By Suleiman Tajudeen
… Continued from last week
CITIZENS COMPASS— Lack of mental health literacy: Limited public understanding that mental disorders are health conditions with biological, psychological, and social causes.
Cultural and religious attribution: Dominant narratives linking mental illness to witchcraft, ancestral curses, or divine punishment.
Fear and perceived dangerousness: Overestimation of violence risk. Actual data show persons with mental illness are more likely victims than perpetrators.
Media framing: Repetitive portrayal of mental illness in crime, comedy, or sensationalist stories without recovery narratives.
Language and labels: Use of derogatory terms such as mad, kolo, psycho, and lunatic that dehumanize.
Lack of contacts: Low personal interaction with people in recovery prevents disconfirmation of stereotypes.
Historical institutionalisation: Legacy of asylums and chaining practices created public images of hopelessness and danger.
Moral model of behaviour: Belief that mental illness reflects weak character, lack of faith, or drug use, leading to blame.
Structural neglect: Underfunding of mental health services signals low importance and reinforces belief that conditions are untreatable.
Policy vacuum: Prior to 2021, absence of mental health legislation meant discrimination had no legal consequence, normalizing stigma.
Effects of stigmatization
Social – delayed treatment: Average duration of untreated psychosis in Nigeria is 8–10 years. Stigma is the most cited reason for delay.
Social – education disruption: Students hide symptoms or are expelled after admission, leading to dropout and reduced lifetime earnings.
Social – Unemployment: Discrimination in hiring and firing leads to poverty. Less than 15% of persons with severe mental illness hold formal jobs.
Social – Housing exclusion: Landlords refuse tenants with psychiatric history; communities protest siting of rehabilitation centres.
Social – Family burden: Courtesy stigma causes caregiver isolation, depression, and financial strain. Some families hide relatives at home.
Psychological – self-stigma: Internalized beliefs reduce self-efficacy, leading to the why try effect and reduced goal pursuit.
Psychological – concealment: Energy spent hiding illness increases stress, worsens symptoms, and reduces medication adherence.
Psychological – suicide risk: Self-stigma and hopelessness are independent predictors of suicidal ideation among PLWMI.
Medical – diagnostic overshadowing: Physical complaints are dismissed as in the head, leading to late diagnosis of diabetes, hypertension, or cancer.
Medical – Mortality gap: Due to poor care and lifestyle factors, persons with severe mental illness die 10–20 years earlier than the general population.
Prevention of stigmatization
Contact-based education: Programs that facilitate direct or video interaction between the public and persons in recovery are the most effective anti-stigma intervention.
Mental health literacy in schools: Integrate basic mental health into Civic Education and Biology from Junior Secondary School (JSS1) to correct myths before they form.
Responsible media reporting: Train journalists to use person-first language, avoid linking illness to violence, and include helplines. The Nigeria Union of Journalists (NUJ) can adopt guidelines.
Language campaigns: Government, NGOs, and leaders model respectful terms. Replace lunatic asylum with psychiatric hospital in all documents.
Religious and traditional leader training: Equip pastors, imams, and herbalists to recognize signs, refer appropriately, and stop attribution to witchcraft alone.
Integration of services: Provide mental health care in general hospitals and primary health centres to normalize treatment and avoid special stigmatized sites.
Workplace policies: Organizations adopt mental health policies, Employee Assistance Programs, and non-discrimination clauses in line with the Disabilities Act 2018.
Legislative enforcement: Implement the National Mental Health Act 2021, which prohibits discrimination and mandates insurance coverage.
Celebrate recovery: Public events like World Mental Health Day should showcase recovery stories, not just problems.
Early childhood programs: Teach empathy, emotional regulation, and acceptance of difference in nursery and primary schools to prevent prejudice formation.
Management
Psychoeducation for individuals: Provide accurate information about diagnosis, treatment, and prognosis to counter self-stigma.
Cognitive behavioural Therapy for self-stigma: CBT techniques help individuals challenge internalized stereotypes and build new self-concepts.
Peer support and advocacy groups: Organizations like MANI and ASIDO Foundation provide safe spaces and empower PLWMI to speak out.
Strategic disclosure: Counselors help clients decide when, how, and to whom to disclose. Selective disclosure balances authenticity and safety.
Family education and counseling: Reduce courtesy stigma by teaching families about illness and involving them in care.
Legal redress: Use the Mental Health Act 2021 and Discrimination against Persons with Disabilities Act 2018 to challenge employment or housing discrimination.
Protest and advocacy: Coordinated campaigns that challenge stigmatizing advertisements, films, or policies. Example: petitions against mad man comedy skits.
Health system changes: Train all health workers in mental health first aid to reduce diagnostic overshadowing and disrespectful treatment.
Restorative practices: In schools or communities, facilitated dialogue after discriminatory incidents educates offenders and repairs harm.
Monitoring and evaluation: Conduct national stigma surveys every 5 years to track change and hold institutions accountable.
Conclusion
Stigmatization is a social process with measurable causes and damaging effects. It delays treatment, increases disability, and violates human rights. Evidence studies show that stigma is not inevitable. Contact-based education, policy enforcement, language change, and empowerment of persons with lived experience reduce stigma effectively. Nigeria’s Mental Health Act 2021 provides a legal foundation. The task now is implementation by individuals, families, schools, media, employers, and government. Reducing stigma improves recovery, economic productivity, and social cohesion.
References
Adebowale, T. O., & Ogunlesi, A. O. (2019). Public perception of mental illness in Lagos. Nigerian Journal of Psychiatry, 17(1), 12–19.
Gureje, O., Lasebikan, V. O., Ephraim-Oluwanuga, O., Olley, B. O., & Kola, L. (2020). Community study of knowledge of and attitude to mental illness in Nigeria. The British Journal of Psychiatry, 186(5), 436–441. https://doi.org/10.1192/bjp.186.5.436
Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363–385. https://doi.org/10.1146/annurev.soc.27.1.363
National Mental Health Act. (2021). Federal Republic of Nigeria Official Gazette, 108(145).
World Health Organization. (2022). Mental health and human rights: Guidance and practice. WHO.
For questions and medical consultations, contact: Dr. Suleiman Tajudeen, CEO and Director of Clinical Psychology, Clear Mind Psychological Consult, Km 15, Badagry Expressway, Ojo, Lagos. +234 803 402 4457
