Imagine a weight so heavy it consumes your breath. Imagine carrying that weight alone, in silence every day. This is the reality for many Nigerians who are living with mental health challenges.

The silence surrounding mental illness in the country is deafening, even as the fear of stigma is fueling the silence.

A diagnosis is like a death sentence, not necessarily from the illness itself, but from the attitudes and behaviour of those around.

Like an invisible wall that prevents seeking help and getting crucial support, stigma limits or stops conversations around the issue.

It prevents the mentally ill from talking about their plight, and delays or denies the need to seek treatment, often making the mental health conditions worse because what started as a manageable problem quickly becomes a crisis.

The stigma is suffocating so much it is keeping those diagnosed in the shadows.

There is an unhealthy culture of silence around mental illnesses and mental health in general because people fear being judged or shamed.

Mental health issues are a hidden epidemic in Nigeria. Many view the issue in a simplistic, negative way, often linking it to spiritual issues.

Although 25 percent of Nigerians experience mental illness, less than 10 percent get the care they require. This staggering statistic reveals a crisis that often goes unnoticed.

Unseen burden

The World Health Organization (WHO) data shows the troubling reality, the numbers are numbing.

About 55 million Nigerians, or one in four, have some form of mental health issue at some point in their lives.

Diverse groups are affected differently, but perhaps the greatest concern is depression – a mood disorder that causes feelings of sadness, loss of interest, and hopelessness.

Depression impacts about seven million, anxiety disorders ranging from excessive worry, fear, and nervousness affect another 4.9 million. Medical records show that the prevalence of depression in Nigeria ranges from 3.1 percent to upwards of 40 percent depending on the population studied and is a significant public health concern with millions of people affected.

Nigeria bears Africa’s highest burden of depression and ranks 15th globally in suicide rates.

WHO data indicates Nigeria’s suicide rate is 17.3 per 100,000 people, which is higher than the global rate of 10.5 and Africa’s rate of 12.0 per 100,000.

Sadly, substance abuse disorders are on the rise, even as suicide rates among young and old, male and female have risen in recent years.

Other mental worries such as Post Traumatic Stress Disorder (PTSD), can occur after experiencing a traumatic event; substance abuse is another significant problem and it can worsen mental health conditions and lead to addiction.

Psychotic disorders, like schizophrenia, affect ability to think clearly and relate to others, also prevail.

Mental health woes

To even mention the real names of the victims interviewed became a challenge. When George D (not real name) was diagnosed with depression, he was practically ostracised. “No one sees my depression because I’m always smiling, but I’m lonely. Family and friends withdrew, whispering accusations of madness, transforming me into someone to be feared rather than supported,” he told Vanguard.

Continuing, he said: “Once people know about my diagnosis, they keep their distance, with some often calling me ‘mad man’. I am like someone to be feared, and the expression ‘mental illness’ has taken on a totally new meaning to me.”

For Kola A, having an anxiety attack in the office cost him his job.

“I’m being treated for panic and anxiety attacks. One day, when I had an attack in the office, my boss who witnessed the incident did not see my condition as a treatable illness. He said I was unstable and a liability and I was fired. Ever since, my efforts to get another job have been tough because of constant fear of judgment. And rejection in job interviews is worse than the anxiety itself.”

Ene M who is bipolar kept her disorder a secret because within the community, mental illness is seen as a spiritual problem, a curse.

“My parents disowned me for seeking therapy for anxiety that they believed was influenced by evil spirits. They said I was bringing shame to the family and said I should pray more. I‘m suffering in silence, pretending that all is well even though I’m falling apart,” she recounted.

For these and several others, the invisible nature of mental illness worsens their plight. Daily struggles are hidden behind a facade of normalcy, leading to dismissal and unhelpful advice to “snap out of it” or “to be positive.”

This lack of understanding masks the real pain and suffering experienced.

There is a general lack of awareness about mental health conditions and many people don’t understand that mental illnesses are real medical conditions and not a sign of spiritual attack, weakness or moral failing.

Stigma a major barrier

“Societal attitudes and discrimination encourage the culture of silence,” remarked a consultant psychiatrist at the Psychiatric Hospital, Yaba, Lagos.

“Stigma makes it difficult for many mentally sick persons to seek help, and there is a tendency to wait until the problem becomes severe before reaching out, if at all. The crushing weight of stigma and discrimination is a major barrier. Stigma has a direct impact on how and when affected individuals seek help,” she noted.

“People with mental health conditions often face discrimination which may be so bad that finding jobs and forming relationships become a major challenge. The negative portrayals of mental illness tend to reinforce stereotypes and fuel stigma, hence mentally ill people often experience prejudice in social settings.”

Shortage of human resources, facilities

Another key problem is the lack of mental health professionals. Nigeria has fewer than 500 psychiatrists and trainees and this shortage limits access to care for those who need it. The shortage of psychiatrists mirrors the overall lack of mental health facilities. With an estimated 0.2 psychiatrists per 100,000 people, and limited dedicated mental health mental institutions in the country, this scarcity leaves many patients without proper treatment. The gap makes it difficult for individuals to receive timely and effective treatment, even as the cost of therapy or medication is prohibitive, and without affordable options, individuals continue to suffer in silence. There are eight regional federal neuropsychiatric hospitals and no less than 35 other federal and state-run mental health centres, but while many general hospitals offer psychiatric care, mental health care resources and trained personnel are generally lacking.

Worse still, medications can be expensive and hard to find, and distribution of resources is unequal. A sizable number of Nigerians cannot afford mental health therapy, medication, or hospitalisation. Insurance coverage for mental health services is limited and experts lament that few Nigerians with mental illness get the care needed.

The mentally ill deserve compassion, kindness, and dignity — Prof Lateef Sheikh

Speaking about the challenge of accessing mental health care and support, a Professor of Psychiatry at the Department of Psychiatry, College of Medical Sciences, Ahmadu Bello University, Zaria, Prof Taiwo Lateef Sheikh blamed limited access to mental healthcare professionals a part of the poor awareness and stigma challenge. Sheikh said that the negative assertion that mental health is more spiritual than physical is wrong, misleading and misconceived.

“Many factors contribute to mental health problems, including biological factors, such as genes, physical illness, injury, or brain chemistry. Others are life experiences, such as trauma or a history of abuse and family history of mental health problems. People with mental health problems can get better and many recovers completely. A person with a mental disorder could be helped by being treated with compassion, kindness, and dignity in a clean, comfortable environment that provides freedom of movement, opportunities for occupational and social activity, and reassuring talks.

“I consider it as very important and also a matter of urgency to address the myths and misconceptions of mental health in Nigeria by increasing sensitization, health education and advocacy activities for mental health. This will reduce stigma towards mental ill health, improve access to care and enhance uptake of available mental health care services, and promote holistic care for both mental health and physical health. Proper integration of mental health into all levels of health care delivery in the country will facilitate openness, improve awareness and reduce mental illness stigma in the country.”

Addressing stigma will normalise help-seeking behaviour for mentally ill — Dr. Kadiri

On her part, Africa’s premier celebrity psychiatrist and leading mental health advocate and coach, Dr Maymunah Kadiri aka “The Celebrity Shrink” calls for an end to stigmatisation of people with mental illnesses, saying that if not checked, social stigma often leads to institutionalised stigma and discrimination against mental health patients.

Kadiri, who is the Founder/Medical Director and Psychiatrist-in-Chief, Pinnacle Medical Services, Lagos, admonishes people with mental illnesses to desist from self-perceived stigmatisation such as negative attitudes and internalised shame.

“With only about 350 psychiatrists serving a population of over 200 million, approximately 80 percent of individuals with serious mental health conditions lack access to adequate care. Additionally, cultural and religious beliefs also play a role, as many Nigerians associate mental illness with supernatural causes, leading them to seek help from religious leaders or traditional healers instead of medical professionals.”

Further, Kadiri said: “The stigma associated with mental health issues in Nigeria can be addressed through a multi-pronged approach involving education, advocacy, systemic change, and community engagement. We should integrate mental health education into school curricula to foster understanding from an early age. Partnerships with religious and community leaders to spread awareness and normalise conversations about mental health will help.”

In normalising help-seeking behaviour, Kadiri argued that public figures and influencers need to be encouraged to share their mental health journey to reduce stigma and to establish safe spaces where people can share their experiences without fear of judgment.

According to her: “Institutional stigma is more systemic, involving policies of government and private organisations that intentionally or unintentionally limit opportunities for people with mental illness. Examples include lower funding for mental illness research or fewer mental health services relative to other health care.

“Stigma not only directly affects individuals with mental illness but also the loved ones who support them, often including their family members,” she remarked.

“In improving access to mental health services, there should be provision of subsidised or free mental health services, especially in rural areas, implement mobile mental health clinics to reach underserved communities and train community health workers to provide basic mental health support. Enforce laws that protect individuals with mental health challenges from workplace and societal discrimination.”

Stop the shame, demystify mental illness — Titi Tade

Also speaking, A Clinical Psychologist and Medical Social Worker at the Lagos University Teaching Hospital (LUTH), Ms Titi Tade, regretted that mental health issues are almost taboo in the country. Tade, who is Director for Training, Publicity & Social Media, for the Suicide Research and Prevention Initiative of Nigeria, SURPIN, Nigeria’s leading suicide prevention organisation, regretted that as a country, mental health is something that Nigeria generally tends to shy away from.

“People just don’t want to talk about it and that is not helping. There is a kind of shame surrounding mental illness, nobody readily admits that they are going to the psychiatric hospital and that in itself is a huge conflict. If someone has hypertension or diabetes, they can readily ask for help, but if it is a mental illness, and even if the illness has started, they just keep quiet about it. We need to change individual solutions into a family health care centre and then, we need to look at how to develop a social welfare programme targeted at vulnerable populations.”

Tade observed that many people are vulnerable and need help and there is the need to develop mental health education, especially now that people need to understand what the signs of mental illness are.

“Among ourselves, within our communities, we need to start looking out for each other, we need to start caring more, counseling and encouraging people on some of the issues they’re going through, going out and talking to people, generally socializing helps with mental health, and I think we need to do a lot more education within the community.”

It is important to understand people’s struggles without judging them — Akhigbe

Also speaking, Sarah Wolu Akhigbe, a.k.a Coach Sazzy, a Psychology Educationist, argues that Nigeria needs to introduce policies that treat mental health as a basic part of healthcare. She notes that it is important to understand people’s struggles without judging them.

“The impact of mental health advocacy is massive. It helps reduce the stigma that stops people from speaking out or seeking help. It also improves access to resources, like affordable counseling or therapy, and creates stronger; communities that support each other. Many Nigerians still see mental health issues as something shameful or tied to spiritual problems. In our society, there’s also a lot of stigma around mental health issues, which stops people from seeking help. Men, especially, face extra pressure to be providers, and this can lead to feelings of failure or despair when things go wrong.”

She said policies that treat mental health as a basic part of healthcare are required including having counselors in primary healthcare centers, introducing mental health education in schools, and funding community mental health programmes.

“Laws should protect people from being discriminated against for their mental health challenges, and health insurance should cover therapy and counseling. The government needs to invest in training more professionals and creating free or low-cost therapy options. Mobile mental health clinics can help reach out. Public awareness campaigns are essential to educate people and reduce stigma. With these policies and resources in place, we can create a system that supports everyone, no matter their situation.”

On tackling mental health stigma, Akhigbe says the first step is to lead by example, showing empathy, sharing personal experiences or relatable stories to normalise conversations about mental health, and creating spaces where people feel safe to talk without fear of being judged.

“The challenges surrounding mental health in Nigeria are significant, yet there are opportunities for positive change. Addressing stigma, improving access to care, and empowering individuals are vital steps towards better mental wellness. Collective efforts are essential. Government support, healthcare professionals, and community members must work together. Everyone has a part to play in creating a mentally healthy Nigeria. With hope and determination, a brighter future for mental health in Nigeria is possible. Let’s stand together and make a change.”