Introduction
In a country like ours, poor mental health facilities, poor health outcomes, health inequalities and disparities exist. The need for mental health literacy and workable health policies are vital and have never been more urgently needed than now.
Mental health is a very integral part of health care as a whole. However, it is not out of place to identify that the issue of mental health care is one that has not been properly addressed in many developing African countries; Nigeria included. The emphasis of the primary healthcare in Nigeria is geared majorly towards maternal and child care. An attempt will be made as is customary, to first create an understanding of mental health in general before limiting our scope to its care in Nigeria. In 1948, the International Preparatory Commission of the International Congress on Mental Health, proposed a definition thus: “Mental health is a condition which permits the optimal development, physical, intellectual and emotional, of the individual, so far as this is compatible with that of other individuals. A good society is one that allows this development to its members while at the same time ensuring its own development and being tolerant towards other societies.” Therefore from the above definition we can deduce that the development of a society is a function of the mental health state of the people who make up that society. Hence, the importance of mental health can never be over-empasized.
“Mental health in simpler terms is a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”
Mental illness (disorder) is a disturbance in one’s ability to cope effectively. One mistake the lay-Nigerian falls prey to is limiting mental illness to the typical image of the mad (deranged) person roaming half-clothed on the streets. While a greater population of those who are somewhat learned lack enough basic knowledge about other mental illnesses apart from the most common one here – depression.
Depression is so common in Nigeria that in 2017, “WHO reported that 7,079,815 Nigerians suffered from depression. The figure, according to WHO, was 3.9% of the entire population of the country thereby making Nigeria the most depressed country in Africa.”
In the same year, the theme of the World Health Day Commemoration in Nigeria was titled “Depression: Let’s Talk”. Asides depression, other mental disorders include: Bipolar Affective Disorder, Schizophrenia, Post Traumatic Stress Disorder (PTSD), Attention Deficit/Hyperactivity Disorder (ADHD) and other psychoses, dementia, intellectual disabilities and developmental disorders causing autism.
CAUSE AND PERCEIVED CAUSE:
While it may seem easy to list factors which might eventually lead to mental illness, factors like substance abuse, economic hardship, trauma, low-quality of life and so on; it should be noted that regarding the causes of mental illness, much is still a mystery. Regardless of this, certain truths are known for a fact. Mental illnesses are not physical defects nor should they dehumanize those suffering from them. They are medical illnesses of the brain as opposed to what majority of Nigerians think.
The attitude of Nigerians towards mental illness include: social distance and avoidance, marriage stigma, job entrustment stigma, perceived dangerousness, social acceptance, indifference.
The most evident attitude seen towards mental illness in Nigeria unfortunately is stigmatization. They look at those going through these predicaments in bad light and discriminate against them. “Stigmatization deprives victims of mental illness full measure of human dignity and participation in the wider society.” Most withdraw themselves from seeking proper medical care as a result of this “fear borne out of ignorance engenders stigmatization of mental illness.” Most Nigerians ignorantly believe that mental illness is as a result of supernatural causes – magic, witchcrafts, sorcery and divine punishments. This has a historical basis and methods of treatment in the past included herbal remedies, chaining, beating, fasting. This is not a Nigerian thing alone because generally mental health is associated with principles dependent upon the prevailing religion or ideology of the community concerned. But what this does is that, it diverts the greater population that should be seeking urgent medical care into traditional healing homes and syncretic churches seeking to appease one god or deity. “A national survey on stigma and mental illness among nursing professionals in Nigeria conducted in the 6 geo-political zones of the country by Obembe et al. reported that 40% of their studied population viewed mentally ill individuals as violent, 26.5% would distance themselves from the mentally ill and a third associated mental illness with lack of self discipline and willpower but generally they held negative views about mental illness.” This misinformation is a major concern.
MENTAL HEALTH CARE SYSTEM
“The Federal Ministry of Health says an estimated 20-30% of Nigerians are believed to suffer from mental illness”. That is about 60 million people in our 200 million population, which is quite astonishing. This means that were all mentally ill persons confined within a territory, they would be more than twice the population of our close neighbours Ghana (28 million)! The 2006 WHO-AIMS report on mental health system in Nigeria made some telling revelations. It reports that there is considerable neglect of mental issues in the country. “The existing Mental Health Policy document in Nigeria was formulated in 1991. Since its formulation, no revision has taken place and no formal assessment of how much it has been implemented has been conducted… No desk exists in the Ministries at any level for mental health issues and only 4% of government expenditures on health is ear marked for mental health”. To worsen matters, the allocation to health from the national budget is also poor. “In the 2018 budget, the total sum allocation to health is ₦340.456bn out of a total national budget of ₦8.612tn. This represents just 3.95% of the total budget. This has been the trend for the last decade.” In 2013,the bill for National Health Act was passed. So, policy-wise efforts are being made but the results have not been reciprocal.
“Mental illness could destabilize a person more than HIV, heart disease, accidents, and wars combined” – Dr. Evelyn Ngige (Director of Public Health). For someone so prominent to say such, that means there is an understanding of how important the mental health sector should be taken. Has this been translated into rigorous actions? No.
Nigeria has only 8 Federal Neuro-Psychiatric Hospitals to serve a population of over 150 million, 8 schools of psychiatric Nursing and 12 Teaching Hospital Psychiatric departments. “The regional psychiatric hospitals are:
• Neuro-Psychiatric Hospital, Aro, Abeokuta.
• Federal Neuro-Psychiatric Centre, Kwara.
• Federal Neuro-Psychiatric Hospital, Uselu, Benin.
• Federal Neuro-Psychiatric Hospital, Calabar.
• Neuro-Psychiatric Hospital, Enugu.
• Neuro-Psychiatric Hospital, Kaduna.
• Neuro-Psychiatric Hospital, Maiduguri.
• State Neuro-Psychiatric Hospital, Awka, Anambra.
• Neuro-Psychiatric Hospital, Eket, Akwa Ibom.
• Psychiatric Hospital, Sokoto.
• Kano State Psychiatric Hospital, Kano.
• Psychiatric Hospital, Abia.’
“Abia and Ebonyi State Teaching Hospital each have part-time visiting psychiatrist and Imo State has no state psychiatrist.” It is appalling that Nigeria has only 150 psychiatrists to care for over 180 million Nigerians. That is a ratio of 1 Psychiatrist to 1.2 million Nigerians. “Records also show that there are five mental health nurses to 100,000 Nigerians. Recently, the Neuro-Psychiatric Hospital, Aro, Abeokuta, Ogun State disclosed that it treated no fewer than 36,000 mental patients in a year”. The above statistics just shows the enormous work that still needs to be done.
CONCLUSION:
“Nigeria’s suicide rate does place it 15th in the world according to the most recent data.” We all cannot feign ignorance to this as it has been all over the news even recently, of various people using the regular household insecticide “sniper” to commit suicide. Experts believe the rising suicide trend in Nigeria can be reduced drastically by fixing the mental health care system in the country. Access to mental health care can be improved upon in the context of four overlapping dimensions: non-discrimination, physical accessibility, affordability and information accessibility. There should be sensitization and medical programmes put in place to reduce the stigmatization and discrimination suffered by mentally ill patients. The proximity to mental health facilities is another huge factor that needs to be put into consideration. This is because most of these facilities are cited in urban areas whereas the victims are also in the rural areas. These facilities should be readily affordable and if possible subsidized by the government. Information is power. Most Nigerians do not even know about the existence of some of these mental health facilities which may even be close to them. Therefore, information dissemination is key if progress is to be made in this sector.
There is no over-stating the glaring fact that more needs to be done. More hospitals need to be built, more health care practitioners need to be trained, more money should be allocated to the mental care sector and to health generally. There should be commitment in the right political offices to this cause. All hands need to be on deck, as this is a fight no one can turn a blind eye to!
REFERENCES:
1Soddy, Kenneth. (1961). Cross-cultural Studies in Mental Health: Identity and Mental Health & Value Systems. London: Tavistock Publications. Pg 70
2. (2014, August). Mental Health: A State of Wellbeing. Retrieved from https://www.who.int/features/factfiles/mental_health/en/
3. The Punch Newspaper. (2018, Novemeber 22). Of the 60 million mentally-ill Nigerians. Retrieved from https://punchng.com/of-the-60-million-mentally-ill-nigerians-2/
4,5,6 Aishatu Yushau Armiyau. (2015, January 26). A Review of Stigma and Mental Illness in Nigeria: Journal of Clinical Case Reports. Retrieved from https://www.omicsonline.org/open-access/a-review-of-stigma-and-mental-illness-in-nigeria-2165-7920.1000488.php?aid=40679
7. The Punch Newspaper. (2018, November 13). 30% Of Nigerians Suffer Mental Illness – FG. Retrieved from http://saharareporters.com/2018/11/13/30-nigerians-suffer-mental-illness-%E2%80%93-fg
8. Ibadan, Nigeria. (2006). WHO-AIMS Report on Mental Health System in Nigeria, WHO and Ministry of Health. Pg 5
9. The Punch Newspaper. (2018, Novemeber 22). Of the 60 million mentally-ill Nigerians. Retrieved from https://punchng.com/of-the-60-million-mentally-ill-nigerians-2/
10. The Punch Newspaper. (2018, November 13). 30% Of Nigerians Suffer Mental Illness – FG. Retrieved from http://saharareporters.com/2018/11/13/30-nigerians-suffer-mental-illness-%E2%80%93-fg
11. Kesi, Jolly. (2018). Nigeria’s Top 10 Psychiatric Hospitals and Mental Health Institutions. Retrieved from http://www.healthnews.ng/nigerias-top-10-psychiatric-hospitals-mental-health-institutions/
12. Eaton, J. Agomoh, A. (2008). Developing mental health services in Nigeria: The impact of a community-based mental health awareness programme. doi: 10.1007/s00127-008-0321-5
13. The Punch. (2018, Novemeber 22). Of the 60 million mentally-ill Nigerians. Retrieved from https://punchng.com/of-the-60-million-mentally-ill-nigerians-2/
14. Joel, Motunrayo. (2019, July 10). Nigeria ranked ‘15th in the world’ for suicide – but Lesotho tops African list. Retrieved from https://africacheck.org/reports/nigeria-ranked-15th-in-the-world-for-suicide-but-lesotho-tops-african-list/
Article by: NWOKPOR N. COLLINS, 200l Medicine and Surgery, Afe Babalola University, Ado-Ekiti.
I love ur article nwokpor it really was an open eye and gave me a nice insight and a different view of mental illness thanks alot