Mind the widening gap: A trauma-driven mental health crisis in Nigeria

 

Background

Nigeria is currently facing its worst economic crisis in about 30 years. The headline inflation rate, largely driven by food inflation, rose to 33.3% in March of this year. Similarly, the Nigerian naira had weakened to an all-time low in February of this year before appreciating in the succeeding months. The persistent economic pressures—highlighted by worsening living conditions—are contributing to substantial increasing stressors faced by Nigerians—particularly those with fewer assets to begin with—and the concomitant risk of worse population mental health.

The ongoing conflicts in Nigeria’s Northern regions pose additional risks to mental health. According to the Armed Conflict Location and Event Data project, there were over 3,773 violent incidents resulting in about 9,000 deaths between March 2023-March 2024. Data from the International Organization for Migration’s Displacement Tracking Matrix show that at the end of 2022 there were over 3.6 million internally displaced persons due to violent conflicts .

Trauma and mental health

The concomitant stressors and traumas being experienced by Nigerians could contribute to a mental health crisis in the country. There is abundant evidence that stressors and traumas can lead to mental and physical health problems, reduced quality of life, earning potential and decreased ability to function in daily activities. The long-term implications of these stressors and traumas are profound and can alter the health trajectory of a large proportion of the population. While data on mental health indicators during phases of acute and rapidly accumulating stressors and traumas is relatively sparse, we do know—based on evidence from similar contexts and personal experiences of working in such contexts‑—that a substantial proportion of affected populations can experience some form of mental illness, some of which can last for years in future.

The existing mental health care gap

Compounding this problem, Nigeria’s mental health infrastructure is grossly inadequate, overwhelmed by increasing demand and chronic underfunding. Mental health currently is funded by only 3.3-4% of the health budget. Additionally, the psychiatrist to population ratio is extremely low at approximately 1.5 per 1,000,000 people. This severely restricts the availability of effective care. While data are sparse, it is almost certain that a large proportion of persons with trauma-related mental health conditions receive little to no treatment, exacerbating the public health challenge facing the country.

In addition, cultural perceptions in Nigeria significantly influence the treatment and acceptance of mental health conditions. There is a prevailing stigma associated with mental illness, which is often viewed as a result of spiritual failings or as a personal weakness, and which strongly discourages people from seeking mental health care.

Strategies for bridging the gap

The recent passage of the new mental health bill is a significant step towards recognizing and addressing the growing epidemic of mental illness in Nigeria, underscoring a growing awareness and commitment to mental health care. However, there is an urgent need for a multi-faceted and culturally sensitive approach to effectively manage Nigeria’s trauma-driven mental health crisis. Building on well-established stepped-care approaches, this could include the following key components:

  1. Public education and stigma reduction: Targeted educational campaigns to transform public perception of trauma and its impacts on mental health can be a first step. These campaigns could focus on reducing stigma and promoting an understanding of mental health as a critical part of overall well-being. Media outlets, schools, and community centers can play pivotal roles in these efforts, disseminating information that challenges myths and misconceptions about mental health and trauma, while highlighting stories of recovery and positive outcomes.
  2. Community-based initiatives: Recognizing that trauma is deeply influenced by cultural contexts, it is essential to integrate cultural practices with clinical approaches in mental health interventions. This approach can leverage cultural strengths such as family cohesion and spiritual traditions, which have been noted to bolster resilience and provide support in the face of trauma. However, it is also important to recognize that these same strengths can sometimes act as barriers to seeking treatment. For example, in some communities, the reliance on spiritual-based support systems may discourage individuals from seeking formal mental health services, under the belief that spiritual intervention alone is sufficient. As such, it is crucial to balance these traditional supports with formal mental health services to prevent them from becoming barriers to professional care.
  3. Trauma care services: There is a need for higher-level services tailored specifically to address the complexities of trauma and its consequences. This includes providing specialized training for mental health professionals in trauma-informed care, ensuring they have the skills to offer effective support. Training should be tailored to both urban and rural settings where the context of trauma may differ significantly. This strategy should include integrating mental health services into primary healthcare settings, which can significantly reduce barriers to access, especially in underserved areas.
Call to action

This is a moment of opportunity for policymakers and health professionals to prioritize trauma-driven mental health care in Nigeria. However, the magnitude of these crises means that the Nigerian government alone cannot address the widespread mental health needs. As such, private organizations, non-governmental organizations, and international partners can also play a role in expanding mental health resources and services. The cost of inaction—a generation marred by untreated trauma— can be the future well-being of much of the population.

 

About the authors: Mohammed Abba Aji is a research fellow at Boston University School of Public Health. He has experience as a physician and public health specialist in conflict-affected regions of Nigeria, where he has provided critical care and developed health interventions.

Sandro Galea is a distinguished professor and dean at the Boston University School of Public Health. An eminent epidemiologist and author, his work focuses on the social determinants of health, mental health, and the consequences of trauma.

Competing interest: None

Handling Editor: Neha Faruqui

(Visited 219 times, 1 visits today)