One day last year, Joseline de Lima was wandering through the dusty alleyways of her working-class neighborhood in the capital of Togo when a disturbing thought crossed her mind: Who would take care of her two children if her depression worsened and she was no longer there to look after them?
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 not an option. “It’s too formal and expensive,” she recalled thinking.
However, help came from an unexpected counselor: De Lima’s hairdresser, who had noticed her aimless walks around the neighborhood and provided a safe space for her to share her concerns among the wavy-haired wigs hanging on colorful shelves under the neon lights of her beauty salon in Lomé, the capital of Togo.
The stylist, Tele da Silveira, is one of nearly 150 women who have received mental health training in cities in Central and West Africa from a non-profit organization in order to address a vital shortage: providing mental health care in one of the poorest regions of the world, where therapy remains almost inaccessible, let alone accepted.
Da Silveira started with kind questions and words of encouragement while braiding or drying De Lima’s gray hair. Then she listened more attentively and suggested trying new braiding styles and taking walks to a nearby lagoon, which De Lima described as “life-saving therapy”.
“In this world, people need attention,” Da Silveira said. “They need to talk.”
Togo and many other African countries face an urgent need for more and better mental health therapies: the World Health Organization (WHO) classifies this region of Africa as having the highest suicide rates in the world and one of the lowest investments in mental health. The region has an average of 1.6 mental health workers per 100,000 people, while the global average is 13, according to the WHO.
Mental health crises are exacerbated by violent conflicts in countries such as Sudan, Somalia, the Republic of Congo, Ethiopia, and the Sahel region; the growing drug use in many large cities; widespread youth unemployment; displacement due to the extreme effects of climate change and rising inflation.
In Togo, a small coastal country in the Gulf of Guinea, there is very little awareness of mental health therapies, whether in the capital or in its villages in the mountainous north. The country has only five psychiatrists to serve more than 8 million inhabitants. Families in need of care for a relative with serious mental health problems often turn to traditional remedies or forced isolation, as well as institutionalizing some relatives with schizophrenia in religious institutions or sanatoriums.
“Many of the people who come to see us do so as a last resort, after being stripped of their money by traditional healers and scammers,” said Daméga Wouenkourama, one of Togo’s five psychiatrists. “Mental health remains a strange concept for most people, including our leaders and our medical colleagues.”
To address what the WHO has described as a “deficit of attention to mental health” in developing countries, local non-profit associations and international organizations operating in Africa are training nursing staff, general practitioners, and even grandmothers in detecting mental health problems, from the early symptoms of depression to post-traumatic stress disorder.
In West and Central Africa, hairdressers have been the most recent recruits to join this fight. For a long time, non-profit organizations and community groups have used hair salons as spaces to raise awareness among clients and apprentices about reproductive health issues. Salon visits are inexpensive (sometimes services cost as little as $2) and are a highly valued gathering place for women.
Mental health professionals now provide stylists with three days of training, during which they learn to ask open-ended questions, detect non-verbal signs of distress such as headaches or unkempt clothing, and, above all, not to spread gossip or give harmful advice.
In interviews, a dozen hairdressers said that when clients come to have their hair undone or get extensions, many share their economic problems or emotional pain over the loss of a loved one; however, it is most common for clients to talk about “household problems,” a euphemism for domestic violence.
“Customers come and cry in front of us; we learn everything,” explained Adama Adaku, a cheerful hairdresser with a wide smile and red yarn braids who participated in the mental health training.
This training is organized by the Bluemind Foundation, conceived by Marie-Alix de Putter, a French-Cameroonian businesswoman who underwent psychiatric treatment for years after her husband, a professor and humanitarian worker, was killed in 2012 when they were living in Cameroon. Her hairdresser was by her side in the hours following his death, De Putter recounted in an interview in Lomé last month.
When she designed the program in 2018, De Putter analyzed where African women spend their time. “Society expects them to be beautiful and often, hair is the first thing,” De Putter said. So, “we go where women are.”
So far, about 150 hairdressers have received the honorary title of “mental health ambassador” from De Putter’s organization after attending training sessions in Lomé, Ivory Coast, and Cameroon. Ghana, Rwanda, and Senegal are next.
Since they are not professional counselors, hairdressers often refer clients with problems to certified therapists. But most hairdressers said their clients found therapy too expensive: a session can cost at least $15 in a country where over a quarter of the population lives on less than $2.15 a day and access to health insurance is uneven.
In the past decade, several African countries have committed to better addressing mental disorders. Last year, the Uganda Ministry of Health reported that nearly one in three Ugandans suffered from mental health problems. Countries like Sierra Leone and Ghana have pledged to replace shackles with professional treatment. Mental health care often falls last, or completely neglected, as is the case in many developing countries.
“People are becoming aware of mental health problems,” said Sonia Kanékatoua, Togo’s only female psychiatrist. “But social stigma persists.”
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 operates twice a year. They listen to patients in consultations or under the towering mango trees in the dusty yard. For hours, the psychiatrists saw people suffering from depression, stress, and addictions, among other problems.
Back in Lomé, De Lima now visits Da Silveira’s beauty salon a couple of times a month, which is located just a block from her house. De Lima, 54, has followed her stylist’s advice to listen to religious music (both are Christians) and has resumed her relaxing walks to the nearby lagoon, which she previously couldn’t reach due to lack of energy. De Lima said she hoped to sell a piece of land and allocate part of the proceeds to her therapy, based on her hairdresser’s recommendation.
“She saw something in me that I couldn’t express,” De Lima said, dressed in a floral outfit as Da Silveira styled her hair.
Providing this kind of support has taken a toll on the mental health of some stylists, despite receiving therapy once a month courtesy of the Bluemind Foundation.
“I can listen and…”