One in four Nigerians suffers from mental illness, psychiatrists have declared. Simply put, over 50 million Nigerians are suffering from varied mental disorders. They further disclosed that 75 per cent of those who need mental care do not have access to it, as Nigeria has only 300 psychiatrists in a country of 200 million people, stressing that Africa has one psychiatrist for every 500,000 citizens, which is 100 times less than the World Health Organisation’s (WHO) recommendation. Some mental health experts made these disclosures on prevalence of mental illness in the world’s seventh- largest country, as Nigeria joins the rest of the world to mark World Mental Health Day (WMHD). Speaking recently with the media, Dr. Olugbenga Owoeye, Medical Director, Federal Neuropsychiatric Hospital, Yaba, Lagos State, said that studies have shown that one out of every four persons in Nigeria has one diagnosable mental illness or the other. The figure according to him indicates that about 25 per cent of Nigeria’s population is suffering from one mental illness or the other. Dr. Owoeye expatiated on how over 50 million Nigerians go about their daily activities in a mentally unstable state, “So, you can see how common this condition is, mental illness is not only synonymous with those walking naked under the bridge; there are many people who dress very well and go to the office occasionally, but who are suffering from mental illness.” He itemised the minor and major conditions of mental illness in Nigeria. According to him, stress-related disorders or acute stress reactions such as generalised anxiety, phobias of various types constitute the minor conditions while the case of effective disorders, major depression or in form schizophrenia, which needs urgent attention are classified as the major ones.
“There are many types of schizophrenia, there is what we call a split mind; here, the mind is shattered and the person loses contact with reality. The person may also be hearing strange voices, seeing strange things, and having odd behaviours. Substance abuse-related disorder is also part of the major condition and this may be comorbid or coexisting with some other major mental illness. Other minor conditions include eating disorders like anorexia nervosa and bulimia nervosa,” the MD stated. Dr. Owoeye noted that of all the number of affected cases of mental illness in the country, about 75 per cent of those who need mental health care do not have access to it. He attributed the country’s high burden of mental disorders to inadequate manpower. “In Nigeria as of today, we have about 300 psychiatrists to treat about 200 million people. The number of clinical psychologists we have is even lower. There is a scarcity of psychiatric nurses, social workers and occupational therapists and despite the scarcity, these groups of people are still travelling out of the country in search of greener pastures.” The MD also noted that another challenge is inadequate infrastructure; out of 36 states and the Federal Capital Territory (FCT), the country has only nine federal-owned psychiatric hospitals, with six of them located in the six geo-political zones. The psychiatrist said there is still a need for more to cover all the states considering how common these conditions are. Speaking in a similar vein, Prof. Taiwo Obindo, President, Association of Psychiatrists in Nigeria (APN), stated that 60 million Nigerians are suffering from mental illnesses.
According to him some factors hindering the management of mental illness in Nigeria include myths and traditional beliefs, inadequate mental health facilities, and the number of mental health professionals. He said, “Mental healthcare is in a sorry state given that we have more than 60 million Nigerians suffering from various mental illnesses and that only about 10 percent of them could access appropriate care.” Prof. Obindo, also the Chairman, Faculty of Psychiatry, West African College of Physicians, added, “We are left with more than 90 percent who are unable to access care and this group is called the treatment gap for mental illnesses. Knowing that 60 per cent of Nigerians live in the rural areas, they do not have access to appropriate care and have to travel long distances to access facilities’’ He said the gap was due to various factors like the knowledge gap in which people do not have appropriate information about the causes and treatment for mental illnesses. The APN president noted that the few available mental health facilities were located in the city centres. He said that the number of mental health practitioners was low as it fell below the ratio recommended by the World Health Organisation. He also said the few trained practitioners were often eager to leave the country. “The environment in which we practice, the security situation and the remuneration that people were given in the country tend to push them out,” he added.
“And then, of course, the pull factor from the developed countries where they tend to poach on the already trained medical practitioners in the country, particularly the psychiatrists.” Roughly, nine out of every ten doctors in Nigeria are seeking to leave the country and find work elsewhere, according to recent polls monitoring the health situation in Nigeria. The desire for better opportunities such as improved pay, facilities, work environments, professional satisfaction, tax breaks and career progression were among the reasons that psychiatrists and other doctors surveyed said they were hoping to emigrate. Recent reports indicate that no fewer than 6,068 medical doctors have moved to the UK since Muhammadu Buhari became Nigeria’s President in 2015. According to data obtained from the General Medical Council of the UK, the total number of Nigeria-trained doctors who migrated to the UK as of August 30, 2022 stood at 10,096. Checks showed that the General Medical Council in the UK licensed at least 353 Nigerian-trained doctors between June 10, 2021 and September 20, 2021. Prof. Obindo advocated for Nigeria’s implementation of the Mental Health Policy on the practice of psychiatry. He said that although the document was last reviewed in 2013, it was not being implemented. He said one major component of the policy was the integration of mental health into primary health care, which was yet to be achieved after over nine years. The psychiatrist added that the law operational in the country was the “lunacy act”, which was first enacted in 1916 and reviewed in 1958. ”
The Mental Health Bill by the mental health stakeholders led by the Advanced Practice Nurse, in conjunction with the National Assembly and the Ministry of Health was yet to be assented to by the President. Mental health is an integral part of health and well-being, and yet it’s been neglected in this part of the world. WHO estimates that worldwide, 450 million people have a mental disorder and 25 per cent of the population will suffer from mental illness at some times in their lives. According to the WHO, mental health is; “a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”. In 2019, a survey on mental health in Nigeria, by Africa Polling Institute (API) and EpiAFRIC shows how awareness of mental health is low in Nigeria, with most respondents being aware that they have mental health disorder, recognized it, and commonly caused by drug abuse, possession by evil spirits and sickness of the brain and a majority of the patients are taken to a prayer house for spiritual intervention. Nigeria is also currently experiencing multiple public health challenges as many other countries around the globe, such as health and social workers’ burnout, suicidal episodes, communal violence and insecurity that can lead to mental health issues.
The country’s health care system is composed of three tiers; the primary health system mostly accessible in rural areas and every ward of local government which is being managed by the local governments’ authorities in collaboration with state governments and international donor organizations, and cases being referred to secondary and tertiary care when needed. The secondary health care which mainly comprises the comprehensive health centres and general hospitals being managed by state governments. While the tertiary health systems which consist of the federal medical centres, specialist hospitals and teaching hospitals being managed by the federal government of Nigeria and in few cases by the state governments. A Consultant Psychiatrist and former Chief Medical Director (CMD), of Lagos State University Teaching Hospital (LASUTH), Dr. Femi Olugbile, proffered that to improve mental health care in Nigeria, Primary Health Care (PHC) facilities need to be activated to recognise and treat basic mental health problems. And that if they are interconnected through electronic medical records/Information Communication Technology (ICT), specialists based in specialist centres could supervise these PHCs in regional clusters and facilitate back-and-forth referral of difficult cases. Dr. Olugbile added, “This is the appropriate pragmatic response to the target, rather than perpetual hand-wringing about the shortage of specialists. Carefully managed task shifting is the way forward, though it should not stop the acquisition of more specialists and facilities. We need to think out of the box.” Last Monday, specifically on World Mental Health Day, WHO made recommendations on how to reverse suicide and mental health crisis in Africa.
The body also inaugurated a campaign to raise awareness and spur action for suicide prevention in Africa, which has the world’s highest rates of death by suicide. According to WHO, around 11 people per 100,000 every year die by suicide in the African region, higher than the global average of nine per 100,000 people. It said this is due in part to insufficient action to address and prevent the risk factors, including mental health conditions, which currently affects 116 million people, up from 53 million in 1990. WHO, in a statement, said the social media campaign aims to reach ten million people across the region to raise public awareness and galvanise the support of governments and policymakers to increase focus and funding for mental health programming, including suicide prevention efforts. According to WHO, such efforts include, equipping health workers to better support those dealing with suicidal thoughts, educating people who may experience these thoughts on where to go for help as well as sensitising the public on how to identify and help those in need and to help tackle the stigma associated with suicide, epilepsy, mental health conditions, alcohol and drug abuse. The African region is home to six of the ten countries with the highest suicide rates worldwide. The common means of suicide in the region are hanging and pesticide self-poisoning, and to a lesser extent drowning, use of firearm, jumping from a height or medication overdose. Studies show that in Africa, for each completed suicide, there are an estimated 20 attempted ones. Dr. Matshidiso Moeti, WHO Regional Director for Africa, said: “Suicide is a major public health problem and every death by suicide is a tragedy.
Unfortunately, suicide prevention is rarely a priority in national health programmes. “Significant investment must be made to tackle Africa’s growing burden of chronic diseases and non-infectious conditions such as mental disorders that can contribute to suicide,” Dr. Moeti said. WHO added that, in Africa, underinvestment by governments is the greatest challenge to adequate mental health service provision. It noted: “On average, governments allocate less than 50 U.S. cents per capita to mental health. Although it is an improvement from 10 U.S. cents in 2017, it is still well below the recommended U.S. $ 2 per capita for low-income countries. Additionally, mental health care is generally not included in national health insurance schemes. “Due to the low investment in mental health services, the African region has one psychiatrist for every 500 000 inhabitants, which is 100 times less than the WHO recommendation. Additionally, mental health workers are mostly in urban areas, with primary and community health facilities having very few if any,” The World Health Organisation recognizes World Mental Health Day on 10 October every year. The theme of 2022’s World Mental Health Day, set by the World Federation for Mental Health, is ‘Make mental health and wellbeing for all a global priority’.
