According to the Oxford-Unabridged Dictionary, “stigma” is defined as a symbol of “shame, dishonor, or disapproval,” originating from the Latin term for “tattoo,” indicating someone as a slave or criminal. The term traces back to the Greek word “stizein” referring to a visible mark made by burning or cutting the skin of a marginalized individual to distinguish them from others in society. Fueled by fear and ignorance, stigma parallels the mental and communal constraints that marginalized those afflicted by historical medical epidemics, now commonly dismissed with clinical detachment in medical facilities worldwide.
Fear, rooted in ignorance, perpetuates the stigmatization of mental illness. It fosters denial among those affected and dissuades them, as well as their advocates, from seeking or adhering to proven treatments. Additionally, it dissuades well-meaning and qualified practitioners from addressing debilitating medical conditions in clients who may have limited access to medical care beyond traditional providers.
Individuals dealing with mental illness often face a dual challenge. Firstly, they contend with the symptoms of their condition itself, which can range from recurrent hallucinations, delusions, anxiety, to mood swings, depending on the specific disorder. These symptoms can significantly hinder one’s ability to work, live independently, or attain a satisfactory quality of life. Secondly, societal misconceptions surrounding various mental disorders lead to stigma. Even those who effectively manage their mental illness may encounter immense obstacles in securing employment due to discrimination from employers.
Consequently, mental illness not only presents difficulties stemming from its symptoms but also entails the disadvantages associated with societal prejudices. Compounding matters, some individuals with mental illness may internalize these common biases, leading to self-doubt and diminished confidence. Stigmatization deprives those affected by mental illness of their inherent human dignity and restricts their participation in broader society by eroding social support networks and impeding access to treatment. This occurs through both individual and institutional discrimination driven by misconceptions, prejudiced stereotypes, and negative attitudes prevalent in both the public and professional spheres regarding mental illness.
Prejudiced attitudes towards conditions like schizophrenia, alcoholism, and substance use disorders persist, contributing to the stigmatization of individuals affected by these illnesses. While psychiatric care providers generally hold fewer negative views, studies indicate significant negativity among other healthcare professionals.
A national survey conducted among nursing professionals in Nigeria revealed that 40% viewed mentally ill individuals as violent, 26.5% would distance themselves from them, and a third associated mental illness with a lack of self-discipline and willpower. Similarly, a study in a Nigerian university teaching hospital found that over half of the respondents attributed mental illness to supernatural causes like witchcraft or demon possession, reflecting strong negative views. Many respondents favored authoritarian and restrictive approaches to treatment. In the general public, there’s a perception that those with psychotic disorders are unpredictable and pose a threat to social order and public safety.
In a study in Karfi village, northern Nigeria, common symptoms associated with mental illness included aggression, loquaciousness, eccentric behavior, and wandering. Drug misuse was cited as a major cause, along with divine will and spiritual possession. While some preferred orthodox medical care, others leaned towards spiritual healing. Negative feelings towards the mentally ill were prevalent, especially among illiterate respondents.
Another report in a rural community in Northern Nigeria highlighted widespread ignorance about mental illness causation, transmission, and available remedies. Negative views led to discriminatory practices, perpetuating stigma. Despite efforts to reduce stigma, widespread belief in supernatural causes complicates effective anti-stigma programs in Nigeria. Strategies are needed to address institutional and community-level stigma surrounding mental illness.
Efforts for Reducing Stigma in Nigeria
Mental health issues have garnered significant attention worldwide, with an estimated 450 million people affected by various brain or mental disorders, including substance abuse and behavioral disorders. Surprisingly, over 30% of countries lack mental health policies or programs despite this widespread prevalence. In Nigeria, mental health services are largely inaccessible to the majority of the population residing in rural areas, with services concentrated in urban areas. Although the first mental health policy was drafted in Lagos in 1991, it has yet to be fully implemented. In 2022, the World Health Organization (WHO) estimates that a 20% of Nigerians, or around 40 million people, are affected by mental illness, highlighting a significant burden.
However, there has been little effort to raise awareness or address the stigma and discrimination associated with mental illness. In response to this gap, the Beautiful Mind and Wellness Foundation (BMWF) was established as a non-governmental organization to provide mental health awareness in Ghana and Nigeria. BMWF focuses on advocacy, education, and evidence-based treatment interventions, aiming to increase awareness and reduce stigma and discrimination through culturally tailored programs.
The foundation offers anti-stigma and social inclusion education through seminars, community-based mental health education, and training for community and traditional leaders. In Lagos state, the government has committed to a mental health policy to combat stigma and discrimination, focusing on expanding mental health delivery systems, providing cost-effective interventions, enhancing human resources, and establishing national health policies and legislation.
Efforts are also underway to utilize radio and television platforms to sensitize and mobilize communities to support individuals with mental illness. While the media’s potential in fighting stigma is still being explored, efforts are made to design programs that support mental health awareness and encourage individuals to seek assistance. Moreover, individuals are encouraged to openly discuss mental health challenges and seek help when needed.
Way Forward in Nigeria
Various advocacy groups aim to combat stigma surrounding severe mental illness, with initiatives focusing on education, awareness, and empowerment. For instance, the National Alliance for the Mentally Ill (NAMI), comprising family members and individuals with severe mental illness, has prioritized stigma reduction among its 172,000 members. NAMI launched the “Campaign to End Discrimination” in 1995, striving to diminish stigma. Similarly, the National Mental Health Association, a longstanding mental health advocacy group, has been educating the public about mental illness for over 90 years. Additionally, the National Stigma Clearinghouse actively responds to negative portrayals of mental illness and promotes positive representations through media communication.
Efforts are being made to encourage government agencies to support initiatives empowering consumers and funding projects aimed at combating stigma. Consumer advocates are advocated for in psychiatric hospitals nationwide to vigilantly address misrepresentations of mental health issues. Private citizens are also urged to engage in efforts to combat stigma, such as Rotary International’s “Erase the Stigma” campaign, which educates American business leaders about severe mental illness truths and misconceptions.
Education and information programs are being developed to enhance understanding of mental illness through various mediums like books, videos, slides, and audio-visual aids. These programs aim to dispel false assumptions, such as the association between mental illness and violence, across the country. Studies suggest that education on mental illness reduces stigma and discrimination, with participation in brief courses leading to improved attitudes towards individuals with mental illness.
