Tanatswa Chikaura Hi, everyone. Welcome to the In Conversation Podcast series for the Association for Child and Adolescent Mental Health, or ACAMH for short. I am Tanatswa Chikaura, a second year PhD student, at the University of Cambridge, and an ACAMH Early Career Branch Member. In today’s episode, I have the privilege to talk to Dr Jibril Abdulmalik, from Asido Foundation. Asido Foundation received the Innovative Research, Training or Practice in Low and Middle Income Countries Award in the 2024 ACAMH Awards. The Asido Foundation is a non-profit mental health advocacy organisation, that aims to promote better understanding around mental health in Nigeria and across the African continent. The Foundation envisions a Nigerian society in which everyone achieves optimal mental health, regardless of age, gender, socioeconomic status, religious creed, or ethnicity. Today, we are joined by Dr Jibril Abdulmalik, who is the Founder and CEO of Asido Foundation. He is an experienced Psychiatrist and Senior Lecturer, with a demonstrated history of public mental health advocacy, research and engagement with the government at all levels, as well as NGOs working in the field of mental health. In our conversation, we’re going to unpack how the Foundation came about, the inspirational work they’re doing in Nigeria, and how that works sits within the global mental health landscape. Welcome, Dr Jibril. Firstly, I would like to say congratulations for your award in the recent ACAMH awards, your work is really, really inspiring. It hits home for me, because I’m from an African country, I’m Zimbabwean, and I truly understand the struggles of ensuring that mental health is a priority, not only in our communities but also for the government. So, to get us started, please may you introduce yourself and the amazing work you’re doing with your Foundation to the audience? Dr Jibril Abdulmalik Thank you so much for having me, and thank you to ACAMH for the excellent work that ACAMH is also doing. We were very pleasantly surprised when we had the nomination and then was given the award, so thank you so much. Now, I’m Jibril Abdulmalik. I work in Nigeria, I’m a Nigerian, and I work in the mental health space. And the Asido Foundation is a not-for-profit organisation that aims to promote mental health awareness in our society, to ensure that there is empathy, that people have the right information about where they should go for help when they need it. As well as to push back against lots of ignorance in the society, lots of shame and stigma, which then leads to discrimination. And so, a lot of suffering goes on for affected individuals and their families, and we at the Asido Foundation feel that we shouldn’t just fold our arms and watch while so many individuals and their families suffer when they can actually access help and get better, especially when they are vulnerable, vulnerable such as children. I mean, there are so many cases of children taken out of school because they have autism or they have ADHD, a condition and – or even epilepsy, and the other parents, because there are misconceptions that, oh, epilepsy can be contagious, if the child is fitting and the saliva, the child touches another child, that child may also develop epilepsy, all sorts of myths and misconceptions. So, because of complaints from other children and other parents, the school will then advise the parents to keep the child at home, so that child will not have the benefit of an education. Or a female who is married and after the pregnancy and delivery has postpartum depression, and the husband, in his ignorance, and their family, say, “Oh, I don’t know what has come over you since you put to bed, you’ve become lazy. You are not looking after yourself, you are not doing anything in the house, even to take care of the baby is a struggle, what’s wrong with you?” Remember that even the lady herself is not aware of the fact that she’s depressed. She just feels tired all the time, has low mood, and so on, and if care is not taken the marriage can break down or cause a lot of stress in the marriage. So, all of these challenges are the reasons why the Asido Foundation try to promote mental health awareness in the society, so that everybody, children, adults, the elderly, can actualise their full potentials and benefit from available treatment, without shame, without stigma, without discrimination. Tanatswa Chikaura Thank you so much for saying that, that’s really, really amazing. I know I said it earlier, and I may say it a lot today, but your work is really, really inspiring, and it will definitely go a very, very long way, and I’m sure it’s already doing that. So, coming from an African background, I know that mental health careers are not usually the obvious path, and you did medicine, and I’m sure everyone expected, or maybe most would have expected, you to take other paths, or specialise in other areas, and mental health careers are not what people expect you to do, although that’s slowly changing. And, like you spoke about, there is so much stigma that’s there. So, can you please tell us how you actually found your passion in psychiatry, and if there were any challenges in doing so? Dr Jibril Abdulmalik Let me start by saying that you’re absolutely spot on, as a medical student, as an undergraduate, I enjoyed psychiatry as a posting, but I never envisioned myself in that field as a Psychiatrist. Not for any reason particularly, but just because, you know, we spend a short period of time in psychiatry compared to the other departments, such as, paediatrics, gynaecology and all of that, so it was just a small component. But I thoroughly enjoyed it, because I like listening to the human stories, human angle stories, the challenges, and being able to help them get better, so I enjoyed it. But I’ve always wanted to specialise in paediatrics, you know, to look after children and, you know, children, once they are ill and you intervene, their recovery is so dramatic. A child that is so weak, you just rehydrate the child and the next hour or two the child is up and about and playing. But after my period of internship, after graduation you do an internship under observation for one year, before you are licenced to practice fully as a Doctor. And then, in Nigeria, we also have a compulsory one year National Service, so you are posted to the other parts of the country, apart from your region of origin, just to promote national unity and, you know, experience, and then you are serving the nation with your expertise, before you then join the labour market or decide to travel abroad and all. So, I was posted to the extreme North East of Nigeria, Borno state, and in that state, I was then posted to a specialist neuropsychiatric hospital. So, the entire work I did every day was attending to patients with mental health difficulties, and that hospital was serving six neighbouring states, a population of about 30 million people, only one hospital. And because it was a border city, the state borders Chad Republic, Niger, as well as parts of Cameroon, so communities in those three countries that are closer to Maiduguri, where the hospital is located, also bring their patients there. So, every day we seen tonnes and tonnes of patient, and I was taken aback, where are all these people coming from? How come there are so many people struggling with mental health challenges? And, you know, some of the time they will have been ill for a very long time before they eventually decided to come to hospital. So, I was struck by the magnitude of the burden, and the fact that there are very few mental health professionals in Nigeria and across Africa really, you know. And that was when I began to change my orientation from specialising in paediatrics, that maybe I should specialise here, I think my services are needed more here. And, of course, it’s challenging, because, you know, as you had mentioned rightly, it’s not prestigious to be called a “Psychiatrist.” You know, some people say, “Oh, Psychiatrists behave like their own patients too,” and so it’s not glamorous. To say that you are a “Surgeon” is more prestigious, to say you are a “Gynaecologist,” it’s more prestigious, and all of that, and then it’s also not seen as financially lucrative. If you are a Surgeon, you can have a private practice, if you are a Gynaecologist, you know, you can make a lot of money, but Psychiatrists, it seemed like it’s not glamorous and all. And then my wife, who was my fiancée then, she’s also a Doctor, when I told her, “I’m no longer interested in specialising in paediatrics, I’m now thinking of psychiatry,” she was worried, on my behalf, because of the societal stigma that may come with that career choice, but, I mean, she came around very quickly and she’s been very supportive over time. So, those were some of the challenges and my evolution to decide to specialise in psychiatry. Tanatswa Chikaura Thank you so much. I did psychology for my undergrad, and I faced similar, call it “backlash,” because, you know, some of the things that were said were very unwarranted. But I think when you do have that passion and you know you can serve in a certain discipline, it’s very important to see it through, and now you’re flourishing in it, which is really, really amazing. So, learning in Zimbabwe, and being Zimbabwean myself, something that has struck me coming to do my postgrad in the UK is how mental health is perceived, both by community members, as well as the government. And I know that… Dr Jibril Abdulmalik Hmmm. Tanatswa Chikaura …we are from different parts of Africa, but in doing my readings, there are some similarities in how mental health itself is prioritised. And I just want to hear your thoughts on what you think we need to do better. Obviously, we have backlash from people when people decide to pursue careers in mental health, and chances are also… Dr Jibril Abdulmalik Hmmm. Tanatswa Chikaura …high these are the people that will become our policymakers, that will get into politics, these are the people that we will interact with, that we will want to lobby things too, so that they can make a difference in our system. So, how do you think we can shift those perspectives? And I know you are already doing that with your Foundation, but it would be really great to just hear what you think we can do, not just as individual countries, but actually as a continent. Dr Jibril Abdulmalik Now, this is so very important, that the biggest barriers are ignorance, shame, stigma and discrimination. And the best way to dispel these barriers is to provide information, create awareness, sustained advocacy, and that’s the work of the Asido Foundation, awareness creation, advocacy. For instance, in Nigeria, attempted suicide remains a crime, punishable by one year imprisonment. That’s ridiculous, because we know that 80 to 90% of those who will think of suicide will have background mental illness, especially depression. So, what they need is treatment, is support, encouragement, not arrest and imprisonment. Part of our advocacy, last year in May 2024, we were able to pay a courtesy visit to the Attorney General of the Federation in Nigeria, and to make a strong case that we think this law needs to be changed. And he assured us of his support, and we are working with other bodies, other coalition of NGOs, to push for the decriminalisation of attempted suicide in Nigeria. We also have an international partner, Lifeline International, which does a lot of work for suicide prevention, and Asido partners with them, so we are working assiduously. So, reforms, advocacy, awareness creation. Awareness creation works at the population level, so that we begin to change the mindset, but we have to also be aware that this is a marathon. It’s not going to change overnight, but gradually, you know, we can move the eye of the needle, no matter how slightly, but positively in the right direction. And so, if we are able to do so, gradually over time, the situation ten years from now should be much better than where we are today. So, once we have that idea that we are in it for the long haul, everything is not going to change in the blink of an eye, and we have similar problems across the entire continent, and even other low and middle income countries across Asia too, the challenges are similar, and we all have to work hard, put pressure on our government representatives, our lawmakers, so that they begin to prioritise mental health. Across Africa, the attention is mainly for infectious diseases, malaria, HIV, reproductive health issues, and so on, but non-communicable diseases, such as mental illness, which is like a silent epidemic, is not given any attention. So, we have to bring this to the front burner and make it undeniable, so that they can’t continue to hide away from it, to make the decisions to support, fund and ensure that mental health gets the right attention that it deserves. Tanatswa Chikaura Thank you for that. I love that you said “do not expect things to just change overnight.” I see it sometimes when people get into the mental health space, they start doing advocacy work, and they get tired, ‘cause they’re, like, “Where are the results?” And I’m, like, “The results may not come soon, but what matter is… Dr Jibril Abdulmalik Hmmm hmm. Tanatswa Chikaura …doing the ground work.” And in your answer, you spoke about “support,” and I think that’s a very important area to think about, especially when we are thinking of the personalisation of mental health support. Dr Jibril Abdulmalik Hmmm hmm. Tanatswa Chikaura I find that this area is not straightforward in non-Western countries. Firstly, there are a lot of misconceptions surrounding how mental health’s perce – is perceived, particularly within the African context, and I think something that’s important is for people to know that there is no monolithic view of African countries and our practices, we are all very diverse. Yes, we all come from the same continent, but, like we always say, “Africa is not a country.” I’ve seen that there is a really big need for the decolonisation of mental health in African spaces, so I’m really interested to hear your thoughts on how we can contextualise mental health in Nigeria. How do you think you can really make mental health a conversation for Nigerian people, thinking about your own perspectives and your own practices, as well? Dr Jibril Abdulmalik So, it’s really very important that we do not forget our cultural roots and history and tradition, and we need to find a middle ground of taking what is positive and beneficial from medical science, from science, from Western developments, and also merging that with what is beneficial and culturally acceptable in our traditions and that is beneficial. For instance, we have a culture where a woman puts to bed and all the female members of the family come around for the next couple of days, ensure that she doesn’t cook, she doesn’t do anything, there’s a lot of social support network. Of course, the flipside of that is that you lose a bit of privacy, if you just want me time, you won’t get that, right? If so many people are in the house. But – so, we have this extended family network that gives a robust social support structure, or network, that is there for you. Many cousins, nieces, people that you grew up with in the neighbourhood, we say “it takes a village to raise a child,” right? And so, that communal sense of living, you would also, for instance, find that elderly individuals who are maybe having problems with dementia will have relatives living with them in the house, helping with the household issues, and so on, so they are not alone in their old age. These are positive things in our culture, in our traditions, that we shouldn’t completely disregard. And we also have to look at beneficial aspects. For instance, when people say, “Oh, I go – I’m going to see a Traditional Healer,” culturally, that is much more acceptable than going to see a Psychologist or a Psychiatrist. And we have to look at how can we leverage on that cultural acceptance that they have, while we are eliminating harmful practices, such as chaining, such as physical beating? Those are things that are harmful and detrimental, and we want to take those out, but how can we partner and work with them? Because when they go there and they tell them, “If you do this, if you take this herb, you will get better,” it has a lot of psychological – whether it’s placebo effect or not, has a lot of psychological reassurance, and they come back feeling much better. So, we need to be able to work with them. We shouldn’t be on our high horse and say, “Oh, I’m the Psychiatrist,” “I’m the Clinical Psychologist, and I’m not going to deal with you because you are not educated,” right? And so on, we have to come off that high horse. We have to be humble, we have to partner and collaborate with Traditional and Faith Based Healers, you know, in an evidence-based manner, where there is mutual respect, so that we can ensure that more people who are suffering get the help they need, devoid of the harmful aspects. We have to be pragmatic, we have to be humble, and we have to reach across the aisle for partnerships and collaboration that ensures that more people have access to quality care that is culturally acceptable to them and that is beneficial to them. That’s my take. Tanatswa Chikaura That is very interesting, and it’s really nice to hear your perspective and how you also do things in Nigeria. I once had a conversation with someone a few years ago, we were talking about mental health, he’s older than me, and he said to me, “Tanatswa, the problem with your generation is that when you bring conversations around mental health to us, you are making it seem like we never understood the concept of mental health from way back. You make it seem like it’s something you have suddenly found out… Dr Jibril Abdulmalik Discovered. Tanatswa Chikaura …and discovered, and it’s something new that you’re coming to us with. But the difference is, we had our own way of understanding things back then. We had our own way of having these conversations, and we had our own way of things in place.” And he spoke about how he appreciates that things are now different, and that our generations are now different, but for us to be able to cover some of those intergenerational gaps, and for us to be able to really break down some of these different types of stigma within our communities, we need to have conversations with everyone, and that also includes respecting people’s cultures and people’s way of living. So, just thinking about some of those cross-cultural differences, even within our own respective communities, how do you think that has influenced Asido Foundation’s work? Do you think that has been a barrier? Because I’d like to believe we’ve – you’ve got the youngsters that are coming in with their TikTok, and they’re saying, “Oh, let’s do this, let’s raise mental health awareness in this way,” and, I mean, it’s great, it’s lovely, I see it, I enjoy it, but I’m sure you have people that are coming in with a more different perspective on how to raise awareness, yet you also have… Dr Jibril Abdulmalik Hmmm. Tanatswa Chikaura …people that still appreciate the traditional way of doing things and collaborating with Traditional Healers… Dr Jibril Abdulmalik Hmmm. Tanatswa Chikaura …and other groups that have been part of Nigeria’s culture, for example. So, do you think you’ve had any barriers in trying to explore those different areas and reach those different groups? Dr Jibril Abdulmalik Yes, I wish I could say that we’ve not experienced barriers, but the reality, unfortunately, is that there are lots of barriers and challenges in this regard. And the most important is the widespread superstitious beliefs about the aetiology of mental health challenges, right? Where people believe that it’s a spiritual affliction, and so, if it’s a spiritual affliction, only a spiritual intervention can help. And so, you are wasting your time if you go to talk to a Therapist or see a Psychiatrist, you are wasting your time, what it needs is spiritual deliverance, and so they seek for spiritual solution. Now, a flipside of that is that places where they go are places that are unlicenced, where they are more likely to experience human rights abuses, be chained, be beaten, or be asked to do a seven days’ dry fast, meaning they only take liquids, no food, for seven days, to, sort of, exorcise the demons or the evil spirits that have possessed them. And so, apart from these abusive practices, what this also does is that it drives people underground. So, if my family member, or my mother or my sister or my wife is having a mental illness, I believe that it’s a spiritual problem, it’s a devil that has afflicted my wife, I don’t want everybody to know that we have a spiritual problem at home, so I will lock her indoors, okay, so that she’s hidden away. Or I have a child with autism, and I believe it’s an evil spirit that has possessed my child, that child will not step out of the house, or I will send the child to the village to stay with my grandmother, locked away from view and, of course, deprived of education, which is not helpful. Now, the other aspects of these superstitious beliefs is that it also makes people to stay away, that if you go and get involved or you try and help the person, that spirit may also afflict you, do you get what I mean? So, because of that, they say, “Oh, you don’t know what the person did to deserve this spiritual problem that has made them lose their sanity, so don’t get involved.” So, because of that empathy and help and supporting that culture of wanting to support someone, also people – many people withdraw because of this perception. And I had also mentioned the legal challenge too, about the fact that attempted suicide remains criminalised, and we – until last year, we had an old mental health law called “the Lunacy Law” of 1958, which we inherited from the British, and we had never revised until last year, when we also did a lot of advocacy around that, because even the name, “Lunacy, Lunacy Law,” even the name makes you cringe, right? And in that old law, anybody with mental health challenge has no right to own property, you know, so – and so many other outrageous things there. So, those were, but thankfully, we now have a Mental Health Act of 2021, which was signed into law 2023, and, thankfully, this is in tandem with global best practice, and protects and promotes the fundamental human rights of affected persons. And we also have a lot of members in the community who are not crazy about digital, online, social media, mental health advocacy and awareness, so we still marry the traditional advocacy approaches. We go to markets, we go to communities, we meet elders, we give talks, we listen to them. And so, we are also trying to partner with religious clergy, and to train them and talk to them so that they can use their very important platform, the pulpit, to encourage people that mental illness is a medical disorder, you should seek medical intervention. Don’t rely only on prayers, we are not even saying, “Don’t pray.” So, we try to find a middle – what we do in Nigeria is – at the Asido Foundation is we are pragmatic. We say, “Please, by all means, you believe in God, you believe God can do it, please by all means, pray. But in additional to prayer, seek medical treatment, right? The medical treatment does not negate the impact of your prayer, let them work together. So, take the treatment, go for therapy sessions, and support all of that with prayers, that is going to work better.” So, that’s a way we sort of navigate that balance, where people say, “Eh, but don’t you think there is a spiritual component?” We say, “Well, you know, if that’s your belief, please pray, but in addition to the prayers, do this, so that you can get the best out of it.” So, those are some of the challenges and our efforts to try and find a middle ground, to navigate them in a way that is acceptable to the community. Tanatswa Chikaura That’s really lovely. You’re doing really great work with your government in Nigeria. I think it’s really amazing to hear that, and really inspiring, and it also gives hope that when you put the work in, you will see the results. So, it’s really… Dr Jibril Abdulmalik Hmmm. Tanatswa Chikaura …great that you managed to do something like that. I have a question pertaining the use of language. In Zimbabwe, we’ve got 16 official languages, and English is one of them, and I’ve realised whenever I want to say “depression” in the other local languages, I struggle. If I want to say anxi – in fact, I don’t even know what anxiety is, like, a direct translation. I can try to use many words to piece it together for someone to understand me, but it’s so difficult… Dr Jibril Abdulmalik Hmmm. Tanatswa Chikaura …to just say, “Oh, you know, you have anxiety and depr” – like, it’s so hard to try and do that in some of our local languages. So, I’m interested in knowing how you have managed, especially in your work as a Psychiatrist, as well, how you have managed to translate some of these mental health terms into the local languages, because I believe it’s very key when we’re talking about the personalisation of support, and also destigmatising, and also people understanding that, oh, this issue’s not just a “Western thing,” as people assume that it is, but it’s a life thing, it’s a human thing, and we all need support. So, how have you navigated the issue of language? Dr Jibril Abdulmalik Thank you so much. So, I will say that compared to Zimbabwe where you have 16 official languages, we have one official language, and, guess what? That official language is English. But we have over 256 different ethnic groups with their different distinct languages, three bi – large ones, the Igbo, the Yoruba, and the Hausas, but there are so many different languages that it’s a nightmare, right? But what we do, what – the only pragmatic thing to do is what you suggested. Most of the time there is no direct word-for-word exact exchange, or translation, of this concept. So, what we tend to do is to then use descriptive terms, involving several words, a phrase, an explanation, to say, “If you feel this way and this way and that way, and so on, this is what’s – it is going on,” and so on, and then they can relate. Because once you start talking about the symptoms, or using the same terms to describe, then people can identify and relate with those. But if you say, “Oh, it’s anxiety,” so what is that? You know, and then you’ll struggle to find a word to translate directly into the local language. But if you describe, use a descriptive approach, so that’s what we have adopted, and that’s what we use in our both clinical work as well as in our research work, to use descriptive terminologies, to explain the concept, and then it is easier and better understood that way. Tanatswa Chikaura Now, the idea of descriptive words is really great, because people also feel comfortable to open up. They don’t feel pressured to understand what a scientific term is. They don’t feel pressured to know the right thing or the wrong thing, and there is no barrier for people to be comfortable to just say, “This is how I’m feeling. I’m feeling sad today and I’ve been feeling sad for the past seven days, I want help.” So, it’s – that’s a really great approach that you’re taking. Looking into the future, what does the future look like for Asido Foundation? I saw on your website, you don’t just want to make a difference in Nigeria, but you also want to do it across the African continent. Do you have any other partners within the continent that you work with? Are you also working with any people in Southern Africa? This is me putting in my CV to say, “We can work together in Zimbabwe,” but what does the future look like, and have you started expanding? Dr Jibril Abdulmalik Now, we have a big challenge. The challenge is that Nigeria is so large and huge, it’s over 200 million population, and mental health receives scant attention. We also have not been – we are still struggling with funding and getting grants and all of that. So, even covering Nigeria effectively is still a very tall order for us. But we have – because most of the time we do meetings online, we have people join from across Africa, from Ghana, Liberia, Sierra Leone, Kenya, and South Africa, Zimbabwe, you know, so we have plans to expand, because we are not going to wait until we say, “Oh, Nigeria is perfect” before we expand to other countries. We believe that we have a good model, which is a – the right admixture of people with mental health expertise, as well as those who are just committed individuals, who are not even health workers, or any such thing, but they’re just passionate about mental health promotion. So, that balance, that combination, of having the right expertise, and one of our core values at the Asido Foundation is scientific evidence. Like, everything we do is underpinned by the right scientific evidence, so that we don’t just wake up and say, “Oh, we are doing this tomorrow,” without looking at. Does the evidence support that it’s going to work? Is it going to have achievement? So, scientific evidence, so, we think that model of having a combination of expertise, plus passion, working together, is a good model to replicate. And down the line we will be very delighted to have – once we have a core group of individuals, up to ten individuals in a particular country, who are ready to work together, we already have a template and a model that we are operating, so it’s very easy to share. And we get – have a country office in Zimbabwe. For instance, when you finish your PhD, if you return to Zimbabwe, we will be happy to have you as a Country Director for Asido Foundation Zimbabwe, in Ghana, and other – in Kenya, and other countries like that, so that we can all carry on this work of promoting mental health and helping our citizens, children, adults, senior citizens, everyone, achieve optimal mental health. That’s our goal, that every citizen is able to achieve the best state of emotional wellness they can. And that they receive care when they are struggling, without any barriers, without any restrictions, without shame, without stigma, or discrimination. Because we – lastly, we should remember that health, as defined by the World Health Organization, is “a state of complete physical, mental and social wellbeing.” So, we cannot claim to have a healthy citizenry if we are focusing only on physical health, while neglecting mental and social wellbeing. So, our goal ultimately is to have all of the African continent, all African citizens, enjoy good health, including, and especially, good mental health. Thank you. Tanatswa Chikaura Amazing, that is a great note to end on. Thank you so much, Dr Jibril, for sharing your inspirational work with us. There are so many young Africans with passion for mental health work, and the dreams to make a difference in their own individual spaces. What these young people need are mentors and people to look up to, and those people are people like you, so we’re very fortunate to have people like you in these spaces and pushing this work forward. So, we really appreciate the time you have taken to share your journey with us. For more details on the Asido Foundation’s work, please visit the ACAMH website, that is www.acahm.org. Also, make sure to take a look at the Foundation’s website and social media. ACAMH is spelt A-C-A-M-H.