School-Based Mental Health Programmes in Nigeria: Issues, Opportunities and Strategies
Issue 1: Lack of Mental Health Components in School- Based Health Programmes in Nigeria
The current National School Health Policy of Nigeria (Federal Ministry of Health 2006) has five sections: ‘healthful school environment’, school feeding services, skills-based health education, school health services and school-community relationships. Scrutiny of the policy reveals the lack of a framework for mental health. For instance, the stated objective of the policy’s ‘healthful school environment’ is exclusively focused on maintaining a physically safe and hygienic school environment. There is no mention in the policy of any strategy to address situations like physical violence, psychological violence (e.g. bullying, intimidation, victimisation), sexual violence/harassment and/ or gender-based violence, which can constitute mental health risks.
The section on school health services shows similar omissions. The stated objective of the policy’s school health services is to:
provide basic services for disease prevention and management of injuries in the school [and to...] build capacity of the school community to identify, treat, and manage simple illnesses, injuries, infections and infestations. (Federal Ministry of Health 2006, p. 12)
The objective and the implementation guideline have no clear direction for addressing child mental health issues.
The stated objective of the section on ‘skills-based health education’ is to promote the development of sound health knowledge, attitudes, skills and practices among the learners, which is to be achieved through skills-based health education curricula for schools. While these stated objectives could be expanded to include mental health, an ongoing review of the national school health curricula for students in Nigeria showed deficient mental health content (Atilola et al., in preparation). Curricula focus largely on physical and environmental health with scant mental health content. Recognition and prevention of substance abuse was overwhelmingly the main thrust of mental health education in the curricula. Help-seeking options, effective self-help strategies and first-aid skills for mental health problems were not addressed in the curricula.
One of the closest things to mental health service provision within school- based health programmes in Nigeria today is the creation of school counsellors (Federal Government of Nigeria 2004). These are diploma or graduate degree holders from faculties or colleges of education in the country, and their duties broadly include academic advice and providing counselling services. Several studies conducted in Nigeria have documented that school-based guidance and counselling services in Nigeria are challenged in the area of poor conceptual framework (Mogbo 2005; Odoemalam and Uwam 2009), severe human resource constraints (Alao 2009; Nwokolo et al. 2010) and uncertainties about the usefulness and relevance of the training curricula (Alika 2012).
The special education service is another area with some presence within the current framework for SBMHPs in Nigeria. The country has one institution dedicated solely for the training of special education teachers. The school awards diplomas in various aspects of special education such as education of the visually impaired, the hearing impaired and the learning disabled. Mental health literacy and knowledge of basic child mental health problems are not included in their curriculum. This is despite the fact that childhood disabilities are key risk factors for CAMH (Witt et al. 2003). There are also a number of public and private schools where exclusive special education is provided for children with disabilities. Inclusive learning support for children with disabilities within mainstream schools is however not yet a popular approach in Nigeria.