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 occurred to her: Who would care for her two boys if her depression worsened and she was gone? to take care of them?
Ms. de Lima, a single mother who was grieving the recent death of her brother and had lost her job at a bakery, knew she needed help. But therapy was out of the question. “Too formal and expensive,” she remembered thinking.
Instead, help came from an unlikely counselor: Ms. de Lima’s hairdresser, who had noticed her erratic walks around the neighborhood and provided a safe space to share her struggles amid the curly wigs hanging from colorful shelves and the bright neon lights from her small salon nearby. Lomé, the capital of Togo.
The hairdresser, Tele da Silveira, is one of about 150 women in West and Central African cities who have received mental health training from a nonprofit organization that is trying to fill a critical gap: providing mental health care in some of the poorest regions of the world where counseling still exists. barely accessible, let alone accepted.
Ms. da Silveira began with kind questions and words of encouragement as she braided or blow-dried Ms. de Lima’s salt-and-pepper hair. More careful listening followed, followed by suggestions for new braiding styles and walks to a nearby lagoon, which Ms. de Lima described as “life-saving 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 therapy: the World Health Organization classifies its African region as having the highest suicide rate in the world and some of the lowest public spending on mental health care. The region has an average of 1.6 mental health workers per 100,000 inhabitants, according to the WHO, compared to the global average of 13.
Mental health crises are exacerbated by violent conflict in countries such as Sudan, Somalia, the Democratic Republic of Congo, Ethiopia and in the Sahel region; by rising drug use in many major cities; and by widespread youth unemployment, displacement from the extreme impacts of climate change and rising inflation.
In Togo, a small coastal country on the Gulf of Guinea, there is little awareness of mental health care, both in the coastal capital and in villages in the hilly north. The country has only five psychiatrists for more than eight million people. Families seeking to treat a family member suffering from serious mental health problems often resort to traditional medicine or forced isolation, including chaining some with schizophrenia to the grounds of religious institutions or clinics.
“Many people who visit us do so as a last resort, after having their money taken by traditional healers and scammers,” said Daméga Wouenkourama, one of five psychiatrists in Togo. “Mental health remains a foreign concept to most people, including our leaders and our fellow physicians.”
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 grandmothers to detect mental health problems, from the first signs of depression. to post-traumatic stress disorder.
In West and Central Africa, hairdressers are the last to join that fight. Hair salons have long been used by nonprofits and community groups as places to raise awareness of reproductive health issues among clients and students. Visits there are cheap – sometimes as little as $2 – and a favorite meeting place among women.
Mental health professionals are now providing hairdressers with three days of training in which they learn how to ask open-ended questions, recognize non-verbal signs of discomfort such as headaches or disheveled clothing and, crucially, how not to gossip or give unfavorable advice.
In interviews, a half-dozen hairdressers said that when clients unbraided their hair or applied hair extensions, many shared their financial struggles or emotional pain surrounding the loss of a loved one. More often, however, clients refer to having ‘domestic problems’ – a euphemism for domestic violence.
“Customers come and cry for us – we hear everything,” says Adama Adaku, a cheerful hairdresser with a broad smile and red wool braids, who took part in the mental health training.
The training is organized by the Bluemind Foundation, the brainchild of Marie-Alix de Putter, a French-Cameroonian entrepreneur who underwent years of psychiatric treatment after her husband, a teacher and humanitarian worker, was murdered in 2012 while they lived in Cameroon. Her hairdresser was by her side in the hours after his death, Ms. de Putter said in an interview in Lomé last month.
When she designed 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,” says Ms. de Putter. “We go where women are.”
About 150 hairdressers have so far received the honorary title of “mental health ambassador” from Ms de Putter’s organization after completing training in Lomé and in Ivory Coast and Cameroon. Ghana, Rwanda and Senegal follow next.
Because they are not professional counselors, hairdressers often refer struggling clients to trained therapists. But most hairdressers said their clients found the therapy too expensive; a session can cost at least $15 in a country where more than a quarter of the population lives on less than $2.15 a day and where access to health insurance is uneven.
Several African countries have pledged to better tackle mental health issues over the past decade. Last year, the Ugandan Ministry of Health reported that almost one in three Ugandans suffered from mental health problems. Countries such as Sierra Leone and Ghana have pledged to replace handcuffs with professional treatment. Mental health care often comes last, or is completely neglected, as in many countries in the global south.
“People are becoming aware of mental health issues,” says Dr. Sonia Kanékatoua, Togo’s only female psychiatrist. “But the social stigma remains.”
On a recent morning, she and three other psychiatrists from Togo traveled to a rural area two hours north of the capital to set up an open-door clinic that takes place twice a year. they listen to patients in consultation rooms or under the towering mango trees in the dusty courtyard. For hours, the psychiatrists received people who were struggling with depression, stress and addictions, among other things.
Back in Lomé, Ms. de Lima now comes a few times a month to Ms. da Silveira’s salon, a stone’s throw from her home. Ms de Lima, 54, has taken her hairdresser’s advice to listen to religious music – both are Christians – and has resumed soothing walks to the nearby lagoon that she previously didn’t have the energy to reach. She said she hoped to sell a plot of land and use some of the proceeds for therapy, following the recommendation of her hairdresser.
“She saw something in me that I couldn’t get out,” said Ms. de Lima, wearing a floral outfit as Ms. da Silveira combed her hair.
Providing counseling has taken its toll on the mental health of some hairdressers, even though they themselves receive therapy once a month from the Bluemind foundation.
“I can listen and talk a bit, 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 had suffered from depression.
There were puppies playing at her feet with a tuft of fake hair. A customer waited inside. With a soft smile, Ms. da Silveira asked, “Why does it feel like everyone has mental health issues?”