With the COVID-19 pandemic affecting billions of people around the world, experts worry that the pandemic will further impact negatively on people’s mental health, PATIENCE IVIE IHEJIRIKA and ROYAL IBE write.
Mental health problem has become a global health burden, with close to one billion people living with a mental disorder and one person dying every 40 seconds by suicide.
The World Health Organisation (WHO), estimates that every 1 in 4 Nigerians have a form of mental illness. In other words, about 50million Nigerians have a mental illness.
Yet, mental health is one of the most neglected areas of public health. More than 75 per cent of people with mental, neurological and substance use disorders receive no treatment for their condition at all, said WHO.
Also worrying over the rates of depression and suicide in the country, the medical director, Federal Neuropsychiatric Hospital Enugu, Dr Monday Igwe, told LEADERSHIP Sunday that the problems vary according to studies.
“This may be due to methodological differences such as the population studied e.g., clinic versus community samples. However, about 350 million persons worldwide have a depressive disorder making it the 2nd most burdensome disease in 2020.
“In Nigeria, a study of 21 out of 36 states representing about 57 per cent of the country’s population, reported a lifetime prevalence of major depressive disorder of 3.1 per cent. This value may increase to 5.2 per cent if you add a chronic depressive condition called dysthmia.
“With regards to suicide, according to WHO, close to 800,000 persons die by suicide every year worldwide, that is 1 suicide death every 40 seconds. In 2016, the World Bank report shows that the rate of suicide in Nigeria was 9.5 per 100,000 population.
“This increased to 15 suicides per 100, 000 population in 2018. In other words it appears that the rate of suicide or its reportage is increasing in Nigeria or both. These figures may be underestimated due to reasons of stigma of suicide death and the restrictive laws criminalising suicide attempts.
Also of concern, is the fact that there are inadequate mental health physicians in the country to care for people with mental illnesses, even as stigma and other factors exist.
According to the Association of Psychiatrists in Nigeria (APN), in 2019, there were about 250 psychiatrists and 200 psychiatrist trainees in Nigeria. The Chief Medical Director, Dr Igwe, however, said that the figures may have changed as new psychiatrists are graduated twice yearly, adding that many have left to practice abroad.
He said that the ratio of psychiatrists to patients in the country is about 1 psychiatrist to 800,000 persons, which is far less than the WHO recommended ratio of 1 psychiatrist to 10,000 persons.
Identifying stigma as a major factor hindering people from seeking help, the medical director said stigma as a spectrum usually begins with stereotypes and prejuidices that result from misconception about mental illness e.g., being dangerous or unpredictable to stigma and discrimination.
Stigma-related to mental illness worsens the burden of the disease and is responsible for substantial distress, treatment delay and reduced indices of social advantage such employment, marriage and accommodation.
He said “Stigma in mental illness could be public or self-stigma. Interventions to prevent or reduce stigma could be classified into three namely: Protest – a reactive measure; it seeks to diminish negative attitudes, but does little to promote positive attitudes supported by facts.
“Education – Public mental health education provides factual information to allow the public make an informed decisions about mental illness.
“Contact – Meeting people with mental illness who are responsible members of the community, able to hold jobs, or are good neighbours further diminishes stigma.”
On investment, he stressed the need for government at all levels to invest in mental health, saying mental health and psychosocial support will substantially increase in the coming months and years, given the COVID-19 pandemic.
“Investment in mental health programmes at the national and international levels, which have already suffered from years of chronic underfunding, is now more important than it has ever been. Hence the goal of this year’s World Mental Health Day campaign is increased investment in mental health.
“This is the time for government at all levels, NGOs, philanthropists and indeed everyone to invest in mental healthcare. Presently there are eight Federal Government funded Psychiatric hospitals in Nigeria, about 250 psychiatrists in the country taking care of the teeming population and 6 in Ebonyi state. This is grossly inadequate. Also most state governments have no psychiatric facilities or mental health personnel in their employ. Ebonyi state is a typical example.
“Other mental health workers are also inadequate such as clinical psychologists, occupational therapists, psychiatric nurses and social workers. This shortage of manpower in mental health is made worse by migration outside the country by medical workers for better pay.
“There is the need to build more mental health facilities, train personnel and provide working materials. Health workers should also be encouraged with better remuneration to reduce migration to foreign countries as their services are even more needed in Nigeria. These will go a long way to enhancing overall quality of life of Nigerians.”
Also, Mental Health Physician and Advocate, Dr Maymunah Kadiri, told LEADERSHIP Sunday that a huge number of Nigerians are currently living with mental illnesses, who need mental health services, but it is not readily available for various reasons.
According to her, “Human resources are not readily available and the healthcare facilities are not there. The availability, accessibility, affordability of medications are not readily available. It is also sad to note that there are about 250 registered psychiatrists in Nigeria, but as it is right now, those living in Nigeria, providing healthcare services for the Nigerian population are very small. The ratio is one psychiatrist to 1 million Nigerians. So sad, but this is the fact.
“In fact, we have more Nigerian psychiatrists in the UK than in Nigeria. As we speak, there is an exodus of Nigerian physicians to the UK and other parts of the world, including psychiatrists. So if we say one psychiatrist to 1 million Nigerians, we don’t know in the next coming years, if that may be less, maybe one to 2 million Nigerians. We really pray we would never get there. But this is a reality that we have to deal with,” she added.
Speaking on depression, Kadiri, who is also the MD/CEO, Pinnacle Medical Services, said currently, one out of every five Nigerians is depressed and globally, for every 40 seconds, somebody somewhere is dying from suicide.
“This just translate to the fact that over 800,000 people die from suicide every year and the sad part is that for every one suicide case, about 25 people have attempted suicide. And for every one suicide completed case, about 135 people are affected. They suffer intense grief, including family members, loved ones and of course colleagues,” Kadiri added.
She said with the COVID-19 pandemic, there have been an increasing rate of mental illnesses, adding that anxiety, depression and substance abuse are the top three result that we are seeing, even among Nigerians, making the rate of depression increasing by the day.
“Discrimination and stigmatisation of people with mental illnesses, including their families have to end. This is 2020, let us normalise mental health. Just the way we have fever, malaria, and any other non communicable diseases like hypertension, diabetes, cancer, we need to understand that mental illnesses are not different.
“Changing the narrative is very important. While advocacy is crucial in changing the narrative, the media, caregivers and the government play a very pivotal role. Government, must not only formulate policies, the policies must be implemented and executed. There is the need to put in place proper healthcare system, where services are available, accessible, and of course, affordable to everyone.
“It is paramount that mental health is being taught in the educational sector, where the curriculum can be revamped to make that happen. As for the workplace, employers must ensure that mental health activities are being carried out in the workplace. All these are the things that we need to carry out, in order to reduce the stigma, and if possible, eliminate discrimination and stigma attached to people with mental illnesses, including their families.”
In the same vein, the medical director, Federal Neuropsychiatric Hospital, Yaba, Dr Oluwayemi Ogun said investment in mental healthcare is one of the major challenges affecting accessibility to treatment in this part of the world.
“The only way we can fix this is through involvement of the government at all levels, especially the state government. Go to other states, how many of them have general hospitals with mental health personnel? so, they need to invest in the mental health of people by engaging professionals.
“Frankly speaking, the federal government is trying, because all the eight psychiatric hospitals owned by the government have manpower, and I must also commend Lagos State in this area.”
Speaking on brain drain, Ogun said majority of psychiatrists are leaving the country for greener pastures in other climes. “It is not as if Nigeria is not training psychiatrists or experts in this field; as we are training, they are migrating to other countries. The number of psychiatrists in this country is not up to 250 and we keep training every year,” she said.
According to her, mental healthcare, which is the ninth component of the primary healthcare, has not been fully integrated, making it difficult for people in the rural areas to access treatment.
She said, “The conflict situation in some parts of the country and emergence of COVID-19 pandemic had further diminished the little accessibility to mental healthcare. The eight Federal-owned psychiatric hospitals are situated in urban centres; mental healthcare is not fully integrated, so, there is need for a massive scale up in investment, to improve mental care.”
Commemorating this year’s World Mental Health Day, the director-general of WHO, Dr Tedros Adhanom Ghebreyesus said the event is an opportunity for the world to come together and begin redressing the historic neglect of mental health,” We are already seeing the consequences of the COVID-19 pandemic on people’s mental well-being, and this is just the beginning. Unless we make serious commitments to scale up investment in mental health right now, the health, social and economic consequences will be far-reaching.”
World Mental Health Day is observed on 10 October every year, the event helps to raise awareness of mental health issues around the world and mobilising efforts in support of mental health.
It is nearly 30 years since the first World Mental Health Day was launched by the World Federation for Mental Health,” said Dr Ingrid Daniels, President of the World Federation for Mental Health. “During that time, we have seen an increasing openness to talk about mental health in many countries of the world. But now we must turn words into actions. We need to see concerted efforts being made to build mental health systems that are appropriate and relevant for today’s – and tomorrow’s – world.
“With so many people lacking access to good quality, appropriate mental health services, investment is needed now more than ever,” said Elisha London, Founder and CEO of United for Global Mental Health.
“Everyone, everywhere can participate in this year’s campaign. Whether you have struggled with your own mental health, know someone who has been affected, are a mental health expert, or if you simply believe that investing in mental health is the right thing to do, move for mental health, and help make mental health care and support accessible for everyone.”
FG Pledges Support For Mental Health Bill
To safeguard the mental health of Nigerians, the minister of health, Dr Osagie Ehanire, has pledged his support for the Mental Health Bill, to be passed into law.
Ehanire who made this pledge at a virtual National Mental Health Summit, vowed to do everything within his power to ensure that the bill is passed into law.
He said the National Health COVID-19 pandemic response action plan, makes provision for mental health and psychosocial support as an integral part of the COVID-19 health response, and promote activities, all in efforts to addressing mental health issues in Nigeria.
The minister who was represented by the Director of the Department of Health Planning, Research and Statistics at the Ministry of Health, Dr Ngozi Azodoh, commended Janssen Pharmaceutical and the Association of psychiatrists in Nigeria for organizing the summit in commemoration of this year, World Mental Health Day.
Themed: ‘Mental Health for all’, the minister said with the COVID-19 pandemic, there have been so much around mental health issues, starting from psychological discomforts to agitations. “So mental health for all is so apt for this season we found ourselves. This could not have come at a more appropriate time than now, when the world is at a critical juncture.
“Our daily lives have also been impacted significantly, that people have found themselves behaving in a way that are alien to them, posing as a challenge to our mental health situation.
“However, the mental health bill which seek to protect the right and freedom of persons with mental health issue and substance abuse programme, as well as ensure a better quality of life , better service delivery, in addition to providing a framework for the patient round mental health, is a first step to tackling the aftermath effect of COVID-19 on Nigerians. As the Minister of Health, I will do everything within my power to ensure that that bill is passed into law,” he said.
In the same vein, the chairman, Senate Committee on Health, Sen Ibrahim Oloriegbe, has given the assurance that the mental health bill will be passed into law by the senate, by November, 2020.
Oloriegbe said the committee set up to look into the bill, has finalised their report. “We now have a clean draft and we hope by next month, hopefully before the middle of November, 2020, the bill will be passed by the senate.”
Speaking on the provision of the bill, the senate chairman said, “The law was established to provide a framework for policy formulation and policy implementation for addressing mental disorder. It also provide the rights of persons with mental disorder and how those rights can be protected.
“It provides for various form of management and treatments for mental health at various levels starting from primary to secondary and tertiary hospitals. For the first time, we are establishing a committee that will be able to do a review of people that require involuntary treatment for mental disorders. It is also going to address the issue of quacks and illegal treatments that we have all over the places.
We hope when it becomes law, the condition of people with mental disorder would be better. Passing the bill into law is one thing, implementating it, is another thing. I urged all stakeholders, be it health practitioners, civil society group and partners to ensure that we have effective implementation of the law.
The president, association of psychiatrists in Nigeria, Dr Taiwo Lateef Sheikh said, “Today in Nigeria, we don’t have Community Mental Health care, except what Lagos state is trying to do. We have extremely poor funding. Federal ministry of health does not have budget line for mental health. Only Lagos Ministry of Health has funding and budget line for mental health among all the states in the country today.
“Mental Health gets less than 3 per cent of the health budget and we are still operating under the regional lunacy law that was adopted in 1958. Only Lagos state has modern mental health law today.
To address all these issues, Sheikh said, “We need to develop a roadmap for implementation of the law. All stakeholders and partners need to support the Federal Ministry of Health for the successful take off of the Department of Mental Health Service, for effective coordination of mental health programs in Nigeria.
“Secondly, we need to revise the 2013 National mental health service delivery policy for effective integration of mental health service delivery at all levels of healthcare delivery using the existing health system. We don’t need to go outside the existing system and structures that we have. We must find a way of introducing community mental health care delivery within the existing healthcare system.
He however said mental health has come a long way in Nigeria, but the country is yet to receive universal access to effective, qualitative and affordable mental care, adding that the signing of a mental health bill into law is a critical investment in mental health in Nigeria that will guarantee access to effective, compassionate and quality mental health care that is desirable.