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Mental health services are scarce in Nigeria but there’s a huge need: what we learnt from callers to a hotline

EMERGENCY hotlines have a crucial role to play in improving access to mental health services, particularly in countries where these services are in short supply.

This is the case in Nigeria, where in one study one in every four people reported one or more types of mental illness. In a country of 200 million people, there are fewer than 150 psychiatrists, and less than 10% of mentally ill Nigerians have access to the care they need. This treatment gap is a result of shortages of mental health professionals and neuropsychiatric hospitals.

Nigeria has not actively pursued installing hotlines to support people in need of mental health support. The idea is relatively new in developing countries, including Nigeria. Mental health illnesses are largely left untreated, or treatment is sought from alternative health providers.

In 2017, the Lagos University Teaching Hospital started an initiative to prevent suicide through research, crisis intervention, health education and early treatment of depression and drug abuse. The Nigerian-based Suicide Research and Prevention Initiative set up a hotline system in Nigeria to respond to those in need of mental health services. The initiative now has a presence in 35 of 36 states, including Abuja, the Federal Capital Territory, and branches in 51 health institutions in the country.

The initiative trained counsellors to receive calls, handle mental health cases, and refer complicated ones to mental health professionals. They also provide follow-up to those counselled, ensuring their needs are addressed.

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We conducted research into the use of the hotline, analysing data collected between March 2022 and September 2023. We focused on this time frame because it was at this point that the hotline was upgraded to a toll-free system, with a dashboard for extensive call monitoring.

The findings show that the majority of calls received were from the southwest geopolitical zone. There was a notable gender disparity in calls, with more male callers from the southern region and more female callers from the northern region. There were more callers from Christians and those who were unemployed.

Most of the calls (71.41%) were focused on seeking mental health services. We concluded from this that there was a substantial demand for and use of the hotline. The focused nature of the calls, including the diverse demographics, suggested in addition that the hotline was effectively providing crucial mental health services to a broad and diverse population across Nigeria.

The callers

The focus of our research was to examine the efficacy of the hotline service, who used it and what they used it for.

The hotline number was advertised on social media platforms like Facebook, Twitter, Instagram and LinkedIn after it was upgraded to a toll-free number. Radio broadcasting was used to tell the public about the phone numbers to call if they required mental health services.

The Suicide Research and Prevention Initiative team also consulted with community stakeholders to gain their support for the project.

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The hotline was operational 24 hours a day. Calls could be made in Nigeria’s three major languages – Yoruba, Igbo and Hausa – as well as English and Pidgin.

During the period in which we collected data, 717 calls were received. Of these, 512 (71%) were made with the caller intending to receive mental health services.

The main categories of callers were as follows:

  • 78% were from the southern states of Nigeria
  • 56% of the calls were from men
  • about half of the callers (51%) were between the ages of 18 and 27 years, across all the geopolitical zones
  • unmarried callers accounted for about 72.9%
  • most callers were unemployed
  • over 60% of those who called in were in crisis – they spoke about severe cases of anxiety, suicidal ideation and attempts, and violent behaviour.

Way forward

The use of emergency hotlines to provide mental health services is relatively new in Nigeria. This is unlike the United States, where they have been used for decades.

Our research shows that people are open to receiving mental health services outside the formal health facilities. This is a huge plus considering the limited number of mental health facilities and health professionals serving the huge population in need of care. However, we call for studies to evaluate the cost of providing mental health services through hotlines.

This study also highlights the need for increased advocacy efforts to encourage people to use the free emergency hotline services. This is particularly crucial for residents in the northern part of Nigeria, where its use was lowest.

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The research lends weight to the case being made by mental health advocates, researchers and civil society organisations for more hotline services.

While addressing the root causes of mental illness (such as unemployment) remains important, tailored interventions are also needed to target at-risk populations, especially in settings where they are most vulnerable.

Aloysius Odii, Lecturer, University of Nigeria
and
Nnenna Mba-Oduwusi, Principal Consultant

By ALOYSIUS ODII and NNENNA MBA-ODUWUSI

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