Over the years, the issue of mental health has attracted little attention in the country with mental health victims often stigmatised, scorned and neglected by families with the belief that their problem is beyond remedy. This is not all.
These mentally challenged individuals are often shackled, locked up and beaten, while a number of such patients are seen in local health centres with significant depression symptoms yet few are diagnosed and while those diagnosed rarely get treatment of any kind.
Following World Health Organisation (WHO) recent estimates that about 20 percent of Nigerians suffer mental illnesses, coupled with the news that mental disorders account for 13 percent of the global burden of disease, experts have tasked government on the need to increase its investment in mental health, pass the Mental Health Bill and have a health policy on mental health as is the case with Gambia and some other countries.
In an interview with BusinessDay, Wilson Edafiadhe, head, Psychiatry Department, Delta State University Teaching Hospital (DELSUTH) Oghara, said that the negative perception about mental illness in Nigeria is widespread and has led to a situation where people seek medicare in spiritual houses and asylums which further impairs the social integration of those affected.
With poor knowledge of mental illness still common, Edafiadhe disclosed that while less than 15 percent is spent on health as agreed in the Abuja Declaration by African Heads of States in 2001, of this figure, less than 1 percent is allocated to mental health.
“A considerable part of the limited resources is spent on large mental hospitals and not for services delivered through community and primary healthcare which is rarely operational. The issue of mental health is on the increase due to stress, drug abuse, depression and anxiety. We need to increase investment for mental health and to shift the available resources toward more effective and more humanitarian forms of services.
“In Nigeria, the progressive 1991 primary healthcare policy states that mental health should be integrated at the primary care level. While this is not fully operational, a bill for a Mental Health Act which was been in the National Assembly since 2003 is yet to be passed into law,” Edafiadhe explained.
Lending his view, Olufemi Olugbile, permanent secretary, Lagos State Ministry of Health said that in the United Kingdom and other nations of the world, mentally ill people are actually not only treated by mental health specialists but by general health practitioners.
Olugbile, who is also a consultant psychiatrist revealed that most illnesses are of such an order that they can actually be substantially treated and relieved by lower level of care, non specialised care, such as what is available in primary healthcare centres and in general practices.
“We are missing that and everybody wants all the mentally ill people to go to the specialists. First of all, there would never be enough specialists for that. It is not feasible and the location for the specialists would be such that it would cost much inconvenience logistically and financially for everybody to be crowding and it is not necessary. We should encourage those at the rural levels of care to see as many as they can so that specialists would attend to difficult cases.
“Those are the kinds of re-orientations, paradigm shift that we are seeking to sell, both to the government and the society at large, working at campaign to distigmatise mental illness. Getting people to understand that there is a wide variety in mental illness with different implications. We are getting people to understand that society has to invest resources in the care of the mentally ill,” Olugbile pointed out.
While the treatment gap for mental, neurological and substance use disorders is formidable especially in poor resource countries, BusinessDay findings show that people with mental disorders have a heightened risk of suffering from physical illnesses because of diminished immune function, poor health behaviour, poor adherence to medical treatments, and social barriers to obtaining treatment.
According to Oye Gureje, professor in the Department of Psychiatry, University College Hospital (UCH), “Attitude to mental illness is characterised by intolerance of even basic social contact with people known to have such illness. In a society in which poor health facilities and poverty make the care of people with mental illness a major burden for both patients and their families, the degree of stigma experienced by individuals with mental illness suggests an unusual level of illness-related burden.”
Taking a global look at mental health, approximately 10 percent of adults experience a current mental disorder and 25 percent are likely to develop one at some point during their lifetimes. More worrisome is the fact that anxiety and depression alone contribute greatly to the global burden of mental illness.
Mental disorder is associated with more than 90 percent of the 1 million suicides that occur annually. In reality, the number is likely to be far greater, due to common underreporting of this cause of death.
While mental disorders account for 13 percent of the global burden of disease and is to rise to nearly 15 percent by 2030, there is the need to address this social malady having a health policy in Nigeria as is the case with Gambia.
It is noteworthy to state that in 2007, the Republic of the Gambia, in collaboration with WHO, completed its first-ever mental health policy and strategic action plan. Major objectives of the Gambia’s mental health policy include de-institutionalisation of the Campama Psychiatric Unit; the provision of equitable, accessible, cost-effective, and good-quality mental health and substance abuse services in the community; and the promotion and protection of the rights of people with mental and substance use disorders.
The strategic action plan which provided a roadmap for meeting the objectives of the policy include strengthening the national mental health coordinating unit at the Department of State for Health; mobilising resources to provide good-quality mental health services; improving the availability, distribution, and cost-effective use of psychotropic medicines; creating inpatient mental health units and outpatient clinics integrated in the general hospitals; recruiting and training a sufficient number of health workers at the specialised, community, and primary healthcare levels in order to provide good-quality mental healthcare at all levels; training and supporting traditional healers in mental health.