria is experiencing a mental health crisis of unprecedented scale, affecting millions across the nation.
With an estimated 50 million people living with mental health conditions, the country faces a severe shortage of mental health professionals, widespread stigma, and inadequate infrastructure. Despite recent legislative efforts, the gap between demand and available services continues to widen, leaving many without the care they desperately need.
The Scope of the Crisis:
Prevalence of Mental Health Disorders
Approximately one in four Nigerians, equating to about 50 million individuals, will experience a mental health issue at some point in their lives.
Nigeria is grappling with a staggering mental health crisis, as millions of its citizens suffer from various mental disorders. The World Health Organisation (WHO), estimates that a whopping 20 percent of Nigerians, or around 40 million people, are affected by mental illness.
Some of the nation’s most prevalent mental illnesses include depression and anxiety disorders. In 2017, about 7 million Nigerians (3.9 percent of the population) had depressive disorders, and 4.9 million Nigerians (2.7 percent) had anxiety disorders. On top of this, substance abuse disorders, bipolar disorder, schizophrenia, and personality disorders are common in Nigeria.
The burden of illness related to post-traumatic stress disorder (PTSD), and other trauma-related disorders is also significant, particularly among individuals who have experienced conflict, violence, or natural disasters. Studies have shown that close to 60 percent of internally displaced persons (IDPs), in Kaduna, for instance, had probable depression, and 16 percent had definite depression.
Mental illnesses have a significant, real-life impact on many Nigerians. The impact of these illnesses extends beyond the individual, with healthcare workers, teachers, and bankers, alike, also affected. Studies have shown that psychological distress and burnout are prevalent among healthcare workers and primary school teachers, with almost 70 percent of teachers experiencing psychological distress. Additionally, the psychological health of bankers has been linked to corruption and unethical behaviour, which is detrimental to banks’ performance and growth.
Shortage of Mental Health Professionals
Despite Nigeria’s huge mental illness burden, the country faces severe challenges in addressing the problem.
The country has fewer than 300 psychiatrists serving a population exceeding 200 million, resulting in an alarming ratio of one psychiatrist per one million people. This is drastically below the World Health Organisation’s recommended ratio of one psychiatrist per 10,000 patients.
With this situation, the problem appears to be exacerbated.
Beyond psychiatrists, there is also a shortage of psychologists in the country. Psychologists are key professionals in providing services for people with mental conditions such as behavioural problems, learning difficulties, depression, and anxiety. Currently, there are only 319 licensed clinical psychologists that are registered with the Nigerian Association of Clinical Psychologists (NACP); however, estimates suggest that there could be 400-500 clinical psychologists in Nigeria. There are several discrepancies in the level of qualifications among clinical psychologists in the country – some have received online training or a 6-month certification program, while others have acquired a professional doctorate – making it difficult to know the true number of certified and experienced clinical psychologists. Nonetheless, these numbers are alarming statistics for the country’s considerable population.
According to the president of the Association of Psychiatrists in Nigeria (APN), Professor Taiwo Obindo, the brain drain of mental health professionals to Western countries such as the US and the UK, is a major factor in this shortage. He revealed that up to two-thirds of well-trained and certified psychiatric doctors leave the country annually.
The Federal Neuro-Psychiatric Hospital Yaba, Lagos, is one of the most indicative case studies of these challenges. Financial deficits and other challenges have caused the Yaba Hospital to lose half of its resident psychiatrists over the past four years, leaving only 33 resident doctors and 22 consultants to address the needs of more than 5,000 patients treated each year.
Comparing statistics with other Sub-Saharan African countries reveals the scale of the issue on the continent – Kenya has only about 80 psychiatrists and 30 clinical psychologists, South Africa boasts 22 psychiatric hospitals and 36 psychiatric wards, and Ghana has three psychiatric hospitals and about 20 psychiatrists.
Inadequate Infrastructure
Another significant issue is Nigeria’s lack of access to mental health services. These services are predominantly concentrated in urban areas, leaving rural communities underserved. The Federal Neuro-Psychiatric Hospital in Yaba, Lagos, for instance, has reported a 100 percent increase in patient admissions, highlighting the strain on existing facilities.
The funding for mental health care is limited, with only a small fraction of the Federal Government health budget (3-4 percent) dedicated to mental health. On top of that, over 90 percent of this budget goes to a handful of neuropsychiatric hospitals, leaving few resources for other facilities. In the private sector, the story isn’t very different. Health Maintenance Organisations (HMOs), which provide health insurance coverage, primarily through employer-sponsored programmes, are also not providing adequate mental health benefits. While some plans include mental health benefits, these primarily consist of psychiatry services that do not cover the much-needed behavioural therapy for those suffering from anxiety and depression.
Access to mental health services in Nigeria is a significant issue, but it is not unique to the country.
Other sub-Saharan African countries equally struggle with limited access to mental health care. In Ghana, for example, 97 percent of mental patients, who need health care, have no access to these services. Around 75 percent of people with mental illnesses in South Africa have no access to psychiatric or therapeutic care. The National Health Insurance programme in South Africa, which could potentially boost access to mental health care, will not be fully implemented until at least 2025. Similarly, according to the WHO, Kenya spends only about 0.05 percent of its budget on mental health.
Cultural and Societal Challenges
Stigma and Misconceptions
Mental health issues in Nigeria are often attributed to supernatural causes such as witchcraft or curses. This misconception leads many to seek help from religious leaders or traditional healers instead of medical professionals, exacerbating the problem.
The situation is further compounded by cultural barriers and stigma surrounding mental health. Other healthcare professionals look down on mental health professionals due to this stigma; as a result, psychiatrists are usually a last resort for very dire patients. Additionally, patients are typically referred to behavioural and clinical/counselling psychologists when it is too late, oftentimes after seeing and receiving medical treatment from psychiatrists.
Insights from the general Nigerian population are even more telling of the severe stigma faced by people living with mental disorders.
According to a survey of over 5,000 Nigerians conducted in 2020, many Nigerians only perceive a person as having a mental health disorder when disruptive behaviour attracts public attention. This stigma is also evident in romantic relationships, with most Nigerians, especially women, unwilling to engage in relationships with people living with mental health disorders.
Additionally, the general population often seeks treatment from traditional and supernatural healers, given the predominant view of supernatural causation. Approximately 70 percent of mental health treatment is provided through non-orthodox means. Respondents believe mental health diseases can be prevented if people stop taking hard drugs and are prayerful. Many believe that a mental health disorder is a curse from God or punishment for the victim’s wrongdoing.
Economic Impact
Untreated mental illnesses result in significant economic losses, with estimates suggesting over $166 million annually in lost productivity. Additionally, many individuals with mental health conditions face discrimination in the workplace, leading to job loss and social exclusion.
Employers taking a more active role in promoting mental health could alleviate some of the burdens within the Nigerian workforce. This can be done by integrating mental health into their employees’ benefits, particularly in the post-COVID world. Studies have shown that mental health problems account for 7.1 percent of workplace absenteeism and $4.5 billion in work-related productivity losses, making it an important issue for human resource managers.
Legislative and Institutional Responses
National Mental Health Act
In January 2023, Nigeria enacted the National Mental Health Act, replacing the outdated Lunacy Act of 1958. The new law decriminalises suicide attempts, protects the rights of individuals with mental health conditions, and mandates the integration of mental health services into primary healthcare. However, implementation remains a significant challenge due to funding gaps and infrastructural deficits.
Role of Non-Governmental Organisations
NGOs such as the Mentally Aware Nigeria Initiative (MANI), She Writes Woman, and the Brain Health Initiative Nigeria are actively working to raise awareness, provide counselling services, and challenge societal stigma. These organisations have reached over a million Nigerians through campaigns and outreach programmes.
Akoma Health is a startup that provides access to quality, on-demand therapy and support for Nigerians. It is actively exploring partnerships with psychiatry and psychology professional societies to expand the supply of their HCPs within their network and integrate their services with HMOs and employers to improve access to mental health services for their members. It recently partnered with Lagoon Hospitals, one of the largest hospital networks in Nigeria, to provide teletherapy mental healthcare support to all of Lagoon’s private and corporate clients.
Recent Initiatives and Public Engagement
Awareness Campaigns
In 2024, Nigerian swimmer Akinrodoye Samuel swam nearly 12 kilometers across Lagos Lagoon to raise awareness about mental health issues. His initiative aimed to challenge the stigma surrounding mental health and encourage open discussions.
International Support
Prince Harry and Meghan Markle’s visit to Nigeria in 2024 included a summit at Lightway Academy in Abuja, focusing on mental health education for teenagers. Their involvement highlighted the importance of mental health awareness and the need for continued support and advocacy.
Recommendations
Increase Funding and Resources: Allocate a minimum of 15 percent of the health budget to mental health services to improve infrastructure and access to care.
Expand Workforce Training: Invest in training more mental health professionals and integrate mental health education into medical and nursing curricula.
Community-Based Care: Develop community mental health centers to provide accessible services, especially in rural areas.
Public Education Campaigns: Launch nationwide campaigns to educate the public about mental health, aiming to reduce stigma and encourage individuals to seek help.
Strengthen Legislation: Ensure the full implementation of the National Mental Health Act and monitor its impact on service delivery and patient rights.
Integration of Mental Health: Equally important is the need to integrate mental health into primary healthcare in Nigeria. This will help improve access to and affordability of mental health services. Many countries, such as Argentina, Australia, and the United Kingdom, have already recognised the importance of mental health as part of primary care, resulting in better health outcomes. Research has shown that one way to achieve this in Nigeria is to establish community-based rehabilitation centres in rural areas with strong primary care networks. These centres can provide complementary care and work closely with secondary and tertiary care centres. The centres can also serve as training sites for psychiatric residents, primary care physicians, and nurses.
Training Health Professionals: On the topic of training, reversing the brain drain for psychiatrists and psychologists in the country is key to unlocking better mental health service delivery. There is need to establish more training institutions and programmes for mental health professionals in Nigeria. Partnerships with societies such as the Association of Psychiatrists in Nigeria (APN), and the Nigerian Society of Clinical Psychologists, could be leveraged to provide these training opportunities. This will address the shortage of mental health specialists in the country and improve the overall quality of mental healthcare in Nigeria.
Adequate Funding: Without adequate funding, implementing any of the solutions discussed would be impossible. It is crucial for the government to increase the allocation of funds from health budgets to improve the accessibility, quality, and affordability of mental health services in Nigeria. With more resources, it will be possible to establish additional rehabilitation centers and train more mental health professionals; thus, improving access to quality care and support for those in need.
Conclusion
Truth is, the nation’s health care system requires urgent improvement. Employers, healthcare providers, and the government need to collaborate to integrate mental health care into primary healthcare, establish more mental health training institutions, and increase funding for mental health services. With the current macro-economic and political pressures and the impact of the pandemic on the workforce and population, prioritising the mental health of Nigerians has never been more critical.
Nigeria’s mental health crisis is a complex issue that requires a multifaceted approach. While legislative measures and public awareness campaigns are steps in the right direction, sustained efforts and increased investment are essential to address the underlying challenges. By prioritising mental health, Nigeria can build a more resilient and productive society.
