If the sign at the mental health clinic read, “Services for mad people,” would you walk in for help?

Yet that is the reality for many people in northeast Nigeria because of the difficulty in translating concepts like ‘mental health’ into Nigerian languages. Translators without Borders (TWB) is working with humanitarian experts in mental health to better understand the nuances among languages so that words can encourage use of services rather than hinder access.

Northeast Nigeria is linguistically diverse, with more than 30 mother tongues spoken by 1.9 million people displaced by conflict. Often traumatized by the conflict, many internally displaced people (IDPs) could benefit from mental health services. Yet the translation of ‘mental health’ into the main two languages used in the response – Hausa and Kanuri – carries a heavy stigma, possibly keeping people away from clinics.

How can those working in the mental health and psychosocial support (MHPSS) sector communicate information about services, when the very name of the sector scares people away?

To address this question, TWB worked with affected people and sector specialists to identify terms that need to be communicated more effectively. The resulting terminology recommendations and the proposed language glossary, with terms translated into Hausa and Kanuri, promote the use of unambiguous and less stigmatizing language. Use of these terms may, by extension, increase the use of services by those who need them.  

TWB began by identifying 301 key mental health terms that are either difficult to translate, commonly misunderstood, or stigmatizing.

This list was then researched and discussed extensively. TWB facilitated a workshop with the International Organization for Migration (IOM) MHPSS specialists to identify particularly difficult words and discuss alternative translations, aiming to use plain language and to avoid words that stigmatize. A group of 53 internally displaced people then reviewed the translations. TWB tested comprehension among the group and explored alternative translations. Throughout the process, TWB discovered key areas where language posed a significant challenge in the delivery of mental health and psychosocial support services.

Points of confusion

One major finding was that many terms commonly used by English speakers when discussing mental health are heavily stigmatized or misunderstood in northeast Nigeria. “Mental health” in Hausa is literally “services for mad people” — a shocking example of stigma. An alternative way of discussing this sector may lie with the phrase “psychosocial support,” which TWB discovered did not carry the same stigma in Hausa.

Generic terms such as “abuse” and “stress” caused confusion as there is often not a comparable generic term in Hausa or Kanuri. In both languages, the translation of “abuse” was generally understood by respondents to refer only to ‘verbal abuse,’ similar to an insult. Similarly, “stress” meant only physical stress to respondents, such as the physical strain you feel after a day of hard labor. If an aid worker intends to communicate how to relieve “mental stress” or how to heal after experiencing “physical abuse,” it’s clear that miscommunication may occur. Therefore, it is best to always pair descriptive words like “physical,” “verbal,” or “emotional,” with “abuse” and “stress.”

A similar issue was found with the concept of a “safe space.” When used in an English-speaking mental health context, it refers to a physical space where one feels cared for and emotionally supported. However, those surveyed understood this concept as a place with armed guards. This is an example of how sector-specific jargon may not make sense to those who need services. In northeast Nigeria, the concept “accepted space” may translate better.

The TWB MHPSS Glossary

“This is a very laudable work that will hasten the delivery of services to the affected people of north east Nigeria.”  
– Dr. Muhammad A. Ghuluze. Director, Emergency Medical Response and Humanitarian Services

To provide a solution for these issues, TWB has updated its Glossary for Nigeria with the 301 MHPSS-related terms. This glossary app includes words, definitions, sample sentences, and audio recordings for the selected terms. It can be accessed on a computer, tablet, Android, or iOS device, and can be used both on- and offline, which is useful given the poor connectivity in northeast Nigeria.

The app is already being used in training sessions with positive results. Thomas Eliyahu Zanghellin, theMental Health and Psychosocial Support / Gender-based Violence Focal Point for the NGO INTERSOS in Maiduguri, Nigeria, has used the glossary in four training sessions already, generating “really fun group work with stimulating discussions.”

Language and terminology play a key role in the delivery of aid. Many sectors, including mental health and psychosocial support, use jargon and generic terms that do not readily translate in some cultures. Discussions about language allow the humanitarian world to challenge this terminology. The TWB Glossary for Nigeria provides a potential solution, allowing affected communities to access services and claim their rights in a language they understand.

Learn more about the TWB Glossary for Nigeria, and other TWB glossary projects here.