With a population of over 200 million people in Nigeria, an estimated 20%–30% of our population are believed to suffer from mental disorders. What makes the narrative such a worry is the unfortunate large scale neglect and ignorance of mental health in Nigeria.
Not so much attention has been given to mental health by government and the lack of awareness of the Nigerian public on mental health issues appears to be very pronounced. In addition to this, there seems to be a continued prevalence of misconceptions by many Nigerians in both rural and urban areas as it concerns mental health issues.
A WHO-AIMS report has stated that several countries in Africa are better resourced in regard to mental health personnel. Countries such as South Africa, Egypt, and Kenya have more psychiatrists per 100,000 persons and also higher proportions of psychiatric beds. This leaves us with the big question of what needs to be done to change the status quo in Nigeria concerning mental health.
A Chat With The Experts
Clearly, mental Health is one common health issue that Nigerians in general don’t take seriously, or rather shy away from. Before the Covid-19 pandemic which hit hard on governments and citizens of most countries, including Nigeria, there have been concerns about mental health neglect and ignorance in Nigeria. In 2017, World Health Day was marked with the topic “Depression: Let’s Talk.” This brought some attention to some of the major challenges and loopholes associated with mental health in the country, and an avenue to address those issues by government and relevant stakeholders.
The increasing rate of suicide reported in the country and other mental health disorders proves there is still a big gap which needs to be filled. To compound the problem, the recent Covid-19 crisis did not spare the mental health of citizens due to the lock downs. Reports from several countries showed an increase in prescription of mental health medications during the period.
To ascertain the level of mental health neglect in Nigeria and the impact of Covid-19 pandemic on the mental health of Nigerians, Medtrend Health had a chat with a health expert who shared some important insight about the subject discussed.
The medical expert, who responded to the interview questions via an audio recording had much to say on the effects, dangers, impact and possible solutions of mental health neglect in the country. See excerpts below.
Can we know you?
My name is Dr Ikwumezie Chidi, a medical officer with interest in specializing in psychiatry to become a pediatric psychiatrist. I am currently located in Owerri, working in a private hospital whiles awaiting placement to start my residency training in psychiatry.
Your general assessment of Mental Health situation in Nigeria
Yes there is both neglect and ignorance of mental health problems in Nigeria. There is neglect on the side of the government and ignorance among the people. On a general assessment of the mental health situation in Nigeria, it is so poor – both from the government and the citizens. And it doesn’t look like we are ready yet to change the situation of mental health in Nigeria. The negligence is so much; and the problem is not just that there is neglect or ignorance, but the big issue is the stigma that is so much attached to anyone who is said to have mental health problem or disease.
Let me start with the side of government. Before independence, we have this lunacy act of 1958. This lunacy act is about involuntary admission of any patient that has been termed lunatic. So with the current new guidelines and the goals of achieving a proper mental health care in the world today, the lunacy act violates both patient right and makes people not to open up that they have mental health issue. This yields to the stigma and it has been an issue because people are not willing to open up.
After this lunacy act, several attempts to establish the mental health law has been futile. In 2003, there was an attempt to see that the mental health act was formulated, but it failed. Then in 2013, it was brought again to the National Assembly and till date the effort has still been futile. So this is making the whole mental health advocacy efforts seem unfruitful. Despite all the advocacy going on, people are still unwilling to say I have mental health issue and seek for help.
Then the reason there is so much ignorance among the citizens is because before the emergence of mental health in Nigeria, there has been established traditional health system, coupled with religious beliefs that any mental health issue or problem is brought by the devil. So people believe that it is only through spiritual means or traditional help that the issue can be solved.
So there is both neglect and ignorance. People are not aware and people don’t have the right information. But there is now much advocacy and non governmental institutions are actually helping to advocate and enlighten people on mental health issues. However, more still needs to be done because there is still need to train more people that will keep on advocating and be providing mental health services to people.
The major challenges of mental health in Nigeria
I think one of the reasons why both the Nigerian government and the citizens are not giving attention to mental health is because we are not really seeing it killing people. I think it is because the mortality rate is not that overwhelming or the life span of the disease is not so short and it is not so tragic that once you have it within days you are dead. So that is why attention is not given to it like other infectious diseases and cancers which people pay attention to a bit more.
In Nigeria, there is poor funding and poor financial budget allocation towards health in general. So you can imagine what would happen to the mental health aspect of health. In addition, there is poor manpower. The number of psychiatrists are less than 200 in Nigeria, and the number of admissions, not to talk about out patients who come in with mental health issues, are so overwhelming that the ratio of doctor to patient is so wide and there is much treatment gap.
Another issue is the high cost of services for those that have these mental health issues. Treating mental health issues is something that requires high mobility, and most people keep fighting with their mental health issue for a long time. The cost of being able to come for follow up, receiving treatments, and doing their investigations is so much that at the end, they run off and go back to the traditional healers who would use incantations and herbal medications. They give up because their whole money is been sapped up from them and then the family also give up on the individual and the individual now start roaming the streets.
If attention is being focused on mental health, just like HIV/AIDS and some other diseases which have actually been a menace to the society, mental health services can be subsidized. At least it would help encourage people to seek for mental health treatment.
There is need to establish the mental health act to protect people with mental health issues. This issue of mental health act is so much needed because even among health professionals, nobody wants to admit that he or she has a mental health issue. Rather they wallow and die in silence. There is no mental health act to help protect them like it is being done for those that have HIV and those that have cancer.
There have been stories and events of even doctors committing suicide who refused seeking for mental health help from psychiatric and mental health providers. It is that bad because once you are discovered, nobody wants know whether it is depression, anxiety and adjustment disorder, they just term it that you are lunatic and your job is even at risk. Even if you don’t loose your job, the stigma would make you decide to sack yourself because you cant just bear the stigma of what would follow up. So the need to establish the mental health act is very necessary.
So when there are no such laws and we are still using the archaic law of once you are found lunatic, you’re sent to the asylum and locked up with your fellow lunatic, people will still be negligent. They need to change the lunatic act and establish the mental health act to protect those that have mental health issues from loosing their jobs, for helping them to seek equal health services and not be stigmatized.
Then there is need to train more mental health providers so that the awareness can be increased. This will help reduce the ignorance of mental health problems in Nigeria. And after this pandemic, there should be effort to train people. In fact at the level of the primary health care, there should be effort to train nurses and community health workers to be able to recognize and detect mental health issues at the level of the primary health care.
Government should increase funding mental health and continue to work hand in hand with Non governmental agencies to be able to help with mental health advocacy and awareness. This is so that the work of the non-governmental agencies would be well channeled and not just haphazard.
COVID-19 pandemic impact on mental health
There has been so much impact on mental health. You know, aside the familiar biological impact, there are still social impacts with this Covid-19 pandemic especially due to the whole lock down issues and policies.
There was also increase in the rate of depression from the disease on those affected and those that had relatives who were affected. In fact, I had one particular patient who had post-traumatic stress disorder (PTSD). He was treated and discharged of Covid-19 and ever since then, he has so much phobia and anxiety and he is so much afraid to go out. He is so cautious, jittery and not willing to step out of his house or even have anyone come close to him. And even the stigma that he once had Covid-19 makes no one wants to also come close to him. So PTSD and depression is actually a big issue. Those who have lost their relatives to Covid-19 may be be wallowing in post traumatic stress disorder and depression.
Because it is a new virus, there was this fear coupled with the wrong notions of Covid-19 and false alarms that increased the rate of anxiety. I had to keep counselling one of my aunties and give medications to help calm the anxiety she has. She is asthmatic and hearing that Covid-19 kills more of those that have other co-morbid conditions like asthma, she became so much afraid of the Covid-19 and was glued to TV, radio, and newspapers for news updates. It made her so tensed up, having palpitations. In fact she kept calling that she doesn’t know what is wrong with her. Then I realised that it was all anxiety from the Covid-19 situation. After counselling her and with some medications, she was able to improve.
The rate of substance abuse also increased because some people tend to cope negatively to distress. They now have to rely on CNS stimulants to help bring them off the moody state and end up abusing substances.
So the mental health problems that people should watch out for during this pandemic are especially anxiety, depression, and substance abuse. Those that have lost their loved ones may end up being depressed and may end up even being suicidal or severely depressed. People should look out for signs of depression such as low energy, low mood, and loss of interest in what the person used to like. Once one starts noticing strange things, he or she should seek the help of a health care provider and if possible, a mental health provider. Likewise for anxiety. Once you are having palpitations, tremors and anxious state for no physical health reason, please seek for mental health care.
Your general advice
Those that have lost their loved ones to Covid-19 should try to manage the stress positively by trying to share with people whatever challenges they have. Talk to someone and let out those feelings. Sleep well, eat well and try to tell yourself it is okay.
People who are also afraid of getting Covid-19 or those that the lock down has pushed to so much hunger shouldn’t also give up or have this hopeless feeling. They should avoid depression by trying to stay positive, dont loose hope, seek for help from people to help you out, and actively look for ways to solve that problem that they are facing.
Sleeping well and eating well helps you stay healthy and well immune. People should obey those guidelines for prevention of the Covid-19 and should not be afraid. When you feel that you have Covid-19 or you have had contact with someone that has Covid-19 or you are having the symptoms, please get tested and get treated. It is not a death sentence.
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