Nigerian mental health policy has for many years recommended integration of mental health care into the general health system so that people can access affordable services through primary health care and general hospitals. This has been realized in only a few isolated examples to date (see examples below), with the result that only around 10-15% of people in this huge and important country access the care they need.1
Nigeria was identified as a priority country for the development of the WHO’s mhGAP programme, and the last ten years have seen a gradual development in Nigeria of ideas around how mental health can be incorporated successfully into the health system. The WHO and Federal Ministry of Health collaborated to form a Mental Health Action committee which helped to foster a greater interest in mental health at the highest levels. A new policy has been adopted4, and a strategy for the roll-out of mhGAP is under way. Several trial programmes, for example in Osun State (University of Ibadan)5, Lagos State, and Benue State (Methodist Church Nigeria), as well as advocacy initiatives6, have provided invaluable lessons that will help to bring the best evidence-base to design a model of mental health care delivery in Nigeria. The Aro Primary Care Mental Health Programme has been running since 2011.
The mhSUN programme is designed to test a model based on this experience, in two pilot sites – Kaduna and Cross River States. The main hub in each state will be the Federal Neuropsychiatric Hospitals, which will support the local (state) structures to integrate and maintain high standards of mental health in existing health services. This use of existing expertise to support decentralized services in a task-sharing model is innovative, and aims to address the problem of not having experts in decentralized locations, and not having sufficient support for people trained in basic skills (like mhGAP) to work in mental health in the field.
One important reason for having a very strong, research-led evaluation is that this pilot aims to provide Federal Government with the information that they need to effectively plan mental health services according to the progressive new Mental Health Policy. This has also been identified as a global research priority.7 mhSUN is closely linked to the Federal Ministry of Health (FMOH) Mental Health Action Committee, and will report results to the Federal Government, as well as develop effective advocacy tools, such as policy briefs, to promote investment in mental health.