…as the world celebrates World Health Day
To medical experts, physical and mental health is intertwined hence, mental health is seen as 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.
Taking a cursory look at the Nigerian society, people with mental and psychosocial disabilities are among the most marginalized group. Even though development actors have pledged to focus their work on the most vulnerable in a community, many programmes continue to ignore and exclude this vulnerable group. Sadly, the treatment gap for mental, neurological and substance use disorders is alarming especially in poor resource countries with Nigeria not left out of this frame.
As Nigeria joins the rest of the world to celebrate World Mental Health Day every October 10- a day set aside to raise public awareness about mental health issues, promote more open discussion of mental disorders, and investments in prevention and treatment services, medical experts in the country have tasked the government on the need for availability and access to mental care to Nigerians.
Speaking recently to newsmen in Lagos, Olufemi Olugbile, Chief Medical Director, Lagos State University Teaching Hospital (LASUTH) said that it has been estimated that at least, about 90 percent of people with clear-cut mental health syndromes do not even get any treatment at all in Nigeria which is an atrocious figure and everybody knows the issue.
Olugbile, who is also a consultant psychiatrist stated that the specialists, such as psychiatrist nurses, social welfare officers, occupational therapists and all those who form members of the mental health team, are very few in numbers, grossly inadequate even as the number of hospital units available for the treatment of mental disorders is also very low.
According to him “Mental healthcare is supposed to be one of the elements of primary healthcare in Nigeria but that is only seen on papers. Most of the people at the level of the primary health care don’t know much about mental health, don’t have interest in it and don’t have facilities, including simple drugs for treating mental illness. We believe that if we reverse all these three things, giving them knowledge, facilities and supervision, mental healthcare would reach its optimal goal. Right now, there are more people outside the net than inside the net.
The problem is not all about non-availability of specialists but the way, services are organized currently do not make for appropriate coverage. Of course, when people do not have access to the so-called mental healthcare services, what are they supposed to do? They patronize people closer to them the traditional healers. What Lagos State has done is that, it has set up a body to coordinate the traditional healthcare and also to help standardize it so that they would be doing some kind of certification, inspecting what people are doing, checking both their environments and the details of their practice.”
He added that “In the United Kingdom and other nations of the world, mentally-ill people are actually not treated by mental health specialists but by General health Practitioners. Most illnesses are of such an order that they can actually be substantially treated and relieved by lower level of care, non specialized care, such as what is available in primary health care centres and in general practices.”
For Oye Gureje, President, Association of Psychiatrists in Nigeria (APN), mental health conditions are responsible for a great deal of mortality and disability, accounting for 8.8 percent and 16.6 percent of the total burden of disease due to health conditions in low and middle-income countries, respectively according to latest reports from the World Health Organsation (WHO).
Guruje disclosed that “this report calls for development actors to address the needs of people with mental and psychosocial disabilities in development work by: recognizing the vulnerability of this group and including them in all development initiatives, scaling up services for mental health in primary care; involving people themselves in the design of development programmes and projects; and improving social services for people with mental and psychosocial disabilities as the nation may not be able to achieve the lofty dreams of Millennium Development Goals (MDGs) if proper attention is not paid to the burning issue of mental welfare of the nation.”
It is eminent to state that In Africa, less than 50 percent of countries have a mental health policy. In Nigeria, the progressive 1991 primary health care policy states that mental health should be integrated at the primary care level but this is still yet to be implemented.
However, the most severe mental illnesses require long-term treatment. Although this treatment when given in the community is not expensive, the system of paying out-of-pocket means that many families find it hard to afford the care their loved ones need month after month. It is unclear whether the National Health Insurance Scheme will adequately cover mental ill health.
Some schools of thought believe that monies expended by the Federal government for mental health is what is being used to run the eight psychiatric hospitals that the Federal government has. If this is what it really is, it means there may be insufficient funds for programmes such as initiative and public education, as well as the scourge of debilitating mental disorder in our nation.
No doubt, to revamp mental healthcare in Nigeria, there must be equal attention, even more attention, paid to advocacy and programmes meant to change the pattern and reverse the statistics which suggest that about 90 percent of people lack access to mental care. This is a paradigm shift which the government has to make.
Alexander Chiejina
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