Africa has the highest suicide rate in the world, but mental illness remains taboo. A scheme that trains hairdressers across west Africa in counselling is shifting the narrative around mental health one braid at a time
When Marie-Alix de Putter’s husband was murdered in Cameroon 12 years ago, her hairdresser was by her side to ease the pain of grief. De Putter was four months pregnant and became deeply depressed, but the power of her relationship with her hairdresser – alongside extensive psychotherapy – gave her the strength and emotional support “to stay alive”, de Putter recalls.
Inspired by her experience, she founded Heal by Hair, an initiative that has trained around 150 hairdressers across Togo, Ivory Coast and Cameroon in west Africa to counsel their clients – all while getting their hair, nails and facials done. Unlike in Europe, where women tend to visit their salons less frequently, many African women regularly spend hours getting their hair washed and braided.
“The biggest challenge was to convince the hairdressers of their value,” de Putter says. “They didn’t believe me when I told them what they do is important for their community.” Yet often, they are the only source of support.
Nowhere in the world is the so-called ‘mental health gap’ wider than in Africa. Between 85% and 95% of people with severe mental health conditions don’t have access to any type of care. Meanwhile, the World Health Organization classifies Africa as the region with the highest suicide rate globally, accounting for about 75% of global deaths by suicide. Among young people on the continent, it is the second most common cause of death, following road traffic accidents.
“It’s a crisis for the future of Africa”, says Prof Taiwo Lateef Sheikh, psychiatrist at the University of Ahmadu Bello University in Nigeria and faculty member at Harvard Medical School. When young people drop out of the workforce because of mental illnesses “it’s killing our collective existence”.
While men more often die from suicide, women suffer the majority of cases of depression. But in a region that only has 1.6 mental health workers per 100,000 people – the global median being 13 – neither have sufficient access to any type of professional care while navigating a mental health crisis.
Marie-Alix de Putter founded Heal by Hair after her husband was murdered
That’s where community-led projects like de Putter’s step in. In her small salon next to a busy street in Abidjan, Ivory Coast’s economic hub, Ariatou Ouédraogo washes a client’s hair. Two fans spin the humid 34-degree air around the pair. Dozens of doll heads and wigs line the walls, each staring in a different direction. “I really want to leave,” the client says while making eye contact with Ouédraogo in the mirror in front of her. “I just can’t stand being married to him any more. I suffer too much.” Her eyes are red, the skin underneath swollen.
Ouédraogo received the title of mental health ambassador after a three-day training course led by the nonprofit Bluemind Foundation. She learned to spot subtle signs of distress and how to ask open-ended questions that encourage people to open up. Many of her clients refer to ‘household issues’, which often including emotional and physical violence, marital problems or substance abuse.
In Ivory Coast, there is little awareness of the benefits of therapy. It’s too expensive for most of the population and still carries a great deal of stigma and fear of social exclusion. While the WHO recommends a ratio of one therapist per 5,000 people, the coastal country only has 50 for its population of more than 29 million. Meanwhile, many Ivorians continue to struggle in the aftermath of the country’s two brutal civil wars. Inflation, a lack of jobs for young people, drug and alcohol abuse and the impact of the climate crisis all contribute to the mental health crisis. Ivory Coast has one of the highest suicide rates on the continent.
Ariatou Ouédraogo with one of her clients in Abidjan. Image: Germain Kouassi
While hairdressers and similar community-led initiatives are limited to providing basic help and first aid, they make up a crucial pillar to address the continent’s mental health gap. “We’re starting with zero”, notes Prof Lateef Sheikh, who advises governments to reform their policies and legislation to improve their mental health systems. “So, training mental health champions is a really important part”.
“This is the only place I can go to,” Ouédraogo’s client says. “Without Ariatou, I wouldn’t know what to do.” Many of her clients have now become ‘sisters’ who go to the beach or exercise together – strategies to help keep their mental health in check.
De Putter plans to further expand her project across west Africa and beyond, even to Spain, Portugal and France. Meanwhile, her Ivorian mental health ambassadors are spreading their knowledge in and outside their salons.
Aya Estelle Tchimou, 38
“Life at home is difficult for many women in Ivory Coast. Their husbands beat them up or leave them for an affair. They see all the messages and calls from the new woman and feel unwanted, they don’t feel beautiful any more. Once, my client’s husband followed her to my salon to beat her up. I was trying to settle the argument but there is little I can do. These situations hurt me a lot because I want my clients to be empowered.
I left my husband because he was beating me, but I managed to rent a studio for myself and my son, I run the salon, I make it work. That’s what I’m passing on to my clients. They don’t have to stay in an abusive relationship. I want to be an example for them and other women. So, often they are sad when they arrive for their appointments, but happier when they leave.
Minata Silué Sorho, 63
“I became a hairdresser because I like to make women look beautiful. I love beauty. That’s what puts us in the spotlight. Before I received the training, I would judge my clients for how they were handling their problems. But now I know that when they trust me, I have to keep the secret and listen to calm their hearts. I’ve become a true mental health ambassador. I don’t just talk to my clients, but I talk to everyone in society about depression and other mental illnesses. It’s a noble job.”
Esmel Semou, 50
“People in Ivory Coast are scared of those with mental health problems. They stay away from them, but I get very close. One of my clients was very ill, she even undressed herself outside of the house. She wanted to kill her own children and her husband, she even put poison into their food. I helped her find a specialist who prescribed some medication. She is doing much better now. Becoming a mental health ambassador has helped my own life, too. Like many young people, my sons are addicted to drugs. I wanted to be a good mother and educate them, but I didn’t know how to communicate with them without starting a fight. The training helped me to give them what I couldn’t show before, the gift of love.”
Ariatou Ouédraogo, 32
“Through my work as a mental health ambassador I learned that depression can come very easily. I felt it myself. When I was a child, my little brother died in front of my eyes. I always thought it had been my fault and carried the guilt with me. It was very heavy. But now I know what to do to feel better: I go out and exercise a lot, I take my children to the beach, read books and free myself through music. I learned to hang on with life and pass this on to my clients. I put myself in their shoes, because we’re all the same, we’re all equal. Most of them have issues at home with their husbands. I now organise little trips to the beach, so we can have fun together.”
Thérèse Gueu, 55
“I was shocked when I started my training because I thought having issues with your mental health meant that you’re crazy. But then I learned that everyone has problems and when you have someone you can trust, it will get better. One of my clients today was very quiet, more so than usual. So, I encouraged her to talk to me. I have a special relationship with the women who come to my salon and always make them laugh. It helps them forget their problems for a while.”
Marie Chantal Kouassi, 43
“I really saw a change in my clients after I became a mental health ambassador. I can now spot the signs when someone has depression. They feel very sad, but I can also see changes in their hair – it often falls out. But sometimes they get violent when I point it out to them. I then explain that I’ve been trained and certified, that they can trust me. The next time they come, they are already more open-minded. But I also learned that in order to help others I need to heal myself first. I’m a single mother and life gets tough, especially towards the end of the month. Now I sing when my worries overwhelm me.”
Main image: Hairdresser and mental health ambassador Aya Estelle Tchimou. Credit: Germain Kouassi
Developing mental wealth is a series produced by Positive News and funded by the European Journalism Centre, through the Solutions Journalism Accelerator. This fund is supported by the Bill & Melinda Gates Foundation
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