The Nigerian Association Mental Health Project: A New Approach to Community Mental Health
An interview with an official of The Nigerian Association Mental Health Project in London, Ontario
Interviewed by Sorcha McNally, BHSc Student, Faculty of Health Sciences
Henry. C. Orewa
Henry. C. Orewa is an international medical graduate and an alumnus of the prestigious Masters in Public Health program of the University of Western, Ontario. He has participated in various projects with the World Health Organization in Africa. His interests lie in program planning and evaluation, Mental health and One health.
On January 25, 2021, a young 26-year-old aspiring Nigerian musician overdosed and died in London, Ontario. During his burial, his mother pointed out that her son was one of the many young men who took drugs within the racialized population and how better knowledge about mental health services and acute care in a drug overdose may have saved his life. This brought about discussions within the executive board of the Nigerian community and a small team was commissioned to apply for a community development grant from the City of London. The grant application (whose objective was to close gaps in mental health awareness, improve access to available mental health services and optimize referrals to such services from racialized communities), was successful and in 2021, the “Mental health and Addiction for racialized populations and Londoners” project was born. To deliver its secondary objective of contributing to what is known about the lived experiences accessing mental health services among racialized populations in London, the project team is consulting with Western faculty, Prof. Cheryl Forchuk (School of Nursing), Dr. Akin Taiwo and Professor Richard Csiernik (Social Works). They will provide guidance on the research component of the project, co-producing evidence to guide future planning by the City’s health authorities and perhaps inspire new approaches for community engagement for mental health services nationwide. Western Health Studies student Sorcha McNally speaks with Dr. Henry Orewa, Western alumni MPH class 2021 and project coordinator, to learn more about this unique project.
Sorcha: Could you describe the Nigerian Association Mental Health Project?
Henry: The Nigerian Association Mental Health Project is a one-year project that spans from October 2021 to September 2022. Our goal is to improve mental health and encourage wellness in London, especially amongst racialized populations. It takes on two objectives to achieve this goal: improve access to mental health care services and increase the mental health awareness among racialized and other populations in London.
The project has two components: an interventional phase and a research phase. The interventional phase adopts a unique method that is novel to the Western world: the Friendship Bench approach. This strategy is used in this project as a tool to drive mental health educational support in the communities.
Sorcha: What is a friendship bench?
Henry: A Friendship Bench adopts a culturally accepted way of communication across racialized populations where people consult local elders for advice on important issues. The Friendship Bench, developed by Dr. Dixon Chibanda, is a community-based approach using talk therapy as a form of cognitive behavioural therapy to address depression in Zimbabwe. It is a unique approach that trains grandmothers as a sort of therapist, to deliver evidence-based talk therapy. These trained grandmothers were then able to identify and refer people suffering from mental illnesses to health facilities for a comprehensive evaluation and subsequent care by experts. Published findings on implementing the approach over 10 years in Zimbabwe showed that the strategy did better than standard clinical therapy in optimizing case identification and referral. This is the component we adopted in addition to Canadian Mental Health Association (CMHA) training modules to improve mental health within our community. We will continue to monitor and evaluate the effectiveness over the next year. After receiving ethical approval, we plan to conduct a retrospective study to measure knowledge gained and behavioural change regarding mental health awareness.
Sorcha: What gap is this initiative filing? Why is the project so important now in the London community?
Henry: Mental illness and drug addiction are growing concerns in London, Canada and globally. As a fast-growing community, London’s population has rapidly increased by almost 10% since 2016 as shown by Canadian census data. To tackle mental health issues within the racialized subset of the population, we must create culturally acceptable approaches to help drive this knowledge across these demographic and Londoners. Although millions of dollars are spent yearly on mental illness and addiction, there are minimal improvements within the society and even much less within the racialized communities. Therefore, if we want to tackle this mental health problem within this population, we have to start now and address barriers which arise from social determinants of health, particularly stigma and discrimination.
Sorcha: What strengths or opportunities can be harnessed /unlocked when racialized populations are empowered to design, implement and be accountable for the results of a community development project like this one?
Henry: There are a whole lot of advantages. There is community ownership when you allow people to implement projects to improve themselves. Those involved become committed to improving the intervention with increased participation and cooperation. This builds confidence within and across communities and improves the community’s strategy. And then there is trust. Trust is enhanced within and between the communities and the health system. Creativity is explored as different people come up with different solutions. There is also teamwork, which becomes a massive part of the project as members of racialized communities improve their recptiveness and ownership of the intervention. And as attitudes changed towards the intervention, health literacy on mental health within the community is improved. Finally, external bias is reduced to a large extent as the problems brought up are done so by members of the community, which affect their culture.
Sorcha: The prevalence of mental health issues is growing worldwide (WHO, n.d). In your opinion, what factors are contributing to this?
Henry: There are three categories of factors, starting first with the grassroot factors of health known as determinants of health. These include income and social status, employment, housing stability, education and literacy, childhood experiences, social supports, access to health care services, gender and so forth. The second category includes social and economic factors, more specific to certain populations like the racialized population. These include self-perception of one’s place in the society, lived experiences of racism, discrimination and trauma. The last factor could be referred to as public health emergencies, like the COVID 19 pandemic, which have caused more problems that could be perceived as triggers of mental illness like loss of income, decreased food production, inflation and increased poverty rates. These factors have complicated the already overburdened health care services by further reducing access, increasing patient waiting times and thereby discouraging the few people who would seek care.
Sorcha: What are your hopes and goals for the Nigerian Association Mental Health Project?
Henry: This initiative aspires to improve a couple of aspects of this problem. Firstly, we hope to increase mental health awareness within the racialized population and Londoners. Secondly, we aim to bring about those difficult discussions on mental health that these demographics tend to avoid. Thirdly, we want to improve mental health education within these populations and activate research and research questions that would help derive culturally-based solutions. Finally, this program aims to create a sustainable relationship between these communities and a mental health care delivery system that is built on trust and is culturally sensitive. As we progress towards the completion of this project, we hope to initiate other related projects that will look further into root causes affecting the mental health of the racialized population.
Sorcha: Thank you so much for your time and the information on this important initiative!
Photo by Dan Meyers on Unsplash
