Can mental health first-aid actually work in Nigeria?

It feels exactly like slapping a band-aid over a busted pipe

Can mental health first aid actually work in Nigeria?

Yes and No.

This article explores the unique reasons why MHFA, as well as free counselling might not work in Nigeria. It also proffers actionable insights on what mental health NGOs or enthusiastic counselors could do (with technology) to make psychological first aid accessible and effectual to Nigerians enduring mental stress.

MHFA — Mental Health First Aid

Mental Health First Aid, according to Wikipedia, is a form of training program that teaches members of the general public how to help a person developing a mental health problem or currently going through a mental health crisis.

Many people in their social circles are not informed on what to do when someone around them is suicidal, deliberately harming themselves or when they experience panic attacks. These sensitive scenarios require immediate action and are classified as emergency situations. In essence, people who find themselves in these scenarios will require first aid, in this case mental health first aid, until full medical treatment such as therapy, is available.

Anyone can be trained. Mental health NGOs such as Mentally Aware Nigeria Initiative (MANI) seek out volunteers who can be trained in mental health first aid to help people going through mental stress by counselling them for short periods of time, or referring them to actual therapists if they do require therapy.

I’ve worked as a volunteer counselor since May 2020. I’ve spoken with and counselled up to 85 people within that time.

For context, I’m the type to take breaks often so as not to overwhelm myself. Many counselors who also started in 2020 must have counseled so much more people than I have.

Some sessions certainly could not take off due to scheduling conflicts or the client ghosting, not responding to my conversation starter. Some understandably opt out of opening up to someone they’ve never met, some realize 2 hours in that this mental health first aid isn’t exactly what they need. People are different.

However, the recent Twitter outrage over mental health counselors being inefficient and hurtful to clients further exposed the blatant ignorance of everyday Twitter users who inadvertently create the narrative with their likes and retweets.

The Twitter Outrage

Several hours before it began, I’d been laughing hysterically at horrible bosses embarrassing themselves on Nigerian Twitter, trying to salvage their messy situation. TechCabal had just published an article on tyranny in the workplace, and everyone was talking about it. Others started opening up about the toxic culture in other organizations and then MANI, the mental health NGO I volunteer for was mentioned.

I went through the thread detailing the tyranny the original poster had experienced as an employee with the NGO. I paid it no mind to be honest, scrolling oblivious of the chaos that was already brewing in its wake.

Not long after, popular crotchet creator and Twitter NG sweetheart, Ore, published a thread about how a counselor had invalidated her as far back as 2019, making her feel like her issues were nothing compared to what other people in Nigeria had been facing. I empathized with her and scrolled past, having experienced almost the same thing in 2020.

Still scrolling through social media (as if there were no more anxiety-inducing tasks left on my to-do list), I started to notice a trend. People started giving negative accounts on what they had faced with ‘Mentally Aware therapists’; how they had invalidated them, worsened their situations or been of no use whatsoever to their mental stress.

I felt bad, but not that bad. I imagined that they were unlucky to have been matched wrongly. I continued reading the unpleasant comments till I stumbled on something shocking.

Someone I knew.

She was someone I had counseled. I knew her face and username from the time she became known on Nigerian Twitter for dropping one last tweet of many that had been suggestive of suicide. At the time of those tweets, we had been speaking. We were in between sessions when she suddenly went AWOL.

My supervisors contacted me immediately they noticed, because I had chosen her case. Thinking back on it now, I realize that was one of the scariest moments of my life.

We had been speaking and it had been a long fruitless conversation interrupted by sunsets. I tried to get her to feel comfortable, suggested certain things to help her realize I was on her side, but my efforts proved futile.

At the time I did not understand her resistance to me. Sure I had read that clients often become reluctant and/or resistant to their therapist for whatever reason. But I am no therapist, and my time is limited. I could not understand why she wouldn’t want to make the most of our time together as I was only volunteering to help her get clarity into her situation. I wasn’t been paid by her family, and she wasn’t coerced into speaking with me. But it certainly did feel that way, at the time.

Fortunately for me, she didn’t die. She was allegedly rushed to the hospital for treatment. I felt several strong emotions during that time. Guilt, fear, shame, it felt like I was responsible for her, even though the conversations had been brief and frustratingly dry. I moved on from her case eventually, occasionally running into her Twitter account by chance.

Back to the present. I saw her distasteful tweet about counselors, confirming that she also had negative experiences to tell the TL about. Frankly, it hurt, because I felt instantly that she might have been talking about me.

I did what I could, what I knew how to do, as a counselor and not a therapist. Reading her tweet took me back to the year when I thought I had killed someone because I couldn’t get her to open up to me. Because I wasn’t good enough as a counselor, I had pushed someone to her suicide.

But that wasn’t me. And it took some time to truly believe that.

Seeing her tweet however felt too much like she had been blaming me for it since that time. And it hurt.

So why did she tweet it? Does she truly believe I was the catalyst? At what point do people realize they are responsible for themselves, and the blame game only permits someone else be in charge of how their lives turn out. Or was this just clout-chasing/sad-fishing at its finest?

Why MHFA will not work in Nigeria

A- Lack of Funds

I have more than enough positive feedback from clients to read if I need to feed my ego. The counselling has certainly helped many people at some point in their lives, contrary to what was said on Twitter.

However, how are those people feeling right now? Is one sniff of our MHFA drug going to last them for the next one year? Do they need to come back every year? At what point will their mind build tolerance and require more and more…?

We live in a unique country with unique trials and tribulations. Literally everyone is going through it, from the beggars on the streets to the middle-class family searching for change to give the beggars.

What my people need is money.

Someone in need of funding for a business venture or schooling can get away with making tweets suggesting of suicide to get on the trend table , so they get the attention and much-needed help from more financially stable people.

When Davido recently decided to give out 20million to 20 people, I witnessed at least one person sad-fishing with a bottle of Sniper on Twitter, tagging Davido to her tweets, paying no mind to the vile comments vilifying her shameless method.

Understandably, people will come under the guise of mental health concerns to solicit for funds, to signal to the world about their financial needs. People will make these signals, disguised as suicidal tweets, to get attention, and ultimately financial aid. This is sad-fishing, and this is understandable.

Other attention-seekers do it solely to gain sympathy or to chase clout. Not that their personal struggles are not significant enough for your attention, but that they exaggerate what they’re going through.

The problem with this is that people who are genuinely going through the mental crisis will suffer in silence because they don’t want to be seen in that light. These are the ones going through anxiety attacks, addictions, panic attacks, depression, trauma, disorders. This category of people are not necessarily looking for money. They need help and should be prioritized over the opportunist. Mental health first aid, not financial first aid.

Another problem arises when there is a mix between both types of people, e.g. people being depressed because they don’t have money. And this is why MHFA might not work here.

Several times I’ve had to send money to people I was counselling, some more than one time. Not because I should be helping financially (it’s unethical), but because I need to work on saying No to them.

Grown men with families, queers that couldn’t take the pain anymore and had to move out, unemployed people who ran into debt after taking out loans, these are people I’ve had to archive to keep from sending them money I don’t have in abundance.

It’s heartbreaking to be very honest. That people aren’t doing so well.

B- Entitlement Mentality

The first thing that jumped out while reading people’s comments about Mentally Aware volunteers was how they kept referring to them as therapists. Mentally Aware volunteers are not therapists, they are counsellors.

Therapy can last for several months to several years, you paid for that! Free counselling on the other hand is free. You did not pay for that.

Naturally time becomes limited, as no counsellor will leave their day or night jobs to come cater to clients, no matter how empathetic they claim to be. It’s just what it is. They need their jobs to make money, so they can subscribe for the internet to speak to clients, or to call the clients.

Also, a lot of people sign up to be attended to and it becomes almost impossible to reach everybody if there were too many sessions for just one person.

Volunteers are human beings with lives and responsibilities. Emergencies can come up, plans could change and they’d often need to tweak their timetables to accommodate sessions with clients.

Once, a client blamed me in advance in case he killed himself, because I couldn’t be available during the day to speak to him. Who sent me work?

Several others I’ve concluded sessions with, come back weeks or months later to vent bitterly about me never checking up on them. I try to explain that they are too many for me to even keep up with, but it doesn’t end well.

Others dump their new stories on you out of the blue, despite having concluded sessions with them. They beg for time for them to talk and for you to listen, paying no mind to the existence of any boundaries. Some want your friendship, a one-sided friendship.

It all starts to resemble a friends-with-benefits relationship where both parties already know what’s at stake. Only in this case, someone breaks the rules and starts to fall in love.

But you knew what this was.

Any attempt to break the chain results in more resentment between the counselor and the client, and this pattern (I’m convinced) is what birthed the narrative of ‘bad therapists’ on Twitter.

People enjoy the feeling of being listened to, being heard and validated. They want it to go on and on because it feels good. And then, the entitlement sets in. Entitlement on free service.

How to make it work?

Therapy is expensive. Yet we all need it, you the reader and I, the writer. Mental health first aid is an alternative to actual therapy and is a good cause in itself. It just needs to be redesigned into a better approach for Nigerians and our unique demons.

Redesign

• Let people understand exactly what they’ll be getting — Let them understand the differences between a counselor and a therapist, and what they need to do to get either. On whatever platform sessions will hold, there should be an automated intro to every client during every session to remind them once again what they’re getting into, to avoid crossing much-needed boundaries.
• Develop ‘contracts’ with each client where their goals for counselling are defined in doable objectives — The act in itself can foster a sense of progress for both the counselor and the client. The client could start to feel ready and not reluctant or resistant, once they realize they’ll be working with the counselor in those doable objectives. The goal is to make the sessions fruitful and not a waste of time. Suggestions given do not necessarily define a fruitful session, a good session might just be one where the client was allowed to vent in peace, without judgement or suggestions from the counselor. The objectives of each session would have been clearly identified in the ‘contract’ in the beginning.
• Do support groups, ditch one-on-one if possible — The one-on-one approach will encourage the entitlement mentality we’re battling with. Anonymous support groups however will help clients be a bit more empathetic to counselors and other clients waiting to be attended to. It could strengthen them when they listen anonymously to someone else’s struggle. This is why I became a counselor in the first place, to be inspired by the resilience of others so as to live my own life meticulously. Also, support groups might mean less backlog of cases.
• Filter cases before they are chosen by evaluated counselors — It might help to further evaluate counselors, eliminate us even. Evaluating counselors to understand their strengths can help clients get matched with the right ones. LGBTQ clients should not by any chance be matched with an ultrachristian counselor. If cases are filtered and counselors are evaluated beforehand, it would be easy to know who ends up with whom, for one-on-one sessions. Also, some cases, by virtue of their severity should have more sessions than others.
• Build an app.

Finally

The redesign I’m proposing may further serve as an hindrance for clients seeking a quick fix. It might take too long to implement, and the new boundaries might make clients feel weird about trying it in the first place.

However, psychological first aid will fail if some of these points are not addressed.

Personally, I’ll stop counseling for a year or two to focus on those I love that love me.

Sad-fishing