The problem we have in Nigeria is that there is no statistics officially, but as at 2007, according to the World Health Organisation (WHO), there were 20 percent of Nigerians suffering mentally.
With a population of 150 million, what this suggests, figuratively, is that about 30 million Nigerians are suffering from mental disorders.
Expert findings also reveal that in the same year, 20 new patients were being admitted at the Psychiatric Hospital in Yaba, in Lagos alone, everyday. This excludes LASUTH and other hospitals, and people who don't come for psychiatric help. There are huge millions of Nigerians going through one depressive disorder or the other. Available facts from experts also point to a startling revelation that the trend will be high in the next 15 years, if nothing is done about it, especially, in achieving the Millennium Development Goals.
Already, the situation is being blamed on the lackadaisical attitude of the policy makers, the public, the psychiatrics, based on stigmatization, poor economic state of the nation, emotional trauma, among others.
While the ugly trend is rampant among the down-trodden masses, occasioned by poverty and since the economic status of man is not the only determinant of manifesting madness but also human depression which leads to capital depression, the men at the helm of affairs in the country also need to go through mental test.
The Chief Executive Officer (CEO), Mental Health Foundation, Dr. Emmanuel Owoyemi, said, “if there are depressed people with some level of insanity at the helm of affairs of a country, it will lead to economic depression because they won't do the right thing.
“When Singapore was preparing for its economic leap back then, they formulated a policy that ensures all of their presidents undergo emotional test before the get to office.
“You should understand that it is insanity when a governor embezzles all of the monies meant for roads and hospitals, and he looks on as people have accidents and die on those roads. It is insanity when lawmakers know they are being watched all over the world, and they will still go ahead to fling chairs and exchange blows in the NASS.”
So many times we assume that only the naked people on the streets are mad but recent studies have proved our guesses wrong as depression that leads to madness comes in form of persistent sadness, anxiety, feelings of hopelessness, guilt, restlessness, loss of interest in activities including sex, fatigue, decreased energy, and difficulty in concentration, insomnia or excessive sleep, overeating, loss of appetite, thoughts of suicide, persistent ache or pain.
Mental health services receive only a very small part of the total annual health budget in Nigeria which is 3per cent of Gross Domestic Product amounting to $7 per capita.
Recent studies discovered that only around 10per cent of those with severe mental illnesses, like schizophrenia, receive treatment.
The state and federal psychiatric hospitals are only located in the urban areas making it difficult for those in the rural areas to access the care they deserve.
For most patients and families, the first point of call is the traditional healer or prayer house.
But then each sickness should be addressed as it relates to the causes.
Owoyemi said “one out of four people will experience some kind of mental health problem in the course of the year, one in four women will require treatment for depression at some point compared to one in 10 men, one in 4 unemployed people has a common mental health problem, depression affects one in 5 older people living in the community, two in 5 living in care homes and 9 out of 10 prisoners ha mental disorder.
Owoyemi said “most Nigerians do not like coming out to tell people that they are mentally disordered because of our secretive nature, yet we are dying silently.
In his own comments, the Permanent Secretary, Lagos State Ministry of Health, Dr. Femi Olugbile, said “any particular person in the course of living his life will have some mental health syndrome or the other and Nigeria has not recognized the special needs for people suffering with mental disorder.”
Olugbile said “any particular person in the course of living his life will have some mental health syndrome or the other and Nigeria has not recognized the special needs for people suffering with mental disorder.”
He revealed that Nigeria has no budget, policy, framework and grant for mental health programme, and the bill is yet to be passed.
According to Director General, Institute of National Transformation, Professor Vincent Anogbogun said “Nigeria will continue to have instability because we have young populations that are unemployed and the situation will be worst by 50per cent by 2030 due to climate change if nothing drastic is done as Nigeria is already at the critical point of failure.”
Owoyemi noted the determinants of wellness as positive sense of being, belief in oneself, ability to deal with the inner world of thinking, managing life, taking risks, ability to initiate and sustain personal relationship and spiritual life.
Anigbogun said the only way to move the nation forward in this aspect is to produce disciplined people with disciplined thoughts and actions that will lead to national transformation.
Essentially, Owoyemi said the place of mental health in nation building and achieving the MDGs is very paramount in the nation because five out its goals are tied to health and “there is no health without mental health.” He stressed the need to address mental health as it cuts across the MDGs and a very important focus in achieving the goals.
Historical details
The first indigenous Nigerian psychiatric professional was a psychiatric nurse, Mr Abraham Ordia. He was the first Nigerian to hold a senior position in what was then called the Asylum at Yaba in 1952.
The first Nigerian doctor specialising in mental health as a Psychiatrist, was the late Professor Thomas Adeoye Lambo. He was trained in Britain, and returned to Nigeria in 1954, making an international name for himself in Aro Hospital, Abeokuta with his renowned Village System of care.
He realised that people who are taken away from their home communities to be treated actually find it harder to be independent when they go home than those who receive care in the community.
This era also saw a revolution in medical treatment for mental illnesses. It was only with the discovery of effective medication in the 1950s that the most severe symptoms could be effectively controlled.
Even people with very disturbed behaviour could recover and return to their communities.
Sadly, the system in Nigeria has not kept up with these early advances. Recent studies based in Nigeria have shown that only around 10% of people with severe mental illness receive the care they need.
The specialist hospitals in big cities like Lagos, Ibadan, Enugu, Calabar and Sokoto are not sufficient to provide care that is affordable and accessible by the majority of the population that needs it.
Lack of human and financial resources
Nigeria only has about 130 specialist psychiatrists, less than one per million of the population compared to a typical figure in European countries of one per 10,000 people. There are more Nigerian psychiatrists in Britain alone than in Nigeria.
We are slightly better served with psychiatric nurses, who would form the basis of a primary health-care based service. Nigeria in fact trains significant numbers of these essential staff, though many are also lost to the brain drain.
In Nigeria less than 3% of Gross Domestic Product (GDP) is spent on health, and of this less than 1% is allocated to mental health.
The figure recommended by the WHO for mental health is 5%, and in many countries it is nearer 15% The low level of expenditure means that even if services were well organised, the majority of cases could not receive the care they need.
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.
Policy and legislation
In Africa overall, less than 50% 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.
In response to the international priority being given to mental health, there are now plans to update Nigeria's legislation.
At present, the existing legislation dates back to British colonial laws of 1916, later adopted as the Lunacy Act in 1958. The legislative process has not responded effectively to the need for radical reform of the sector.
A 2003 bill for a mental health act passed a public hearing and was adopted by the Senate, but was not able to pass the House of Representatives and be adopted into law before the end of the last administration.
With support from the WHO, the Federal Ministry of Health has brought together a team of experts to make recommendations for laws that will safeguard the interests of people with mental health problems in the country, and a policy that will allow for services to reach those whose needs are currently not met. If these plans are to be implemented, significantly higher levels of resources will need to be devoted to this neglected area.
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