By Chidinma Ewunonu-Aluko, News Agency of Nigeria (NAN)
For many Nigerians, mental health means one thing: a “mad person” on the street.
But experts say that is a dangerous myth. Anxiety, depression and trauma are also mental health issues killing silently.
WHO-backed study found that closer to one in eight Nigerians (roughly 12.5 per cent) experienced a mental health condition during their lifetime, with anxiety and depression being the most common disorders.
Yet, less than 10 per cent receive adequate care, leaving a treatment gap of 85 to 90 per cent without help.
Ahead of World Mental Health Day marked Oct. 10, experts spoke with the News Agency of Nigeria (NAN), with one message coming out – the need to move from awareness to access.
A licensed clinical psychologist at Mytherapist.ng, Mrs Abigail Oni, called for a shift from mental health awareness to access, urging the Federal Government to integrate psychological services into PHCs nationwide.
Oni is also the Founder and Clinical Director of Abbey Wellness Clinic, Abuja.
She said while awareness had improved over the years, access to affordable and culturally relevant care remained a luxury for most Nigerians.
“This World Mental Health Day, we need to move the conversation from awareness to access. We have been talking about awareness for a long time now,” she said.
Oni, a trauma and inner-child healing specialist and hypnotherapist, said economic pressure, family responsibilities, work stress, religious expectations and unresolved childhood experiences often intersect.
She added that this made many Nigerians deal with more than just anxiety or depression.
According to her, therapy must, therefore, address both symptoms and underlying patterns while remaining practical to the person’s reality.
She identified cost, stigma, lack of awareness, shortage of professionals and misconceptions about therapy as major barriers preventing Nigerians from seeking help.
“Some people still believe therapy is only for people who are ‘mad,’ while others interpret psychological distress solely through a spiritual lens. These beliefs delay professional intervention,” she said.
She also noted that many Nigerians simply cannot afford regular private therapy.
Oni recommended task-shared, stepped psychological care within PHCs as a scalable low-cost solution.
“With appropriate training and supervision, primary healthcare workers can provide basic screening, psychoeducation, behavioural activation, problem-solving and stress-management interventions, with clear referral pathways for specialist care,” she said.
She added that technology could support the model through telepsychology and remote supervision, particularly in underserved communities.
The psychologist said with the passage of the Mental Health Bill, mental health must no longer remain a luxury available only to those who can afford private care.
“If we are serious about closing Nigeria’s mental health treatment gap, psychological support must become part of primary healthcare, schools, workplaces and communities.
“Not something people encounter only when they reach crisis point,” she said.
Oni said her clinical approach was integrative and trauma-informed, drawing from Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT), Compassionate Inquiry and trauma-focused interventions.
She said for trauma-related cases, establishing safety and emotional regulation before deeper trauma processing was critical, adding that recovery was not just about feeling better but helping people function again.
“Mental health is not a privilege. It is healthcare. And access to care should not depend on how much money you have,” she stressed.
Dr Olufemi Aworinde, the Chairman of the Nigerian Medical Association (NMA), Oyo State Branch, said many people who need mental health care in the state are seen too late or never reach care at all.
Aworinde listed stigma, cost and distance as major factors delaying treatment, stressing that mental health must be treated as part of everyday healthcare with a clear route to specialist care when needed.
“Our concern is that many people who need help are seen too late — or never reach care. Stigma, cost and distance can delay treatment.
“Mental health must be treated as part of everyday healthcare, with a clear route to specialist care when needed,” he said.
Aworinde said the association was pushing for mental health services to be built into primary healthcare.
According to him, trained PHC staff should be able to recognise common conditions, offer initial support and arrange referrals, while psychiatrists and other specialists provide supervision and care for complex cases.
He said affordable follow-up and insurance coverage were essential to retain patients in care, adding that developing the psychiatry unit at LAUTECH Teaching Hospital, Ogbomoso, would help equip the referral centre.
On what was blocking the integration, he said trained personnel were few and that training alone would not close the gap.
“PHCs need staff time, supervision, appropriate medicines, confidential consultation space and reliable referral links.
Stigma and the cost of repeated visits also stop people from staying in care,” he said.
The NMA chairman called on the Oyo State Government to launch a funded mental health programme in selected PHCs, train and supervise their teams and connect them to specialist hospitals.
He said government should also specify which consultations, medicines and follow-up services its health insurance scheme would cover.
He urged government to measure how many people are identified, referred and retained in care, and then expand what works.
“World Mental Health Day should lead to services people can actually use. Anyone experiencing distress deserves to be heard without shame and to know where to obtain help,” Aworinde said.
Dr Victor Makanjuola, a Consultant Psychiatrist at the University College Hospital (UCH), Ibadan, affirmed that integrating mental health services into primary healthcare was the easiest and most cost-effective way to close the treatment gap in Nigeria.
According to him, reports show no fewer than 20 per cent of Nigerians are affected by mental disorders, with less than 10 per cent having access to care.
Makanjuola said closing the gap could only be achieved if state governments mustered the political will to pursue integration of mental health into primary healthcare.
According to him, one way to do this is by ensuring nurses receive mental health training through psychiatric nursing schools and posting them to oversee service provision in local government areas.
“These nurses can then be posted to the three local government areas to oversee mental health service provision.
“They would supervise and train primary healthcare workers, community health workers and nurses working in primary healthcare centres within each local government,” he said.
He said the nurses would also provide ongoing support as PHC workers begin delivering treatment for mental disorders across the state.
Makanjuola said collaboration should also be extended to traditional and faith healers who already provide care to many people in communities.
This, he adds is so that people whose conditions require additional care can be appropriately referred to teaching hospitals or state hospitals.
“For those who require sedation, psychiatric nurses can also provide the necessary care, helping to reduce the likelihood of shackling and other harmful practices that may occur in some of these facilities,” he said.
The psychiatrist said the commonest cases seen in clinic were severe cases like psychosis and drug abuse complicated by psychotic symptoms, while the most common disorders in the community were anxiety and depression.
For alcohol and drug abuse, he urged families to be conscious of any change in behaviour, particularly among teenagers, including changes in dressing reflecting drug-using culture, drop in school grades, withdrawal from previously pleasurable activities like sports or extracurricular activities.
He said families should watch out for sudden unexplained redness of the eyes, keeping eye drops in rooms, using perfumes excessively to mask smell of substances.
He also cautioned against becoming overtly aggressive or being extremely docile and withdrawing from routine family activities.
“This also may be a strong pointer to either psychosis or complications of drug abuse,” he said.
Makanjuola said UCH Department of Psychiatry, as a specialised department, received patients by referral after being seen by a physician or nurse first.
He said the department runs general adult psychiatry clinics on Mondays and Fridays and specialised clinics almost every day of the week.
He said it included geriatric clinic at Tony Anenih Geriatric Centre, drug and addiction clinic on Wednesdays, and child and adolescent clinic on Mondays and Thursdays.
“Having a variety of clinics to attend has made it easier for people to access care, and promptly as well in UCH,” he said.
On what government can do now to reduce burden, he said Oyo State needs to significantly improve mental health services, noting that currently the only major source is at Ring Road State Hospital.
“Oyo State, with its huge population, deserves a specialised psychiatric hospital.
“The state also needs to improve the systematic integration of mental health services into primary healthcare.
“At a minimum, each local government should have a psychiatric nurse as part of its staff, heading the mental health unit,” he said.
He said such nurses can then be supervised by psychiatrists appointed by the state within the healthcare system to provide necessary supervision and support.
Similarly, Dr Rasheed Keshinro, a school administrator, educational and counselling psychologist, identified anxiety, negative peer influence and substance abuse as the most common mental health challenges among students.
Keshinro said many students experienced excessive worry about academic performance, examinations, family expectations and their future.
He said the anxiety could manifest as poor concentration, restlessness, fear of failure, sleep difficulties and withdrawal from school activities.
“Some learners experience emotional distress because of pressure from peers to conform to unhealthy behaviours, engage in risky activities, or gain social approval.
“This in turn affects their self-esteem, decision-making ability and academic engagement,” he said.
Keshinro said there was increasing concern about the use of substances such as alcohol, cigarettes, cannabis and other psychoactive substances among youths.
He noted that students turned to the substances due to peer pressure, curiosity and craving to belong.
He said this negatively affected their behaviour, learning, emotional stability and overall well-being.
The counselling psychologist said regular counselling sessions combined with peer-support activities and life-skills training had produced positive results.
According to him, students are taught coping skills such as problem-solving, emotional and self-regulation, assertiveness and stress management, while parents and teachers are engaged in supporting learners.
“These approaches have helped students become more confident, resilient, bold to say no where necessary and willing to seek help when facing challenges,” he said.
He said the interventions had led to substantial reduction in disciplinary cases, improved classroom participation, increased school attendance, enhanced peer relationships and increased willingness of students to discuss concerns openly.
“Feedback from teachers and parents also indicates noticeable improvements in students’ behaviour, emotional stability and academic engagement,” he added.
Keshinro listed inadequate funding, insufficient number of trained counsellors, limited counselling facilities and lack of understanding about counselling by some parents and students as major limitations hindering participation in counselling and follow-up services.
Proferring some solutions, he recommended that all private and public schools should have a standby counselling psychologist whose role excludes teaching and who would help learners solve social, educational and emotional challenges.
He also called for government funding for school-based mental health services, continuous teacher training on mental health awareness, stronger collaboration with healthcare professionals and sustained parental education programmes.
“Mental health is highly germane to learning, academic performance, personal development and overall well-being.
“Schools should see counselling services as a priority, not a necessity for only students with problems, and adopt a preventive and developmental approach that promotes emotional wellness for all learners,” Keshinro said.
For Social Worker and Oyo State Coordinator of Child Protection Network Nigeria (CPNN), Dr Rosemary Odigbo, noted that lack of continuous support after hospital discharge was a major reason patients would stop mental health treatment.
Odigbo, who has experience in community-based social work and follow-up support, said cost of medication and transportation, stigma, poor family understanding and patient reluctance when symptoms improved, also contributed to treatment discontinuation.
Further suggesting ways to improve seeking help /treatment for mental healthcare, she said regular follow-up visits, counselling and psychoeducation for both patient and family, medication support where necessary and a caring, non-stigmatising home environment would help keep patients stable.
“Families also need guidance on recognising early warning signs and knowing when to seek professional help,” she said.
Odigbo called for a stronger community mental-health referral and follow-up system linking hospitals, social workers, primary healthcare centres, community leaders and families.
According to her, affordable medication, transportation support, proper case management and accessible mental-health professionals would make significant difference.
She said a community-based, integrated model would be effective in reaching more people.
This, she added, could be done by bringing basic mental-health awareness, early identification, referral and follow-up closer to people through PHCs, trained community workers, schools, faith-based organisations and other trusted community structures.
The social worker said the model should be supported by referral pathways to specialist care when needed.
“Mental-health care should not end at the hospital gate.
Recovery is greatly influenced by what happens afterwards — the family, community, social environment and availability of continued support,” she said.
According to Odigbo, Nigeria needs to move from a largely hospital-centred approach to a continuum of care where patients are supported to reintegrate into families and communities with dignity and without stigma.
“Early intervention, family involvement and sustained community follow-up can prevent many cases from becoming more severe,” she said.
Mental health is beyond the mad myth.
As such, in unison, the stakeholders said it must become everyday care at PHCs, schools and communities, where Nigerians live, learn and work.
With the Mental Health Act now law, they said government must fund integration and cover care under insurance.
Hence, anyone experiencing distress deserved to be heard without shame and to know where to obtain help. (NANFeatures)
***If used, credit the writer and the News Agency of Nigeria (NAN)
Edited by Vivian Ihechu
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