World Mental Health Day: Inadequate personnel, skewed facilities’ distribution worry stakeholders

As the World Mental Health Day was celebrated October 10, a group of stakeholders marked the day in Abuja pondering how to overcome the enormous challenges of mental health care in Nigeria.

The meeting was facilitated by Olive Prime Psychological Services, a private institution providing mental health service in the Federal Capital Territory. It was held on Wednesday at the organisation’s office in Kado District of Nigeria’s capital.

World Mental Health Day is an initiative of the World Federation for Mental Health (WFMH) and the World Health Organisation (WHO) and has been celebrated every year since 1992. The day was set aside for global mental health education, awareness and advocacy.

Since the inception of the day, several themes have been drawn annually to bring attention to mental health issues and its effect on the lives of people worldwide.

This year, the theme is: “Young People and Mental Health in a Changing World.”

Mental health disorders are the major cause of disabilities worldwide; accounting for 37 percent of all healthy life years lost through disease, experts say.

In Nigeria, an estimated 20 percent to 30 percent of the population are believed to suffer from mental disorders. This number is very significant, bearing in mind that Nigeria has an estimated population of 200 million people.

Unfortunately, in spite of this huge burden, less than 20 per cent of persons with mental disorders receive treatment in Nigeria, and of these, only 10 per cent maintain follow-up treatment over a 12-month period.

Furthermore, Nigeria has an insufficient and skewed concentration of facilities: there are only eight federal psychiatric hospitals; and even fewer private facilities tin the country.

Most of these facilities are concentrated in the southern and south western urban areas with a few in the north and no psychiatry services in rural areas.

Lagos, home to about 21 million Nigerians, has only one federal mental health institution and a smattering of privately-owned centres.

This shows that even in the regions where psychiatry services exist, it is insufficient to cater to the population burden, making access to mental health services laborious for most Nigerians. This is aside the still prevalent stigma attached to mental health challenges.

As a contribution to discussions around mental health and to commemorate this year’s World Mental Health Day, Olive Prime Premium Psychological Services organised a forum to discuss the state of healthcare for mental illnesses in a Nigerian context and also cultivate solutions in the process.

The goal of the programme was to foster a conversation on an important subject matter tagged, “Changing Attitudes Towards Mental Health Care in Nigeria.”

The event aimed to critically examine and proffer solutions to the myriad of challenges affecting access to mental health care in Nigeria.

In attendance were stakeholders across different sectors, including representatives of the Federal Ministry of Health (FMH), Premium Times Centre for Investigative Journalism (PTCIJ), Mentally Aware Nigeria Initiative (MANI), Sigma Pensions, Heartland Alliance International (HAI), Reconnect HDI, Synapse Services and many other such stakeholder groups interested in the issue of mental health.

The meeting identified the challenges facing access to mental health care for most Nigerians. One of these are physical barriers, which describe poor knowledge about the availability of mental health services and access to them, as well as the skewed distribution of the few facilities available for these services.

There are also financial barriers, which include the high cost of mental health services; and poverty, which is compounded by the loss of productive income for caregivers of the mentally ill.

Cultural barriers include feelings of shame and guilt that is engendered by fear of stigmatisation and discrimination, superstitious and religious beliefs and the inhumane treatment of mentally ill persons, which include chaining, starving, flogging, and even isolation.

The most alarming of the challenges, however, is the disproportionate number of trained psychiatrists to the population of Nigeria.

Nigeria has only about 250 certified psychiatrists to its recorded 60 million mental illness burden. This means an alarming ratio of four psychiatric nurses to 100,000 persons, about one psychiatrist to one million persons and one psychologist and social workers per five million persons.

This very poor statistics is due to a combination of reasons, chief of which is the mass migration of medical professionals from the country to other countries for better opportunities and benefits.

While medical tourism is becoming a significant economy booster for countries like India and Dubai, it only spells brain drain for Nigeria as medical professionals migrate to regions where they have tools to work with and relatively commensurate benefits for their service.

Stakeholders at the roundtable in Abuja proposed initiatives that can tip the balance back in the country’s favour as it concerns access to mental health services.

The solutions proposed include outreaches to institutions like religious bodies, introducing mental health psycho-education to schools; and organising outreaches to the lesser reached regions like the grassroots communities to help change perceptions on mental health challenges.

The stakeholders also proposed identifying and training mental health advocates in these rural regions, who will champion the perception change and be the first point of call and contact on cases of mental health issues.

They also advocated collaboration with religious institutions to join the advocacy towards better mental health practices; and developing information materials on mental health in local languages to improve awareness on the subject matter.

Other solutions include establishment of psych wards in state hospitals across the country and in every primary health care centre, setting up a national 24-hour mental health call-centre; subsidisation, through public private partnership, of mental health care costs.

They also sought enactment of a Mental Health Act that reflects some of the suggestions made as well as stipulations to how organisations and institutions should approach the issue of mental health.

The meeting concluded that much can still be done in Nigeria towards building mental resilience from early childhood through adolescence and adulthood; in order to prevent mental distress and illnesses.

It also identified that much more also needs to be done to enable Nigerians access care and get optimal management for mental distress and illnesses after they have occurred. This will require joint investments by government and private stakeholder groups.

All stakeholders in attendance agreed that conversations around mental health should be an ongoing conversation so that a more mental health aware and mentally healthy Nigeria can emerge.

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