Poor policies, facilities hinder management of mental disorder in Nigeria

A Hospital used to illustrate the story
A Hospital used to illustrate the story

Leke Adetayo sat at a beer parlour nursing his drink when this reporter first met him in the company of friends. He felt like the world was coming to an end for him. In fact, he had contemplated suicide, he would much later reveal, because he could no longer stand the emotional turmoil he was going through.

Mr. Adetayo, who lives in Kubwa, a suburb of Abuja, works in a bank as a marketer. He said he had been struggling to meet his service target of attracting N100 million cash deposits and was scared he could be affected by a downsizing exercise hinted by the bank.

As if to complicate his situation, his wife was due to put to bed in a month, his house rent was due and he still had his child’s school fees to settle.

Mr. Adetayo was buffeted by emotional problems – fear, resentment, guilt, anger, loneliness and worry, all stemming from an economic predicament for which he could not think of a solution.

“The recession in the country has affected a lot of things, there are few Nigerians able to make large deposits in banks and those who have such money in this town are scared of the EFCC. But the management of my bank seems not to be aware of this”, he said on a rare occasion that he opened up to a friend.

Those who used to know Mr. Adetayo said his behaviour has changed. He has become more violent and gets angry at little things.

He felt physically tired, emotionally drained, economically threatened and had withdrawn from people around him. He saw himself as a failure and sought escape in alcohol.

Mr. Adetayo had gone into what behaviour specialists call depressive mood.

Unfortunately, he and his family were not aware that he could get medical help, probably because they had no knowledge of how severe his case was or how to handle it.

Tayo Daramola, a consultant psychiatrist at Karu General Hospital, Abuja, in an interview with PREMIUM TIMES, said many people experiencing similar problems as Mr. Adetayo also have no knowledge of how to handle it.

According to the consultant, what he was experiencing was a mild form of depression, which if not treated medically, could become severe, leading to suicide.

“Many people with this kind of disorder do not seek medical attention”, the psychiatrist explained darkly. Some who were knowledgeable and courageous to do so lack enough funds to keep accessing treatment, and this discourages them from continuing treatment, he said.

“At least, 1 in 5 people fall into mild depressive mood due to changes in events and circumstances, with nothing less than 5 percent of the general population suffering from severe depression disorder at any particular time”, Mr. Daramola said.

So what causes mental disorder?

“Depression is not usually a sudden development”, said the consultant. “It is usually triggered by a happening in someone’s life. Everybody is susceptible to depression. It is usually an emotional and hormonal response to challenges in everyday life.

“This usually has a direct effect on the economy, as the individual will not be at the best of his/her potentials if there are no quick medical intervention, as the milder form of depression can progress to a severe form”.

The World Health Organization said depression is a common illness with an estimate of 350 million people of all ages suffering it globally. And it is becoming more rampant in the world, especially in developing countries, said a report on the website of the organisation.

Adedeji Akiije, a senior resident doctor at the Lagos University Teaching Hospital, said the economic situation in the country has increased the level of depression among Nigerians. He said it is the reason for the increase in the reported cases of suicide in the country.

“This is usually the end results of depression, when medical attention is not quickly administered or when not well-managed. A depressed person is mostly suicidal”, Mr. Akiije said.

“Depression comes in different forms and almost everybody struggles with depression.  Sometimes, it is what happens to people that puts them into emotional stress, making them exhibit different behaviours to manage it.

“This is the reason why you see some people become alcoholic, start using drugs or harmful substances to get them out of the feeling. Some go into seclusion, while others who cannot manage the situation either go mad or commit suicide”, he said.

NEED FOR GOVERNMENT ACTION

Mr. Daramola, the psychiatrist, said there was a need for government and policy makers to pay more attention to issues relating to mental rehabilitation in the country.

“This will help improve the health status of many, because there is a great overlap between anxiety disorders and clinical depression,” he explained.

“The government needs to treat issues pertaining to mental health with utmost importance; this is because mental stability is the bedrock for productivity in any country.

“Currently, the facilities available are grossly inadequate for the treatment of the mentally-challenged in the country”, Mr. Daramola lamented.

“For example, there is only one government-designated facility in Abuja that can cater for the mental health of the people living in the FCT. Others available are private-owned and might be a bit expensive for the less-privileged”, he said.

According to him, government needs to focus on establishing counselling facilities to help publicise and educate people on causes of mental illness. He said awareness campaign for mental illness should be taken seriously like with HIV/AIDS. This will help curb the stigmatization and discrimination people suffering with the aliment face and thus encourage them to seek for help, he canvassed.

“The public needs to have awareness on mental issues. People need to know that there is a difference between normal depression and clinical depression so as to be able to know when to seek for help.

“There is a need for free treatment facilities for the management of mental health. There should be sponsorship for treatment of mental treatment.

“Lobbying policymakers on the issue has not yielded any result, maybe because they don’t want to be labelled or associated with the people living with the aliment. There isn’t any bill or law guiding the practice of mental health in this country as of now; we are still using the Lunacy Act of 1958,” he said.

DEARTH OF PROFESSIONAL PERSONNEL

Due to, or arising from, the gross inadequacy of facilities to treat the mentally-challenged, there is constant brain drain in the sector as psychiatrists are leaving the country for greener pastures.

Mr. Daramola said those who remain in Nigeria are not evenly circulated across the country.

“There is a large concentration of expertise at the South-west, which is marked as the training site. Policy makers need to make polices that will attract these specialists to places where they are very few or nonexistent”, he said.

“The shortage of specialists is a big problem that needs to be urgently tackled if there is to be an improvement in treatment of mental disorder in the country, starting from the care givers to care for the patients.

“We don’t have enough practitioners in the field; there was a time when there was only one psychiatrist in the whole of Abuja. Now we have about 10 consultants, which is a far cry for the population of people living within the town as compared to the ratio of those who are suffering from depression.

Mr. Akiije said the challenges faced in the practice, such as poor working conditions, poorly-equipped medical facilities, lack of friendly policies and scarcity of drugs to treat patients have caused most of the trained specialists to leave the country to practice in more health-friendly countries.

“There is a dearth of clinical psychologists that are supposed to help in preventing people from getting to that level of mental illness. Psychiatrist nurses, occupational therapists and social health workers are hardly found.

“Even with the shortage of professional psychiatrist in the country, some of the trained specialists who are still within the country do not have places of practice yet because there are no facilities to absorb them”.

“This has an adverse effect on the ratio of doctors to patients. The ratio can be put at 1 to 40,000”, he explained.

SYMPTOMS OF CLINICAL DEPRESSION

Depression is a mood disorder; it makes the person feel very low most of the time. It also affects the thought system of the individual, making him/her believe in most negative things.

According to Mr. Daramola, depression is a mental disorder, characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness and poor concentration.

Clinical depression is different from normal everyday cases. A person can be termed clinically depressed when the individual has a problem of constant low mood that cannot be attributed to a cause or reason, such as loss of job, person, or something of value.

The symptoms are low energy level, feeling weak and not being able to carry out the activities they usually do without much ado. They withdraw from social gathering and do not want to interact. They lose interest and stop doing things they liked to do. It is not unusual for a depressed person not to be interested in their marriage or partner, due to loss of appetite for both food and sex.

The first sign might be withdrawal. Such persons are socially withdrawn and may not talk to people. There could also be refusal to eat and undue forgetfulness.

If the pathology continues, they get to the point of feeling suicidal, feeling hopeless and worthless.

CONTRIBUTING FACTORS

There are interrelationships between depression and physical health, experts say.

People who have gone through adverse life events like unemployment, bereavement, psychological trauma are more likely to develop depression. Depression can, in turn, lead to more stress and dysfunction and worsen the affected person’s life situation.

According to experts, there are lots of things that can trigger depression in a person. It can be an outcome of complications at birth, such as a prolonged labour during child birth, loss of a loved one or an object. Not necessarily because of the market value of the object, but because of the importance attached to it

Though depression is mostly common among young adults, it is more prevalent among the female gender because they are the ones that carry on with life activities.

Mr. Akiije noted that depression is more common among women than men because men have other ways of combating situations, as compared to women who do not speak up.

DEPRESSION IS TREATABLE

Experts stressed that depression is treatable. The problem is that most depressed people refuse to own up to it, they said.

People live in denial due to fear of stigmatization from families and friends. Most people resort to the use of alcohol, hard drugs and deviant attitudes in combating the ailment. This is usually common among the male, while the female most times go into seclusion and not own up to people around them.


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