Joseline de Lima was wandering the dusty alleys of her working-class neighborhood in Togo’s capital one day last year when a disturbing thought crossed her mind: Who would take care of her two boys if her depression worsened and she was no longer around. watch out for them?
Mrs. de Lima, a single mother grieving the recent death of her brother and having lost her job at a bakery, knew she needed help. But treatment was out of the question. “Too formal and expensive,” he remembers thinking.
Instead, help came from an unexpected adviser: Ms. de Lima’s hairdresser, who had noticed her erratic walks around the neighborhood and provided a safe space for her to share her struggles amid the curly wigs hanging from colorful racks and bright lights. neon sign of her small salon in Lome, Togo’s capital.
The hairdresser, Tele da Silveira, is one of about 150 women who have received mental health training in West and Central African cities from a non-profit organization trying to fill a critical gap: providing mental health care in one of the poorest regions of the world, where counseling remains barely accessible, let alone accepted.
Ms. da Silveira began with gentle questions and words of encouragement as she braided or dried Ms. de Lima’s hair with salt and pepper. More careful listening followed, then suggestions for new braid styles and walks to a nearby lagoon, which Ms de Lima described as “lifesaving therapy”.
“People need attention in this world,” Ms. da Silveira said. “They need to talk.”
Togo and many other African countries face an urgent need for more and better mental health treatment: The World Health Organisation ranks the African region as having the highest suicide rate in the world and some of the lowest public spending on mental health. The region has an average of 1.6 mental health workers per 100,000 people, while the global median is 13, according to WHO
Mental health crises are exacerbated by violent conflict in countries such as Sudan, Somalia, the Democratic Republic of Congo, Ethiopia and the Sahel region. with the increase in drug use in many major cities; and due to widespread youth unemployment, displacement from the extreme effects of climate change and soaring inflation.
In Togo, a tiny coastal nation on the Gulf of Guinea, there is little knowledge of mental health treatment, either in the coastal capital or in its villages in the hilly north. The country has only five psychiatrists for more than eight million people. Families seeking to treat a relative suffering from serious mental health problems often resort to traditional treatments or forced isolation, including committing some with schizophrenia to the confines of religious institutions or clinics.
“Many of those who come to see us do so as a last resort, after having their money taken from them by traditional healers and scammers,” said Daméga Wouenkourama, one of Togo’s five psychiatrists. “Mental health remains a foreign concept to most people, including our leaders and our medical colleagues.”
To address what the World Health Organization has described as a “mental health gap” in developing countries, local nonprofits and international organizations operating in Africa are training nurses, general practitioners, and even grandmothersin identifying mental health problems, from early signs of depression to post-traumatic stress disorder.
In West and Central Africa, hairdressers were the latest to join this struggle. Salons have long been used by non-profit organizations and community groups as venues to raise awareness of issues such as reproductive health among clients and apprentices. Visits there are cheap – sometimes as little as $2 – and a favorite gathering place among women.
Mental health professionals now give hairdressers three days of training in which they learn how to ask open-ended questions, spot non-verbal signs of distress such as headaches or disheveled clothes and, critically, how not to gossip or give damaging advice.
In interviews, a half-dozen hairdressers said that as clients untangled their hair or added hair extensions, many shared their financial struggles or emotional pain over the loss of a loved one. More often, however, clients refer to having “domestic problems” – a euphemism for domestic violence.
“Clients come and cry in front of us – we hear everything,” said Adama Adaku, a grinning hairdresser with red wool braids who participated in the mental health training.
The training is organized by Bluemind Foundation, the brainchild of Marie-Alix de Putter, a Franco-Cameroonian businesswoman who underwent years of psychiatric treatment after her husband, a teacher and humanitarian, was killed in 2012 while they lived in Cameroon. Her hairdresser was by her side in the hours following his death, Ms de Putter said in an interview in Lomé last month.
When designing the program in 2018, Ms de Putter looked at where African women spent their time. “Society expects them to be beautiful and hair often comes first,” Ms de Putter said. “We go where the women are.”
Around 150 hairdressers have so far received the honorary title of ‘mental health ambassador’ from Ms de Putter’s organization after training in Lomé and Ivory Coast and Cameroon. Followed by Ghana, Rwanda and Senegal.
Because they are not professional counselors, hairdressers often refer struggling clients to trained therapists. But most of the hairdressers said their clients found the treatment too expensive – a session can cost as little as $15 in a country where more than a quarter of the population lives on less than $2.15 a day and where access in health insurance is unequal.
Several African countries have made commitments over the past decade to better address mental health disorders. Last year, the Ugandan Ministry of Health mentionted that nearly one in three Ugandans suffered from mental health problems. Countries like Sierra Leone and Ghana have vowed to replace shackles with professional treatments. Mental health care often comes last or is neglected altogether, as is the case in many countries of the global south.
“People are becoming aware of mental health issues,” said Dr Sonia Kanekatua, Togo’s only female psychiatrist. “But the social stigma remains.”
On a recent morning, she and three of Togo’s other psychiatrists traveled to a rural area two hours north of the capital to set up a biannual open-door clinic. they listen to patients in conference rooms or under the towering mango trees in the dusty courtyard. For hours psychiatrists saw people suffering from depression, stress and addictions, among other issues.
Back in Lomé, Ms. de Lima now comes a few times a month to Ms. da Silveira’s living room, a block away from her home. Ms. de Lima, 54, took her hairdresser’s advice to listen to religious music — they are both Christians — and continued taking relaxing walks to the nearby lagoon that she previously didn’t have the energy to get to. She said she hoped to sell a plot of land and use some of the proceeds for treatment, on the recommendation of her hairdresser.
“She saw something in me that I couldn’t get out,” said Ms. de Lima, wearing a floral dress as Ms. da Silveira combed her hair.
Counseling has taken a toll on the mental health of some of the hairdressers, even though they themselves receive treatment once a month thanks to the Bluemind Foundation.
“I can listen and talk, but there comes a point where I can’t help anymore,” Ms. da Silveira said one morning as she sat outside her salon. She said she herself was suffering from depression.
Puppies played at her feet with a tuft of fake hair. A customer was waiting inside. With a gentle smile, Ms. da Silveira asked, “Why do we feel that everyone suffers from mental health problems?”