Opportunities and Strategies
Contextualised School-Based Mental Health Policy from the Outset
As reviewed, SBMHPs in Nigeria are still in the development phase. The bright side of this unsettling situation is that Nigeria has an opportunity to develop an SBMHP from scratch, drawing on the strengths of school-based approaches to mental health services while being cognizant of the inherent weaknesses of such programmes. Nigeria could take a lead in evolving a model SBMHP that may serve as reference point for many sub-Saharan African countries, which are at similar level of development with Nigeria and with a similar socio-cultural milieu. There has been a growing critique of globalised approaches to scaling up mental health services in developing countries where several unique social, economic and cultural factors contend with and confound mental health (Brhlikova et al. 2011; Das and Rao 2012). Focus on curative or restorative approaches to mental health as a strategy to bridge mental health gaps in low- and middle-income countries (LMIC) has been described as ‘insufficient and narrow’ (Campbell and Burgess 2012). It has been argued that mental health and disorders are dictated by social circumstances as much as they are by personal vulnerabilities (Skovdal 2012) underscoring the need for mental health policies that take into consideration the social-cultural, economic and political realities of LMIC.
Therefore, one of the strategies for a context-relevant SBMHP for Nigeria is to evolve an appropriate school-based mental health policy for the country, which can set the tone and direction for the programme from the outset. Rather than relying on policy suggestions from developed countries that may be de-contextualised, policy advisers in Nigeria should evolve a school-based CAMH policy for the region taking cognizance of local realities and tapping on local experience and expertise. Doing this will require an understanding of the unique ecology of the school environment in Nigeria. In other words, there is a need for theoretical frameworks to capture the full ramification of the school environment in Nigeria, from which multilevel, context- appropriate and holistic school-based mental health policy directions can be understood (Atilola 2014). For instance, based on an ecological model of CAMH in Nigeria, Atilola (2014) recommended that strategies that promote resilience such as child-sensitive social protection for vulnerable families and improved access to childcare resources should be the thrust of CAMH policies in the region.
Drawing on such perspectives, CAMH policy in Nigeria needs to prioritise strategies to promote the mental health and resilience of children from the community in the first instance, enhance the capacity of the school environment to build resilience and provide complementary mental health services. Building the mental health and resilience of children within the community will entail ensuring they have access to early childcare resources (i.e. good nutrition, immunisation and quality parenting), including opportunities to access school. It will also involve rallying the community to secure their support for and buy-in into SBMHPs. Invigorating the school environment to support mental health will include provision of a safe environment and promoting the resilience of school children through promotion of self-efficacy, personal agency, spirituality, religious and social engagement, and any other resilience-enhancing activities as may be suggested by future local research.
