…Calls for implementation of national suicide strategy, improved economy, poverty reduction.
Resuming efforts to safeguard and enhance mental health was made possible by the 2022 theme, “Make mental health & well-being for all a global priority”.
With the theme “Mental Health is a Universal Human Right” for Global Mental Health Day 2023, the globe is advocating mental health as a human right.
Good Health Weekly spoke with Dr Olufemi Oluwatayo, a Consultant Psychiatrist and a Fellow of the Royal College of Psychiatrists.In Nigeria, he is also the Chief Executive Officer, of the Retreat Healthcare, Ikorodu, Lagos
Oluwatayo who was formerly a Consultant and Medical Director at Lakeside Hospital, Wyboston, Bedfordshire UK, spoke on obstacles to mental health services in Nigeria, and why mental health should be regarded as a human right. He said despite making little progress, inadequate funding, stigma and brain drain remain the biggest obstacles to delivering mental health services to Nigerians. Excerpts:
October 10 is World Mental Health Day, what is your take on access to services?
The provision of mental health services is still grossly inadequate in Nigeria. Although in the last decade, there has been an improvement, because of the massive gap that we had, we are still a long way from where we should be. At present, almost all Federal and State Teaching Hospitals and Federal Medical Centres, FMCs, have a functional department of psychiatry. There are also provisions at most General Hospitals. This is being supplemented by private sector providers like The Retreat Healthcare and some charities. I know a lot of efforts are being made to integrate mental health services into Primary Health Care. So overall in terms of provisions, we are making some progress.
However, inadequate funding, stigma, and brain drain remain the biggest obstacles to delivering mental health services to Nigerians.
Funding is still key to improving mental health services as the level of funding committed to mental health by all levels of government are grossly inadequate. We need funding to provide general mental health services and specialist teams, for example to manage people using illicit drugs. The funding does not have to come from government alone but from multinational organisations, NGOs and the private sector. The funding level has to be such that the services are subsidised and made affordable to an average Nigerian.
Brain drain is affecting all sectors of our society especially the health sector and mental health is not an exception with many psychiatrists, mental health nurses and clinical psychologists leaving the country. This depletes already scarce resources. I believe the Tinubu administration is already looking at strategies to stem the brain drain and reverse the trend to a brain gain. Unfortunately it will take a while before things get better as long as insecurity and the adverse economic situation persist.
Impact of violence and insecurity
Unfortunately, there has been a massive increase in insecurity and violence in Nigeria with serious implications for mental health.
Worries about being a victim is real and can be a source of stress. For people with underlying mental disorders, this can be a trigger for a relapse. Being a victim of or witnessing violence may lead to, in the short term, Acute Stress reactions including Adjustment Disorders and in the long term, Post Traumatic Stress Disorder. The families of the victims are also adversely impacted as they worry about their loved ones. For me, the most significant impact is on the psyche of the nation, how the insecurity worries are changing our lifestyles curtailing our movements and leading to massive emigration of middle-class Nigerians.
This has massive implications for the brain-drain and manpower shortages in the mental health sector.
Suicide cases
Increasing reports of suicide in the media is indeed a worrying trend and appears to be a reflection of an increase in the act. The presence of common mental disorders such as Depression and the worsening economic situation with people really struggling to make ends meet and feeling unable to find a way out is likely to be a factor. With increase reporting in mainstream media and subsequent sharing on social media, copycat suicides are most definitely another factor in the increase. Unfortunately, we are now beginning to see suicide hotspots where the act is commonly perpetrated. So implementing a national suicide strategy, more appropriate media reporting of suicide acts and obviously improving the economic situation of the country and reduction in poverty are key areas of intervention. Early detection and treatment of mental disorders such as Depression is also important Also, there appears to be increasing self-harm behaviours among the youths probably through the influence of social media and other exposure to western cultures. Also, increasing exposure to and use of illicit and street drugs is now common among the youths.
In terms of interventions, we need to educate the youths and provide more targeted mental health services for them. Managing access to and availability of illicit drugs requires active implementation of a national drug strategy as it is a complex issue that require a strategic approach.
Mental health disorders
Depression and common mental disorders affect millions, according to the WHO. Resources remain inadequate and governments at all levels need to increase their efforts and reduce the neglect in the sector. Stigma remains a significant issue.
As we mark World Mental Day 2023, it is a good opportunity for governments to restate their commitments and give more attention to mental health.
Mental health as a universal human right
Lack of knowledge and understanding of the nature and causes of mental disorders continue to fuel ignorance and superstitions as such people with mental disorders are stigmatised discriminated against and abused in our society almost on a daily basis. We all have a responsibility to reverse this trend. People with mental disorders need to be treated with respect and dignity. Their voices must be heard in their treatments. They have equal rights with any other Nigerian and their universal human rights need to be protected.
Mental and general health services
Nigeria, as in many parts of the world, has inadequate integration of mental health services into mainstream services with a lack of parity of esteem. It is an ongoing battle as there are many challenges towards integration. Historically, the services have been kept separate for many reasons including stigma, prejudice, and lack of understanding of the causes of mental disorders and their treatments. However, things are changing and the push to integrate mental health into PHC and mainstream services is gathering steam
Implementation of Mental health law
Nigerian professionals and stakeholders in mental health services are indeed grateful for the ascent of the Mental Health Bill by the Buhari administration. Despite its flaws, it is a comprehensive document that sets the agenda for the provision of mental health services in Nigeria and safeguarding the rights of people with severe mental disorders, their families, and the practitioners in the field. I look forward to its immediate implementation.
I believe preparations are currently ongoing towards implementing the Act. There are massive challenges along the way but I believe we are capable of doing it as a country. The way we look after the vulnerable members of our society says a lot about our conscience as a nation.
A significant numbers of people who suffer from mental disorders are unable to make decisions about the need for treatment and to manage their affairs including finance and properties. The disorder impairs their capacity to make these decisions thus health professionals need to step in and make decisions on their behalf in their best interests. This is why we need extra protections under the law for these people and part of the reasons for the new Mental Health Act. This adds additional protection of their rights in addition to the rights of all citizens as guaranteed by the constitution.
Causative factors of mental illnesses
The causes of mental disorders vary and are complex. It ranges from genetic inheritance to stress, to illicit drug use and early life traumas. Many are preventable. We can enhance our mental health by making lifestyle choices such as avoiding drug and alcohol use, having adequate night sleep, exercising and keeping warm and healthy relationships, and being altruistic in our acts.
Personal experience
In my experience as the Chief Executive Officer of The Retreat Healthcare, there is more awareness of mental disorders in society and things are getting better. Obviously, we still have a very long way to go but I’m optimistic. My biggest concern is the amount of mental health professionals emigrating from Nigeria. I’ve lost count of how many of our staff have left for the UK and US since we opened in 2017.
Number of Psychiatrists: Obviously not, I think the Association of Psychiatrists of Nigeria, APN, some time ago, said that there are only 250 Psychiatrists for 200 million Nigerians. I do not know the facts but the recommended ratio is 1 psychiatrist to 10,000 people. I don’t think there is any country that is currently able to meet this ratio as post-COVID-19, manpower resources challenges have become a global health issue.
What we need to do as a country is to think out of the box, and come up with unique solutions to this challenge. You don’t need a psychiatrist to treat many mental disorders, middle grade professionals can be trained to fill the gap and the training does not have to be done by governments alone. Just like we have private schools and universities, private health providers such as The Retreat Healthcare can step in and fill the gap.
Cost of treatment
Many people still cannot afford the cost of treatment for mental disorders even though it is already subsidised by all government hospitals. It is virtually impossible to pay out of pocket for these treatments because they are often long term treatments as many mental disorders are long term conditions that require ongoing treatments. This is why experts in the field have recommended that mental disorders should be included in health insurance scheme packages.