October 10, every year, is marked as World Mental Health Day. It is a day set aside by the United Nations to commemorate, promote and bring mental health issues to the fore. Although October 10 may have come and gone, the issues and the complexities surrounding mental health in Nigeria are still very much around. In this report, SAMSON BENJAMIN examines the misconceptions, stigmas and other issues surrounding the disease.
The federal government recently raised the alarm that estimated 60 million Nigerians are believed to be suffering from mental health disorders. The Permanent Secretary, Federal Ministry of Health,
Abdulaziz Mashi Abdullahi, stated this during a mental health action committee and stakeholders’ workshop in Abuja.
Abdullahi blamed the country’s high burden of mental disorders on inadequate attention paid to mental illnesses, misconceptions and lack of awareness on the part of the Nigerians.
He said more people will be disabled by psychological challenges than complications arising from HIV/AIDS, heart disease, accidents, and wars combined by 2020.
He identified ways of addressing the country’s mental health burden to include; fast-tracking the enactment of the Mental Health Act as well as the resuscitation of the national mental health action committee for the coordination of stakeholders’ activities on mental health and psychosocial supports in the country.
He said: “In Nigeria, an estimated 20%–30% of our populations are believed to suffer from mental disorders. This is a very significant number considering Nigeria has an estimated population of over 200
million.
“Unfortunately, the attention given to mental health disorders in Nigeria is inadequate. The level of awareness of the Nigerian public on mental health issues is also understandably poor and with lots of
misconceptions.
“By 2020, it is estimated that common mental disorders such as depression, anxiety, and substance abuse-related disorders, will disable more people than complications arising from HIV/AIDS, heart disease, accidents, and wars combined! This is an astonishing statistic and possesses serious questions as to why mental health disorders are not given the needed attention that it currently
receives.
“A policy for mental health services delivery was developed with several key provisions of the policy, including establishing a body at the Federal Ministry of Health to focus on Mental Health issues.
“Some of the pertinent issues is how to address and dialogue with stakeholders on the burden of mental health, intimate them on the Mental Health policy, identify ways to fast-track the enactment of the Mental Health Act and modalities for resuscitating the National mental health action committee for coordinating the activities of various stakeholders on mental health and Psychosocial supports in Nigeria.”
Global phenomenon
Mental health disorders are not limited to Nigeria alone. It is now a global phenomenon and the global burden of mental health disorders is projected by World Health Organisation (WHO) to reach 15% by the year 2020. Deborah Chuka, a psychologist told Blueprint Weekend that “When the World Mental Health Day was commemorated on October 10, the World Health Organisation released a study that claimed that one in four people in the world would be affected by mental or neurological disorders at some point in their lives; that is at least 1.7 billion persons, making mental disorder one of the leading causes of ill-health and disability in the world.”
Asides , a new report published on October 9 in The Lancet to mark 2018 World Mental Health Day revealed that depression and anxiety were on the rise in all countries of the world and claimed that mental illness would cost the global economy £12 trillion yearly by 2030.
Causes
Although the symptoms of mental illness can range from mild to severe and are different depending on the type or severity of the disease, a person with an untreated mental illness often is unable to cope with life’s daily routines and demands.
Dr Victor Makunjuola, a psychiatrist, confirmed that it is “becoming clear through research that many of the conditions are caused by a combination of genetic, biological, psychological and environmental factors.”
However, he cautioned that “just because your father or mother may have or had a mental illness doesn’t mean you will have one; hereditary just means that you are more likely to get the condition than if you didn’t have an affected family member.”
Similarly, Funke Adeosun, a sociologist, attributes the high rate of mental illness in Nigeria to the state of the economy. She said: “Considering the current economic situation in the country, the above statistics are damning and in light of the recent suicidal episodes recorded in many parts of Nigeria, the onus is on government to revive the economy to create the enabling environment for job creation for the teeming unemployed to save the citizens from preventable death.
“The situation forces a rethink in our general attitudes to mental health and questions our current maintenance of the status quo.”
Misconceptions, ignorance
Even though many Nigerians suffer from one mental illness/disorder or another, Adeosun said: “It is unfortunately, the attention given to mental health disorders in Nigeria is at best, fleeting. More
worrisome is the low level of awareness by Nigerians about mental illness. This lack of awareness serves as a breeding ground where all manner of misconceptions and discriminations about mental health
disease flourish.”
Significantly, in Nigeria, once mental illness is mentioned, what comes to people’s imagination is a mental picture of a dirty, violent and insane man or woman wearing rags and picking trash in the street, sometimes dancing without the sound of any music. But Dr Chuka said “such cases of extreme mental disorder are just a small part of a bigger picture as far as mental health is concerned.” She added that other forms of mental health common to Nigerians include; depression, anxiety, schizophrenia, drug addiction, bipolar disorder, insomnia, and eating disorders.
Spiritualists on the prowl
Furthermore, as a result of widespread ignorance about the causes, mode of transmission and remedies available for mental illness, many Nigerians attribute it to spiritual attack or punishment for doing evil. Speaking with Blueprint Weekend, Hauwa Ojeifo, a former patient of mental disorder, said: “Mental health in Nigeria is shrouded in myth and patients have always been believed to have a spiritual case with sufferers treated as societal outcast and with spiritual healers treating them in the most inhumane ways.
“Nigerians are very spiritual people, and this cuts across different religions. The fact that we have reduced mental illness to a spiritual attack deters a lot of people from seeking help.
“Regrettably, most mental health patients seek for professional medical attention very late. That is when the symptoms have reached melting point or when every other option has failed. Most have already put in long stints at churches and mosques -where they are often subjected to feastings and long period of isolation or centres run by traditional healers, where they are chained and flogged.
Consequently, Dr Makunjuola lamented that “psychiatrists find themselves treating the ‘treatment’ as well as the illness, with many patients showing symptoms that have been exacerbated by work of
quacks.”
Stigma
As a result of these misconceptions, there is blanket stigma and discriminations towards the mentally ill in Nigeria, even among the so-called educated population. Dr Ada Ikeago, a psychiatrist, observes that “persons with mental illness in Nigeria struggle with double problems.” She said: “First, they have to cope with the symptoms of the disease itself, depending on the particular mental disorder they may be having problems with such as hallucinations, delusions, anxiety or mood swing. These symptoms can make it difficult for someone with mental illness to work, live independently or achieve a good quality of life. Secondly, struggle with the stigma arising from society’s misunderstandings about various mental disorders.”
“Even those who seek professional attention still suffer various degrees of stigmatisation, loss of jobs, stereotypes, negative societal perceptions among others.”
Similarly, Ojeifo agrees that “a lot of people deal with their family being in denial even after the individual has come to a place of acceptance; sometimes denial might mean that they are going to stop you from seeking help because they believe there is nothing wrong with you.”
In the same vein, Nathaniel John, a care-giver to a patient of mental health disorder, added that “a more serious problem is the way families hide their relatives suffering from one mental disorder to the other because of social stigma and the patient end up with a severe mental disorder; and these are probably the cases you see in the streets.”
Dearth of professionals, facilities
Unfortunately, in Nigeria, the situation is worsened by poor government funding, inadequate legislation, the shortage of psychiatrists and other professionals who specialise in mental health
like psychiatry nurses, clinical psychologist and other care-givers.
Speaking on the lack of adequate attention given to mental health by stakeholders in Nigeria, Dr Makunjuola said: “The consequence of this indifference of government to the health sector funding over the years is that health care facilities and mental health care professionals in the country are not enough or well – equipped to handle the burden of mental illness. The statistics are too grim to consider. Nigeria has only about 150 psychiatrists to care for over 180 million Nigerians; that is a ratio of one psychiatrist to 1.2 million Nigerians.
“Records also show that there are five mental health nurses to 100, 000 Nigerians while the country has only eight neuropsychiatric hospitals, most of which are in deplorable condition with little or no
maintenance.
“ What is the fate of the Mental Health Bill 2008 sponsored by Senator Anthony Manzo, aimed to replace the anachronistic Lunacy Act , of 1958 , which is lying somewhere in the National Assembly, not passed , a decade after . Are we also claiming ignorant of the extant legislative lacuna in the management of mental health in the country?”
As a result, people who suffer from mental illness and disorders hardly have access to proper treatment. This forced Dr Ikeago to lament thus: “We have about eight psychiatrists in Abuja, what is the population of Abuja? That would tell you that we need a lot of professionals, psychiatrist nurses who are specialise nurses, aid workers, psychologist in all cadre, we need a lot of work force.”
In addition, Dr Emmanuel Owoyemi attributes the dearth of experts in Nigeria to poor working conditions and stigma attached to the profession. He said: “There is high level of stigma in mental health; many people don’t want to specialise because of stigma. Even we that are working, people say a lot of things, but because you have grown thick skin and this is your passion, you do not really care.”
Cost of treatment
Also, the treatment of mental health disorders is also expensive. This is compounded by the fact that majority of Nigerians are not under any form of medical insurance cover. They pay directly from their pocket. Dr. Ikeago also told Blueprint Weekend that “treating mental disorder can be expensive, especially if it is not detected early.” “It is late if you left to deteriorate. The cost is the cost of hospitalizations which a time can be prolonged.” In the same vein, Ojeifo adds that therapy can be expensive depending on what you are looking at, in public sphere, therapy cost about N3, 000 for six sessions which is fantastic, but again we are talking about a country where some people live on less than $2 per day.”
The family unit is one of the single support system that someone suffering from mental health can have. This is because most times, they bear the financial and the psychology burden of taking care of the patient. Dr. Dorathy Nnamani, founder of Novo Health Africa, sums up the burden on the family thus
“the person who is taking care of the person with mental health doesn’t go to work. It is like taking care
of someone with disability, some people have to quit their jobs. And they enter into unemployed market.”
However, a family can also be the biggest obstacle for some people. This is due to the fact that some families can be in denial even in face of glaring symptoms of mental disorder.
She concludes that “the single most powerful key to tackling all the negativity surrounding mental health in Nigeria is awareness.”
“When people are aware; they will speak out when they have mental health issues. When people have better understanding of mental illness; they are less likely to stigmatise or discriminate against sufferers.
In the light of this, it is imperative that government and all stakeholders commit more resources towards creating awareness and treatment of mental disorders.”
