Joseline de Lima was wandering the dusty alleys of her working-class neighborhood in the capital of Togo one day last year, when a disturbing thought crossed her mind: Who would take care of her two boys if her depression worsened and she were no longer around to look after 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 recalled thinking.
Help came instead from an unexpected counselor: Ms. de Lima’s hairdresser, who had noticed her erratic walks in the neighborhood and provided a safe space to share her struggles amid the curly wigs hanging from colorful shelves and the bright neon lights of her small salon in Lomé, Togo’s capital.
The hairdresser, Tele da Silveira, is one of about 150 women who have received mental health training in West and Central African cities from a nonprofit trying to fill a critical gap: provide mental health care in one of the world’s poorest regions, where counseling remains barely accessible, let alone accepted.
Ms. da Silveira began with gentle questions and encouraging words as she braided or blow-dried Ms. de Lima’s salt-and-pepper hair. More careful listening followed, then the suggestions for new braiding styles and walks to a nearby lagoon, which Ms. de Lima described as “lifesaving therapy.”
“People need attention in this world,” said Ms. da Silveira. “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 Africa region as the one with the highest suicide rate in the world and some of the lowest public expenditures on mental health. The region has an average of 1.6 mental health workers per 100,000 people, while the global median is 13, according to the W.H.O.
Mental health crises are exacerbated by violent conflicts in countries like Sudan, Somalia, the Democratic Republic of Congo, Ethiopia and in the Sahel region; by rising drug use in many large cities; and by widespread youth unemployment, displacement from the extreme effects of climate change and soaring inflation.
In Togo, a tiny coastal nation on the Gulf of Guinea, there is little awareness of mental health therapy, whether in the seaside capital or its villages in the hilly north. The country has only five psychiatrists for more than eight million people. Families seeking to treat a relative suffering from severe mental health issues often resort to traditional remedies or forced isolation, including shackling some with schizophrenia in the precincts of religious institutions or clinics.
“Many of those coming to see us do so as a last resort, after they’ve been stripped of their money by traditional healers and scammers,” said Daméga Wouenkourama, one of Togo’s five psychiatrists. “Mental health remains a foreign concept to most people, including our leaders and our fellow doctors.”
To contend with 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, even grandmothers, in spotting mental health troubles, from early signs of depression to post-traumatic stress disorder.
In West and Central Africa, hairdressers have been the latest to join that fight. Hair salons have long been used by nonprofits and community groups as places to raise awareness around issues like reproductive health among clients and apprentices. Visits there are inexpensive — sometimes as little as $2 — and a favored gathering place among women.
Mental health professionals are now providing hairdressers three days of training in which they learn how to ask open-ended questions, spot nonverbal signs of distress like headaches or disheveled clothes and, critically, how not to gossip or give detrimental advice.
In interviews, half a dozen hairdressers said that as clients get their hair unbraided or add hair extensions, many shared their financial struggles or emotional pain around the loss of a loved one. More often, though, clients refer to having “household problems” — a euphemism for domestic violence.
“Clients come and cry in front of us — we hear everything,” said Adama Adaku, a buoyant hairdresser with a wide smile and braids made of red wool, 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 killed in 2012 while they lived in Cameroon. Her hairdresser was by her side in the hours that followed 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,” Ms. de Putter said. “We go where women are.”
Some 150 hairdressers have so far received the honorary title of “mental health ambassador” by Ms. de Putter’s organization after undergoing the training in Lomé and in Ivory Coast and Cameroon. Ghana, Rwanda and Senegal are next.
Because they are not professional counselors, hairdressers often refer struggling clients to trained therapists. But most of the hairdressers said that their clients found 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 unequal.
Several African countries have in the past decade pledged to better tackle mental health disorders. Last year, Uganda’s Health Ministry reported that nearly one in three Ugandans suffered from mental health problems. Countries like Sierra Leone and Ghana have vowed to replace shackles with professional treatments. Mental health care often comes last, or is entirely neglected, as it is in many countries in the global south.
“People are becoming aware of mental health issues,” said Dr. Sonia Kanékatoua, Togo’s only female psychiatrist. “But social stigma remains.”
On a recent morning, she and three of Togo’s other psychiatrists 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 suffering from depression, stress and addictions, among other issues.
Back in Lomé, Ms. de Lima now comes a few times a month to Ms. da Silveira’s salon, a block away from her home. Ms. de Lima, 54, has heeded her hairdresser’s advice to listen to religious music — both are Christians — and has resumed soothing walks to the nearby lagoon that she previously hadn’t had the energy to reach. She said she was hoping to sell a plot of land and use some of the proceeds for therapy, on the recommendation of her hairdresser.
“She saw something in me that I couldn’t get out,” Ms. de Lima said, wearing a flowery outfit as Ms. da Silveira combed her hair.
Providing counseling has taken a toll on the mental health of some of the hairdressers, even though they themselves get therapy once a month courtesy of the Bluemind foundation.
“I can listen and do some talking, but comes a point where I can’t help anymore,” said Ms. da Silveira one morning as she sat outside her salon. She said that she herself had suffered from depression.
Puppies were playing at her feet with a tuft of fake hair. A client was waiting inside. With a soft smile, Ms. da Silveira asked, “Why does it feel like everyone suffers from mental health issues?”
