By Caitlin Clark
Sadat Abiri ’99, MSN ’10, MPH ’12 arrived in Cooper Hall at 5:30 pm on a Wednesday in early June. She came straight from her 10-hour day at Madison’s Journey Mental Health Center, where she is a psychiatric nurse practitioner. A mental health advocate, particularly for immigrants and the homeless, she is eager to talk about her work to treat patients and de-stigmatize mental illness. She moves slowly but deliberately, exchanges a warm greeting, and then collapses into the chair offered to her. She’s clearly exhausted from her long day, but after taking a moment to catch her breath, she is ready to talk about her work.
Abiri immigrated to the United States from Nigeria in 1981 when her then-husband was a student. While she doesn’t go into detail, she says that her husband became physically abusive, and she realized she needed to “pull [her] life together” and go back to school for nursing in 1992.
Now a psychiatric/mental health nurse practitioner at Journey Mental Health, Abiri regularly draws upon her personal history with domestic violence as well as another family member’s mental illness in her practice. She hopes her honesty about her experience makes her more accessible and relatable to patients and make it easier to shed the shame they may harbor about their mental health struggles and become more open to treatment and assistance. “They are not a burden. People helped me [too]. [I tell them] ‘Here’s my story and here’s my experience’…and I think saying that helps them feel quite sure that ‘Yes, she’s going to help me,’” Abiri says.
Abiri discovered her interest in psychiatric nursing during an undergraduate community mental health clinical rotation at Dane County Mental Health (now Journey Mental Health). She did a second independent clinical rotation at Dane County Mental Health and later worked there briefly after graduation before moving to St. Mary’s Hospital.
Her commitment to mental health awareness and advocacy extends beyond her clinical practice. After recognizing a need for culturally specific support, Abiri created and continues to run a monthly faith support group for Muslim women facing oppression or domestic violence at home. She has even helped individuals personally when they had no family or friends to turn to for assistance, including one woman from this group who made the decision to leave her abusive husband. Without any of her own credit, the woman could not find housing. Abiri stepped in, using her personal credit to cosign on a home.
“I put my own credit on the line because I felt she could pay, but because she’s never really established credit, she couldn’t find housing. So I co-signed for a year and a year later, she was able to buy her own house,” Abiri says.
Mental Health Stigma in Nigeria
Early in her practice, Abiri realized that she could not individually assist everyone she wanted to help. To confront stigma and expand access to mental health services, she knew systems and attitudes would have to change.
So Abiri again went back to school for a master’s degree in public health and certificate in global health. In 2009, Abiri traveled back to Nigeria to complete her MPH fieldwork. She found herself at Federal Neuro-Psychiatric Hospital, the largest mental health hospital in Nigeria, where she witnessed the pervasive and damaging stigma of mental illness first-hand. Families, she says, hid relatives with mental illness from society. Parents, particularly mothers, were treated as though a child’s mental illness was karmic punishment for the parent’s poor behavior. Even worse, some people were chained and treated like criminals. “There were places I went where people were shackled with rusted iron rods to trees,” Abiri says, appalled by the scenes she witnessed.
Little has changed, Abiri says, in the ten years since she finished her fieldwork. The stigma is still pervasive and profound, affecting both the willingness to seek treatment and the availability of it. Villages often have only one psychiatrist to treat 100,000 patients, and overflow patients are often referred to traditional healers who are ill-prepared to treat mental illness. And yet most who are suffering never seek help at all. Abiri wants to see that change.
Linda Oakley, a professor in the School of Nursing and one of Abiri’s advisors, says Abiri was always cognizant that the problem was on a scale far bigger than the patient. “[She recognized that] you’re not going to make a difference one person at a time, one country at a time, one hospital at a time,” Oakley says.
Yet Oakley adds that instead of being daunted by the size of the problem or her capacity to resolve it, Abiri was fearless and determined. “[She has this] ability to conceptualize how to make this issue global, how to make it something. It never occurred to her as a nurse that maybe this might be difficult,” Oakley says. “You have to admire somebody [like that].”
Global Mental Health Learning Exchange
After returning from Africa, Abiri published her fieldwork report and has remained in contact with the mental health professionals she met in Nigeria. At first, she did not have a definite plan on what to do or how, but she knew she would have to leverage the connections she made. “My goal in the beginning was to—and I knew this was a long shot—to just find leaders in their country to change policies and to take a tiny fraction of what’s allocated for mental health to bring this awareness out,” says Abiri.
Over time, Abiri realized that opportunities to discuss and influence mental health policy would not present themselves. And if she wanted to change attitudes and practices in Nigeria, she was going to have to start the conversation herself.
Her perceptions are accurate. Nurses are often excluded from healthcare policy discussions, especially those regarding mental health.
So, with the help of Oakley and a visiting scholars grant from the UW African Studies department, Abiri is bringing leaders and psychiatrists from Nigeria, Uganda and Ethiopia to Madison to continue their conversations about the global need to dispel myths and stigma and to increase access to mental health care.
During the two-week learning exchange, the group of international professionals will tour mental health facilities in Milwaukee and Madison and meet with local mental health care providers to collaborate on ways to reduce stigma and improve mental health care policies and practices. Their visit will culminate with two public lectures—Unlocking Mental Health Care and Global Psychiatry Grand Rounds—Critical Cases in Community-based Care—where Abiri will bring a nurse’s voice to the conversation.
Read more about the learning exchange and lectures.