As part of the Guardian’s new mental health series, psychiatrists and psychologists from around the globe talk about the view from the couch

‘People with psychosis usually end up with a healer’: Nigeria

Oye Gureje, professor of psychiatry

Banditry, terrorism and kidnapping are on the rise in Nigeria, and life is not getting any less chaotic in our cities. These are factors that predispose mental health problems, and although we don’t have good survey data on this, we probably have more problems than other countries.

We have 250 psychiatrists serving 200 million people. That’s barely one per million – an incredibly low number.

For most Nigerians with common mental disorders like depression, anxiety, PTSD or some degree of substance-use disorder, the chances are that they will never get treatment.

If they have the most severe mental disorders like psychosis, then most will end up with either a faith healer – usually Pentecostal or Islamic – or a traditional healer.

They use herbs and apparently some of them are efficacious. They use rituals, sacrifices, prayer, fasting, holy oil and holy water, but also things that are potentially harmful, like shackling, beating, prolonged fasting and scarification.

We found that in Ibadan, a fairly well resourced city of about 2.5 million people, we had about 90 places for admission for mental illness, whereas healers had just over 400 places. So irrespective of what we feel about what they’re doing, what we need to do is look at how we can improve the service they offer.

Not acknowledging a mental health problem doesn’t stop it manifesting in other ways, and there seems to be a rising tide of suicides across the country. Whether there really is more suicide or whether it’s just considered more newsworthy at the moment, I don’t know.

We can’t train hundreds more psychiatrists overnight. But the government needs to pay more attention, to improve policy and implement programmes, and they can do that with the resources already available. And we need to train up our primary care providers to recognise and treat common mental disorders. As told to Ruth Maclean

Oye Gureje is professor of psychiatry at the University of Ibadan, and director of the WHO’s Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse

‘One psychologist recommended reading Tolstoy’: Russia

Vitaly Sonkin, psychologist

There’s a fair amount of scepticism toward psychiatry in Russia because it is seen as being used for official purposes. People are worried that you will be put on a government registry [of those with psychological issues]. It’s associated with formal procedures –whether you can serve in the army or drive – or even as a way to punish people for dissent.

But thanks to the media and also a lot of popular films and books, psychotherapy is becoming more mainstream and less marginalised here. Especially among hipsters, the young creative class, it’s seen as a sign of caring for yourself. I work with highly motivated patients and have a long waiting list.

Russians have got used to a harsher way of being treated by doctors Vitaly Sonkin, psychologist

That’s still a small slice of society. For many other Russians, psychotherapy is still a curiosity. Therapy is far more popular and available in big cities like Moscow than in more remote areas of Russia.

I hear a lot of stories. One client told me she had been to a psychologist who started recommending books that she should start reading: classics like Tolstoy and Chekhov. The doctor said it would tell the story of her life and could serve as a model for how to behave. Obviously that doesn’t work.

Antidepressants are becoming more popular and the growth in their use is somewhat chaotic. Since people don’t really trust psychiatrists, some prescribe themselves antidepressants. It’s not hard to get your hands on them via the internet.

I’ve studied abroad in the west, and I don’t think that Russians require a different approach. But I do think Russians have got used to a harsher way of being treated by doctors. And then when you use a more humane approach, they immediately say, “Yes, that’s what I wanted.” As told to Andrew Roth

‘Social media is increasing levels of anxiety’: Egypt

Salima Barakat, psychologist, Cairo

There are still stigmas about mental health treatment in Egypt. One is that once you start treatment, it will open up a can of worms and you’ll never be able to get out of it. Another is that having treatment makes you weak, or “crazy”, in a way that could affect your work, or your chances of getting married. But these are lessening with time.

The state of Egyptian mental health has changed a lot since I graduated in 2001. I don’t want to use the word better, but it’s certainly developing in terms of the training that practitioners and nurses get, for in-patient treatment.

The main problem that I tend to treat is anxiety, and this is definitely increasing. There are several reasons for this. One is the 2011 revolution in Egypt and everything that came along with it, but also the invention of smartphones. Worldwide, the increasing use of technology and social media is definitely increasing their levels of anxiety.

I operate on a sliding scale based on what people can afford Salima Barakat, psychologist, Cairo

My observation is that there’s a clear generational divide in the patients I see. Younger patients tend to be more aware about therapies as a rule. While whether someone was pro-revolution or not doesn’t determine if they have anxiety, the younger pro-revolution generation that wanted to make a difference has been more focused on their mental health in the eight years since.

There’s certainly a need and a demand for mental health services in Egypt. It’s not an easy place to live, especially right now with the country undergoing tough austerity measures. But there are a range of talking therapies on offer from CBT to existential therapy.

There are public and private options. Still, it’s safe to say that I see the people who can afford to pay, and while sessions aren’t cheap I do operate on a sliding scale based on what people can afford. I think many providers do the same here.

In the end, it’s not about how much money someone has. Sometimes I see wealthy people where their level of awareness about mental health is limited due to their upbringing and mentality, while someone with fewer means is more exposed because they’re online more, or they’re younger. As told to Ruth Michaelson

‘We have a lot of absent parents’: China

Dr George Hu, chief of mental health, Shanghai United Family Pudong Hospital

I see almost anyone and everyone, but more than half of my patients are children and adolescents. They most often present with anxiety, depression and suicidal behaviour, which can manifest as learning problems, attention and hyperactivity difficulties, and behavioural problems. These symptoms arise from a variety of sources, but they often come from a difficulty in their relationship with their parents. We have a lot of absent parents who have not been able to prioritise their relationship with their children.

In China now we have a large middle class, as well as people who are very poor, and people who are very rich. What we’re seeing is that the two tails of the bell curve are coming closer together in terms of mental health difficulties. Obviously there are galactic differences in income and lifestyle, but whether you’re a CEO or a migrant worker, if you live apart from your children and only see them twice a month, it’s going to cause the same stress. In an effort to provide a lavish and advantageous lifestyle, the rich are inadvertently causing themselves many of the same problems as the poor.

There’s definitely a change in attitudes to mental health, which used to be a taboo subject. The Chinese public system has rolled out resource access to 1.4 billion people in a way that’s unprecedented. Where there’s room for improvement is in access to psychotherapy as a valid mental healthcare treatment, in complement with psychiatry. It’s very much on the radar, but psychotherapy takes time and training, there are a lot of moving parts.

I think technology will lead the way to increase access to psychotherapy. Attitudes to technology are much more open in China, and there are no old, established ways to push against. I’ve been able to establish a distance psychotherapy practice that would face significant hurdles in the US.

There’s a lot of work to do, but we’re in an exciting place. As told to Andrew Killeen



’Public hospitals often run out of psychiatric drugs’: Argentina

Juan Tenconi, former president of the Argentine Association of Psychiatrists

Argentina far outranks any other country in the world with its number of psychologists. Here, we have 223 psychologists per 100,000 inhabitants, while second-ranking Netherlands clocks in at only 123, Germany 50 and the USA 30, according to the World Health Organization.

This means that, if you are suffering from a mild neurosis, if you want to know yourself better or are seeking to improve yourself, you are in a fantastic situation in terms of mental healthcare.

On the other hand, if you have a low income and a severe mental condition and are forced to rely on the public medical system you may find yourself in a problem, depending to a large extent on where you live.

The public health system is overstretched and underfinanced. Some provinces have very good mental healthcare, but far from all of them. Public hospitals will often run out of psychiatric drugs, just the same as they run out of penicillin or medical gauze.

One of the main problems is there are no separate wards for mental health patients, so someone with a case of schizophrenia can end up in the same room as a patient who’s just had a heart attack, with all the trauma this can cause both patients.

So if you are living in a shanty town and have a severe condition you may end up interned in inadequate facilities.

The problem could be compounded soon by the new national health law that foresees closing down the old psychiatric hospitals during 2020. This will throw a large number of patients out on the street: many of them will end up homeless.As told to Uki Goñi

‘There is still entrenched prejudice toward psychotherapy’: Italy

Alberto Pellai, psychotherapist and researcher, University of Milan

Mental illnesses are on the rise among Italians. The most common and widespread disorder is depression. However, despite Italy’s intermediate ranking among European countries, numbers do not reflect the true scope of the problem. Stats do not consider individuals who continue to believe that seeking the help of a psychologist or psychiatrist is for “crazy” people. There is still an entrenched cultural prejudice in Italy toward psychotherapy and antidepressants, which are viewed as ineffective or only for people who have lost their mind.

The use of antidepressants is rising too, as are mental illnesses among adolescents. Among teenagers and their European cohort social isolation syndrome is increasing. Their lives play out entirely in their bedrooms. They inhabit a virtual world, glued to their computer or mobile phone screens. This has led to a growing challenge for young people to socialise.

Unfortunately, there is no diversification of psychological illnesses on the basis of seriousness, and the requests for care or consultation are so numerous that the waiting period can last months. If a man who has attempted suicide goes to hospital, then automatically doctors accelerate the process and he will receive immediate psychological assistance. But what if the men and women who suffer from depression [haven’t got to that stage yet]?

… Those suffering from less grave disturbances, such as attention deficit disorders or hyperactivity, risk bypassing others with serious signs of depression. The risk is that someone with suicidal tendencies goes from thought to action before receiving psychotherapeutic help in a public facility. As told to Lorenzo Tondo