Nigeria strengthens mental health response using public health perspective

Abuja ‒ Nigeria has revitalized mental health policy and programmes in the last three years. Dr Tunde Massey-Ferguson Ojo, a psychiatrist, global mental health expert and National Mental Health Programme coordinator, is driving this progress. His guiding principle: "There is no health without mental health."

Dr Ojo sheds more light on the country's progress, why mental health response in emergencies is critical, and his vision is moving forward.

What has been the recent progress on mental health in Nigeria?
Quite a lot has happened in the past three years. Mental health has gained real traction - both from what we're doing as government and from global trends. With more conversations happening through globalization and social media, there's now a broader understanding of mental health, especially among young people.

At government level, we've seen major milestones. In 2022 we reviewed the 2013 National Policy on Mental Health Service Delivery and replaced it with the 2023 National Mental Health Policy. The old policy focused narrowly on service delivery, but the new one takes a broader public health perspective. We also developed Nigeria's first National Suicide Prevention Strategic Framework, aligned with the Sustainable Development Goals on noncommunicable diseases and mental health.

Importantly, this work was strengthened by the signing of the 2021 National Mental Health Act, which received presidential assent in December 2022 after strong advocacy and collaboration with World Health Organization (WHO) and partners. The act provided a solid legal foundation for policy and action. It specifically calls for a national suicide prevention strategy, which we have since developed, and guides our work on mental health governance.

One of our priorities has been the decriminalization of attempted suicide. Nigeria is among the few countries that still criminalize this act and we believe this must change. The government has established a National Task Force on the Decriminalization of Attempted Suicide and we are now working closely with the Office of the Attorney-General to finalize a draft amendment bill. We expect tangible progress very soon.

We have also taken an integrated approach to mental health. It is now embedded within programmes on neglected tropical diseases and HIV and WHO's Mental Health Gap Action Programme (mhGAP) 3.0 framework has been contextualized and endorsed by Nigeria's National Council on Health. Any partner seeking to integrate mental health into their work can now build on that.

We also found that very few states had mental health leadership for. So we pushed for the creation of mental health units within every state's Department of Public Health. Today, 27 out of 36 states and the Federal Capital Territory have established such units, a big step towards strengthening coordination across the country.

What is the perception of mental health among the Nigerian public?
There's growing awareness that there's no health without mental health. That phrase, once just a statement, has become a reality. More people and programmes now recognize that mental health is integral to overall wellbeing.

Attitudes are changing. However, stigma and discrimination remain our biggest barriers. Beyond resources or infrastructure, the root challenge often lies in societal attitudes. The conversation is improving, people are more open to talk about mental health, but there's still a long way to go before stigma is truly reduced.

Why is it important to integrate mental health into emergency preparedness, response and recovery, particularly in Nigeria?
The treatment gap for mental health in low- and middle-income countries is already high - between 65% and 90% - and it becomes even greater during emergencies. Conflict, displacement and trauma all disrupt services and family life, while increasing the risk of developing new mental health conditions or worsening existing ones.

In Nigeria, conflict and insecurity, particularly in the northeast, have displaced over 3.2 million people. These communities face enormous psychosocial needs. We've worked to strengthen mental health and psychosocial support in these settings using the WHO mhGAP Humanitarian Intervention Guide. Unfortunately, as resources decline, many partners are scaling down activities.

Our goal is a more responsive and sustainable system that can be activated not only in humanitarian crises but also in epidemic and pandemic responses.

What is your vision for the next few years of Nigeria's mental health response?
We want to transform Nigeria's mental health landscape. Our goal is universal health coverage that truly includes mental health - where people no longer must pay out of pocket for care. Currently, fewer than 3% of people with mental health conditions are covered by health insurance.

We expect the decriminalization of attempted suicide to open access to care and strengthen data collection and surveillance. We're also working to ensure mental health indicators are included in the National Health Management Information System and to build a data-driven approach to planning and service delivery.

Nigeria has never had a costed national mental health plan and that's a gap we're closing. Alongside the new policy, we're developing a clear, funded action plan.

Ultimately, we want to see a Nigeria where mental health is promoted from childhood, supported across sectors, in schools, workplaces and communities, and addressed through prevention and treatment. With collaboration and commitment, I believe we are moving in the right direction.