Mental Health Is Health: Breaking the Stigma in Somalia
Mental health is health. But for millions of people, stigma can become a barrier to receiving it.
Mental health conditions are among the most important public health challenges of the 21st century. In 2025, the World Health Organization (WHO) reported that more than 1 billion people worldwide were living with a mental health condition, while most people affected still did not receive adequate care.
Behind these numbers are people living with depression, anxiety, post-traumatic stress disorder (PTSD), bipolar disorder, psychosis, substance-use disorders and other conditions.
Yet the problem is not only a shortage of services.
For many people, stigma itself becomes a barrier to care.
Fear of being judged, rejected, discriminated against, labeled as "crazy," considered weak, or excluded from family and community life can prevent people from talking about their symptoms or seeking professional support.
This is why mental health stigma should not be viewed merely as a cultural or social problem.
It is a public health problem.
What Is Mental Health Stigma?
Mental health stigma refers to negative attitudes, stereotypes, shame and discrimination toward people experiencing mental health conditions.
Stigma can take several forms.
Public stigma refers to negative attitudes, stereotypes and discriminatory behavior toward people with mental health conditions.
Self-stigma occurs when people internalize negative beliefs about mental illness and develop feelings of shame or believe that seeking help means they are weak.
Institutional stigma occurs when policies, practices or systems create disadvantages for people experiencing mental health conditions.
People may also experience anticipated stigma—fear that others will judge, reject or discriminate against them if they disclose their mental health difficulties.
It may cause people to:
Hide their symptoms
Avoid healthcare services
Fear being labeled "crazy"
Withdraw from family and community
Delay diagnosis and treatment
Experience discrimination at school or work
Stigma can therefore turn a health condition into a wider social and public-health problem.
The Stigma Cycle
Stigma can create a cycle:
Symptoms → Fear of stigma → Silence or concealment → Delayed help-seeking → Prolonged or worsening condition → Greater social burden
Breaking this cycle requires changing attitudes while also ensuring that appropriate mental-health services are available and accessible.
Why Is Stigma a Public Health Issue?
When people are afraid to seek help, conditions may remain untreated for longer.
This can affect:
Mental health → Physical health → Family relationships → Education → Employment → Social participation
Stigma can also reinforce a cycle:
Symptoms → Fear of stigma → Silence → Delayed care → Worsening condition → Greater social burden
However, stigma is only one of several barriers to mental-health service use.
People may also face limited availability of mental-health professionals, cost of care, transportation difficulties, conflict and insecurity, displacement, humanitarian emergencies, limited awareness of available services, and shortages of medicines and psychosocial interventions.
Reducing stigma is therefore important, but it must be accompanied by efforts to make mental-health care available, affordable, accessible and acceptable.
Self-Stigma
Self-stigma occurs when people internalize negative beliefs about mental illness.
A person may think:
"If I ask for help, people will think I am weak."
Or:
"I should be able to deal with this myself."
These beliefs can lead to shame, secrecy, social withdrawal and delayed treatment.
What Does Research Tell Us About Somalia?
The evidence from Somalia is particularly important because mental-health stigma is documented in research rather than being simply an assumption about Somali culture.
A 2024 qualitative study conducted in Somalia explored perceptions and experiences of mental health after decades of humanitarian crises. Participants and key informants identified stigma, poor awareness and inadequate services as major barriers to care.
The study also reported that people may seek traditional or religious forms of support before accessing formal mental-health services.
However, seeking help from religious leaders or traditional healers does not necessarily indicate stigma.
People may seek support from these sources because they are trusted, accessible, affordable, culturally familiar or available when professional mental-health services are limited.
This also creates an opportunity for collaboration.
Religious leaders and traditional healers can receive basic mental-health awareness and training so they can recognize warning signs, provide appropriate initial support and become potential referral partners when professional assessment or treatment is needed.
The researchers concluded that Somalia needs greater mental-health awareness, more trained professionals and interventions specifically addressing barriers to care, including stigma.
Mental Health Among Displaced People in Mogadishu
Research among internally displaced people (IDPs) in Mogadishu also illustrates the scale of need among vulnerable populations.
A 2024 study involving 522 adults living in 10 IDP camps in Daynile and Kahda districts of Banadir reported anxiety symptoms in 43.7% of participants and depression symptoms in 35.8%.
Another study among 401 IDPs in Mogadishu found that approximately 59% met the study's symptom criteria for depression and nearly 32% met criteria for PTSD.
These findings need to be interpreted carefully.
The reported percentages refer to symptoms or screening results within specific study populations. They should not be interpreted as the percentage of all Somalis who have clinically diagnosed anxiety, depression or PTSD.
A screening tool can identify people who have symptoms and may require further assessment. A clinical diagnosis requires an appropriate assessment by a qualified healthcare professional using established diagnostic criteria.
This distinction is important when communicating mental-health research to the public.
These studies are population-specific and should not be generalized to all Somalis.
But together they illustrate an important public health reality:
There is a substantial mental health need among some highly vulnerable populations, while access to services remains limited.
Stigma and Somali Communities
Research among Somali communities outside Somalia also provides useful evidence.
A qualitative study among Somalis in the United Kingdom found strong community stigma surrounding mental illness, with participants describing people with mental-health conditions as being viewed negatively and identifying stigma as a barrier to accessing healthcare. The researchers emphasized culturally appropriate services and stronger trust between Somali communities and healthcare professionals.
A 2024 study of Somali women in London similarly identified judgment, shame, stigma and secrecy as important influences on attitudes toward mental health and help-seeking. Participants also identified faith and family as important sources of support.
These findings should not be automatically generalized to every Somali community, but together they show that stigma and cultural understandings of mental health are important considerations in designing services.
Somalia's Mental Health Service Gap
The stigma problem exists alongside a major shortage of mental-health services.
WHO's Mental Health Atlas 2024 Somalia profile reports only about 1.3 mental-health workers per 100,000 population, including approximately 0.1 psychiatrists, 0.4 psychologists and 0.2 mental-health nurses per 100,000. Less than 10% of primary-care facilities reported availability of essential mental-health medicines and psychosocial interventions.
This means Somalia faces several interconnected challenges:
People may hesitate to seek mental-health care because of stigma, while appropriate services may also be limited by shortages of trained professionals, cost, conflict, displacement and inadequate availability of medicines and psychosocial support.
Addressing only one of these problems will not be enough.
How Can We Reduce Mental Health Stigma?
1. Improve mental-health literacy
Communities need accurate information about depression, anxiety, PTSD, psychosis, suicide prevention and when to seek help.
2. Integrate mental health into primary healthcare
People should be able to discuss mental health within ordinary healthcare settings rather than feeling that visiting a psychiatric service automatically identifies them as "mentally ill."
3. Train healthcare workers
Doctors, nurses, community health workers and other frontline staff need training in recognition, communication, psychological support and referral.
4. Engage communities and religious leaders
Faith and community structures are important sources of support for many Somali families. Religious leaders and traditional sources of support can be engaged through appropriate mental-health awareness and referral training, helping them recognize when someone may need professional assessment or treatment.
5. Listen to people with lived experience
People who have experienced mental-health conditions should participate in awareness campaigns, service design and policy discussions.
6. Use responsible language
Instead of saying:
❌ "He is crazy."
say:
✅ "He may be experiencing a mental-health condition and may need support."
Instead of:
❌ "She is weak."
say:
✅ "She may need support and professional care."
Instead of:
❌ "Don't tell anyone."
say:
✅ "Let's find someone qualified who can help."
Instead of:
❌ "Mental illness is something to hide."
say:
✅ "Mental health is part of health."
These may appear to be small changes.
But public health often begins with changes in how societies understand health.
The Public Health Message
Mental health stigma is not simply a matter of changing people's attitudes.
It can influence whether a person:
recognizes a problem → seeks help → receives treatment → recovers → remains socially included.
But whether someone receives care also depends on whether services are available, affordable, accessible and safe.
For Somalia, the response needs to combine mental-health awareness, stigma reduction, stronger primary healthcare, trained professionals, community-based services, better referral systems and better national data.
Most importantly, mental health should be treated as an essential part of health—not something that should be hidden.
Conclusion: Mental Health Is Health
The global mental health challenge is enormous.
More than 1 billion people are living with mental health conditions, while large gaps remain between the need for care and the services available.
In Somalia, the challenge is compounded by conflict, displacement, humanitarian needs, limited services, workforce shortages and major gaps in national mental health data.
But stigma is not the only barrier to care, and reducing stigma alone will not close the treatment gap.
We can change how mental health is discussed.
We can train healthcare workers.
We can strengthen primary healthcare.
We can engage communities and religious leaders.
We can improve referral pathways and access to appropriate services.
We can protect people from discrimination.
We can listen to people with lived experience.
And we can treat mental health as an essential component of public health rather than an issue that should remain hidden.
Mental health is not a luxury.
Mental health is not a weakness.
Mental health is not something to be ashamed of.
Mental health is health.
And protecting mental health is a public health responsibility.
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