Improving mental healthcare delivery in Nigeria

Primary Health Care

Primary Health Care

A psychiatrist, Dr Emmanuel Owoyemi, recently raised concern about the level of neglect in the mental healthcare delivery system in Nigeria.

Owoyemi, the founder of Mental Health Foundation, Lagos, observed that poor working conditions and stigma associated with the profession were responsible for the dearth of mental health experts in the country.

“It is not easy to get mental health experts because they are very few in this country; we still have less than 200 psychiatrists in Nigeria.

“There is high level of stigma in mental health; many people don’t want to specialise in mental health because of stigma.

“Even, we that are working, people say a lot thing, but because you have grown thick skin and then this is your passion, you are interested in it, you do not really care.

“So, many people are not being encouraged to specialise because of the stigma while the salary and the condition of work are not encouraging.

“The Federal Government should employ those that have been trained, retrain them and provide incentives for them to be efficient.

“Then, the curriculum for medical students has to be reversed because people who specialise in psychiatry have only four weeks to go for anything that has to do with it.

“I don’t think they really have enough time to understand what it means to be able to have an informed decision to either specialize in psychiatry or not,’’ he said.

Also, Prof. Olayinka Omigbodun, a consultant and Head of Department, Children and Adolescent Psychiatry, University College Hospital (UCH), Ibadan, called for more attention on mental healthcare because there were more cases of mental disorder.

“The Nigerian government has not put enough emphasis on this area of health challenge which is on the increase daily.

“For instance, out of every 20 admissions made daily at the UCH, six or seven are generated from schizophrenia.

“Half of this admission is discharged early after full recovery from treatment, but a lot of others remain for longer periods of time in the ward.

“Government had done much in the area of Primary Health Care and HIV/AIDS much has yet to be done in the area of psychiatry and mental health.

“In a population of about 170 million people, we only have about 250 psychiatrists. The nurses and social workers are even fewer than the doctors.

“This is because of the stigmatisation of people who are caregivers to those with mental disorders. So, most of the patients are managed unprofessionally at home.

“A more serious problem is the way many families hide their wards and children at home because of social stigma and the patients end up being in permanent conditions of unwellness; these are probably the cases you see on the streets,’’ he said.

He also identified inadequate funding, dearth of manpower, high cost of treatment, poor facilities, lack of infrastructure and obsolete mental laws as impediments to effective mental health delivery in the country.

Sharing similar viewpoints, Dr Taiwo Ladapo, Medical Director of the Federal Psychiatric Hospital, Yaba, Lagos, said that the ratio of psychiatric doctors to the nation’s population was worrisome.

“Most Nigerians do not believe that they need psychiatrists. They do not even understand what a psychiatrist is about. They associate a psychiatrist alone to someone taking care of people with mental problems,’’ he said.

Yet, statistics from the World Health Organisation (WHO) Regional Director for Africa, Dr Matshidiso Moeti, reveals that one out of every six African suffers from the mental disorder.

Corroborating the statistics, Prof. Oye Guruje, a psychiatrist with the University of Ibadan, said that one out of seven Nigerians suffered from the serious mental disorder.

“In Nigeria, one out of seven persons will have serious mental illnesses while one in four persons will have some form of mental disorder; and this is a conservative estimate.

“Mental illness is one of the major contributors to disease burden globally; it is the sixth largest burden worldwide and this is much more burdensome than HIV,’’ he said.

In the light of this, Prof. Oye Guruje of the World Health Organisation Centre for Research and Training in Mental Health, Substance Abuse and Neuroscience, advised the government to accord mental healthcare top priority because its burden was more than that of HIV and AIDS.

In his view, Dr Abayomi Olajide, a Consultant Psychiatrist in Ogun State, expressed concern about lack of proper legislation for the care and management of the mentally challenged.

Olajide of the Neuropsychiatric Hospital Aro, Abeokuta, argued that mental disorder remained a menace and the most neglected in medicine in spite of its prevalence.

He recalled that the Mental Health Bill which had been in the National Assembly in the last 10 years had yet to be passed into law even though it was categorised as an executive bill.

“As of now, there is no modern legislation backing the operation of mental health services except the obsolete 1914 Lunacy Act.

“The mental health policy domiciled with the Federal Ministry of Health is moribund and hardly do we find mental health desks in any state ministry,’’ he said.

According to Olajide, there is no clear policy direction as to how a sufferer can be treated and no specific budgetary allocation for mental health services.

“There are no social welfare services in most states. There is no specific budgetary allocation for mental health services except what is given to the psychiatric hospitals for running and personnel costs; and oftentimes, for capital projects.

“Because of this, the traditional healers take advantage of the situation to exploit and abuse both the mental patients and their relatives,’’ he said.

Irrespective of this challenge, Dr Abdulganiyu Olarewaju, a Consultant Psychiatrist at the University of Ilorin Teaching Hospital (UITH), urged the Medical and Dental Council of Nigeria to regulate the activities of traditional mental homes in the country.

He noted that the practices of these mental healing homes were unethical and should not be encouraged.

According to him, many of the traditional healing homes compound the problems of mental patients because of their crude methods.

“Many of the unorthodox practices at the traditional homes are at variance with modern psychiatric practice because they belong in the Stone Age,’’ he said.

He called for proper training for traditional healers such as the traditional birth attendants so that they would have the rudimentary knowledge of the psychiatric practice.

All in all, medical experts insist that government at all levels should commit more funds to the management of mental disorders in the country.

They note that deliberate efforts must also be made to further halt the brain drain of qualified psychiatrists in the country and rehabilitate lunatics who are roaming on the streets in major cities across the country.

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