Concerns about the mental health of Nigerians have become dominant among medical experts who feel that not enough is being done by the authorities to manage what is beginning to assume a crisis proportion. Recently, it was revealed at a mental health forum that over 40 million Nigerians suffer from one mental health disorder or another. As alarming as this revelation is, estimates suggest that there are less than 200 psychiatrists in the country at the last count to manage these cases.
To compound the problem is the fact that budgetary allocation to manage the health challenge is going down instead of increasing to meet the needs of Nigerians afflicted by the ailment. Painfully, in our view, there is no clearly defined budget allocation for mental health in the national health budget. Allocation for health sector as a whole amount to about 3.65 percent in 2016 budget and about 3.3 per cent of the health budget of the federal government goes to mental health, with over 90 per cent of this going to institution-based services provided through eight stand-alone mental hospitals
Even worse is the stigma associated with mental health disorder which must be demystified if the nation was to have an effective, practical, affordable, and compassionate mental health care system.
Furthermore, the Association of Psychiatrists in Nigeria, APN, is worried that the treatment gap in mental health cases had grown to as high as 85 per cent. Part of the problem is that mental health issues are guided by obsolete laws dating back to 1920 and was last reviewed in 1964. The law is to make people with mental health disorder to disappear as a result of stigmatization, discrimination, denial and lack of understanding. The signing of the mental health bill into law is a critical investment in mental health in Nigeria that will guarantee access to effective, compassionate and quality mental healthcare the nation desires.
A mixture of factors is responsible for the deterioration in the mental health of the number of persons in the record books already. Even the experts do accept that that figure of 40 million is conservative for a number reasons which include the poor record keeping in the various health institutions as well as the attitude of the average Nigerian to hide cases of mental health because of the stigma it attracts not just to the patient but also to the family as well.
Unfortunately, mental health is now considered one of the most neglected areas of health in the country, where over 70 per cent of patients with mental health problems/disorders seek unorthodox interventions before orthodox care. This, in our view, is inevitable in an environment where there are 0.09 psychiatrists, four psychiatric nurses, 0.02 clinical psychologists and 0.02 social workers per 100,000 persons.
As bad as the situation is, experts are disturbed that happenings in and around the country today tend to worsen what is, without doubt, a serious health problem. Some of these factors include but not limited to insecurity in the country, the pervasive economic hardship, unemployment among the youth and the incidences of drug abuse.
Recently, a survey conducted by the United Nations office on Drugs and Crime, UNODC, on drug use, ranked Nigeria as the highest in drug use prevalence in the world. While some countries have average of 4.5 to 5 per cent drug abuse prevalence rate, Nigeria has 14.3 per cent prevalence rate in drug use.
It is pertinent to observe that mental health issues cut across the broad spectrum of the population, affecting men and women in all stages of life, the rich and the poor, rural and urban settings. Lack of political will and up-to-date legislation, inadequate resources, overburdened health services, resistance from policy makers and health workers, cultural as well as religious beliefs and practices have hindered the development of a coherent mental health system.
Also, the misunderstanding about the nature of mental disorders and their treatment has also complicated the progress. It is assumed that people with mental disorders are violent and unstable and, therefore, should be locked away, whereas majority of them are nonviolent and capable of living productively within their communities.
It is imperative to stress the factors critical to ensure better mental health care in Nigeria. There is the urgent need to build community mental health services, develop mental health services in general hospitals, integrate mental services into primary health care, build informal community mental health services, employ trained and skilled practitioners, among others.
These are at the level of super-structure. As essential as they are, there is no denying the fact that the people deserve to be in less stressful environment. We have said it earlier that the security challenges, economic hardship, unemployment and substance abuse are man-made and can only be addressed through interventions by the government in a manner that will reduce the causative factors. Mental health challenge, we state unequivocally, is the effect of the inadequacies as well as insufficiencies in the system. Remove them, the problem will be solved substantially.