One day last year, Joseline de Lima was strolling through the dusty streets of her working-class neighborhood in Togo’s capital when a troubling thought flashed through her mind: Who would care for her two sons if her depression worsened and she was gone ? to look after them?

Ms. de Lima, a single mother who was grieving the recent death of her brother and losing her job at a bakery, knew she needed help. However, therapy was out of the question. “Too formal and expensive,” she recalled.

Help came instead from an unexpected advisor: Ms. de Lima’s hairdresser, who had noticed her erratic walks around the neighborhood and offered a safe space to address her problems amid the curly wigs hanging on colorful shelves and the bright neon lights of her small salon share Lomé, Togo’s capital.

Hairdresser Tele da Silveira is one of about 150 women in West and Central African cities who received mental health training from a nonprofit organization aimed at filling a critical gap: providing mental health care in one of the world’s poorest regions, in who still have advice, are hardly 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 attentive listening followed, then suggestions for new braiding styles and walks to a nearby lagoon, which Ms. de Lima described as “life-saving therapy.”

“The people of this world need attention,” Ms. da Silveira said. “You need to talk.”

Togo and many other African countries face an urgent need for more and better mental health treatment: The World Health Organization ranks its African region as having the highest suicide rate in the world and some of the lowest public spending on mental health. According to the WHO, there are an average of 1.6 mental health professionals per 100,000 people in the region, while the global average is 13

Mental health crises are exacerbated by violent conflict in countries such as Sudan, Somalia, the Democratic Republic of Congo, Ethiopia and the Sahel; due to increasing drug consumption in many large cities; and by widespread youth unemployment, displacement caused by the extreme impacts of climate change and rising inflation.

In Togo, a tiny coastal nation on the Gulf of Guinea, there is no awareness of mental health treatment in either the coastal capital or the villages in the hilly north. There are only five psychiatrists in the country for more than eight million people. Families seeking to treat a loved one suffering from severe mental health issues often resort to traditional remedies or forced isolation captivate some with schizophrenia in the areas of religious institutions or clinics.

“Many of those who come to us do so as a last resort after traditional healers and fraudsters have drained them of their money,” said Daméga Wouenkourama, one of Togo’s five psychiatrists. “Mental health remains a foreign concept to most people, including our managers and our medical colleagues.”

To address what the World Health Organization calls the “mental health gap” in developing countries, local nonprofits and international organizations working in Africa are training nurses and even general practitioners grandmothersto identify mental health issues, from early signs of depression to post-traumatic stress disorder.

In West and Central Africa, hairdressers are the youngest to join this fight. Hair salons have long been used by nonprofits and community groups as places to raise awareness Issues such as reproductive health with customers and trainees. Visits there are inexpensive – sometimes as little as $2 – and are a popular meeting place for women.

Mental health professionals are now offering hairdressers a three-day training course that teaches them how to ask open-ended questions, recognize non-verbal signs of stress like headaches or disheveled clothing and, most importantly, how not to gossip or give harmful advice.

In interviews, half a dozen hairdressers said that when they had their hair unbraided or had hair extensions installed, many of their clients shared financial struggles or emotional pain related to the loss of a loved one. More often, however, clients refer to “household problems” – a euphemism for domestic violence.

“Customers come and cry in front of us — we hear everything,” said Adama Adaku, a bubbly hairdresser with a wide smile and red wool braids 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 after his death, Ms. de Putter said in an interview in Lomé last month.

When she designed the program in 2018, Ms. de Putter researched where African women spend their time. “Society expects them to be beautiful, and hair often comes first,” Ms. de Putter said. “We go where there are women.”

Around 150 hairdressers have so far received the honorary title of “Mental Health Ambassadors” from Ms de Putter’s organization after completing training in Lomé as well as Ivory Coast and Cameroon. Next up are Ghana, Rwanda and Senegal.

Because hairdressers are not professional counselors, hairdressers often refer clients with difficulties to trained therapists. But most hairdressers said their clients found therapy too expensive – a session can be expensive 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 is, cost at least $15.

Several African countries have committed to better addressing mental health disorders over the last decade. Last year, Uganda’s Ministry of Health reported that almost one in three Ugandans suffered from mental health problems. countries like Sierra Leone And Ghana have vowed to replace restraints with professional treatments. Mental health care is often placed last or completely neglected, as is the case 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 the social stigma remains.”

On a recent morning, she and three other Togolese psychiatrists traveled to a rural area two hours north of the capital to set up a twice-yearly open clinic. They listen to patients in consulting rooms or under the towering mango trees in the dusty courtyard. The psychiatrists spent hours caring for people who suffered from, among other things, depression, stress and addictions.

Back in Lomé, Ms. de Lima now comes to Ms. da Silveira’s salon, a block from her home, a few times a month. Ms. de Lima, 54, has followed her hairdresser’s advice to listen to religious music – both are Christians – and has resumed taking calming walks to the nearby lagoon that she previously didn’t have the energy for. She said she wanted to sell a property on the recommendation of her hairdresser and use some of the proceeds for therapy.

“She saw something in me that I couldn’t get out,” said Ms. de Lima, wearing a floral outfit while Ms. da Silveira combed her hair.

Providing advice has put a strain on some hairdressers’ mental health, even though they themselves receive therapy once a month courtesy of the Bluemind Foundation.

“I can listen and talk, but there comes a point where I can no longer help,” Ms. da Silveira said one morning as she sat outside her salon. She said she had suffered from depression herself.

At her feet, puppies played with a tuft of fake hair. A customer was waiting inside. With a gentle smile, Ms. da Silveira asked, “Why does it seem to me that everyone suffers from mental health issues?”