Sunday Magazine

COVID-19: Time for Nigeria to invest more in mental healthcare’

•Fewer than 10% of mentally ill Nigerians have access to healthcare

 

–WHO •Nigeria ranks 15th in world’s frequency of suicide –NAS

 

 

Nigeria has Africa’s highest caseload of mental health, and ranks 15th in the world’s frequency of suicide, according to World Health Organisation (WHO). The COVID-19 pandemic has further pushed the prevalence rate from 25 to 40 per cent, yet, there are less than 150 psychiatrists in a country of 200 million people. Thus, the 2020 Mental Health Day harped on increasing investment in mental healthcare services to address the citizens’ care needs. CHIJIOKE IREMEKA reports

 

 

 

The Corona Virus pandemic which was first reported in Wuhan, China December 2019 and landed in Nigeria towards the end of February this year, has brought out more than ever, how mental health is integral to overall well-being. Restrictions on movement and gathering, job losses, deaths of loved ones, and widespread COVID-19 infections have affected people’s mental wellness. During this COVID-19 pandemic, WHO which has been working with the government of a number of countries on mental health care as part of the continuity of essential health services.

 

The world health body is also providing psychosocial support skills training for first responders, which has been said to have been badly affected leading to a number of people going through depression and seeking to take their lives.

 

In Nigeria, the situation is equally bad as mental health practitioners said there is the urgent need to increase the number of mental health practitioners to help manage the situation in the country. According to the global estimates, there are nine mental health workers per 100,000 people and among this workforce, one third are non-professional workers, meaning there is a severe shortage of psychiatrists.

Today, WHO calls on partners and communities to promote social interventions by strengthening peer support, re-integrating long-stay patients into communities, and equipping caregivers with the knowledge and resources to better support people with mental disorders. Sequel to this, experts said it’s time for Nigeria to invest more in mental healthcare as the world observed the World Mental Health Day, with the theme, ‘Mental Health for All – Greater Investment, Greater Access.

 

The National Association of Seadogs expressed its deep concern on the extremely low awareness about mental health in Nigeria, saying the peculiar social architecture of the ongoing COVID-19 pandemic serves to further highlight the interconnections between mental health disorders, physical health, and the general condition of the society.

 

According to the Association, the impact of the pandemic has exposed the deep inequalities, ignorance, and deepening levels of neglect and poverty experienced by many, causing further mental distress and vulnerability.

 

This sad situation, it noted, is felt more starkly in low and medium-income countries such as Nigeria where there is an urgent need for increased workforce of consultant psychiatrists, psychiatric nurses, and psychosocial experts. It said that Nigeria has the highest caseload of depression in Africa and ranks 15th in the world in the frequency of suicide, saying that poor knowledge of mental health problems accounts for the increasing incidences of drug abuse, resulting in self-inflicted mental injuries, which ordinarily build up from neurosis to psychosis. the Association in a statement signed by its Capoon, Abiola Owoaje, it said mental  illnesses include mood disorders (such as depression or bipolar disorder), anxiety disorders, personality disorders, psychotic disorders (such as schizophrenia), eating disorders, trauma-related disorders (such as post-traumatic stress disorder), developmental disorders, and substance abuse disorders.

 

The statement reads in part: “The telling effects of these outcomes include, but not limited to, high costs on the health system, impaired functioning and lost worker productivity, personal stigma, caregiver burden on family members, and human rights violation.

“As the world marks this year’s Mental Health Day, NAS has lined up robust mobilisation and sensitisation advocacy programmes geared towards creation of stakeholder/public awareness on the health needs of citizens, provision of comprehensive, integrated and responsive mental health and social care services in community-based settings.

“The campaign would also include raising awareness on the need for statistical data on mental health administration in Nigeria, canvassing measures for the improvement of mental healthcare services, and the urgent need for stakeholders to scale up provision of a healthier and safer workplace that takes into consideration the occupational hazards for mental healthcare staff on the frontlines.”

NAS, however, noted that it is important for stakeholders in the country’s mental healthcare sector to appraise, review and apply all international protocols in the nation’s mental health care administration, urging the state to collaborate with the Federal Government to integrate mental health as part of the primary healthcare services within each state.

 

The Association of Seadogs insist in accordance with WHO guidelines, that Nigerian government should strengthen leadership, governance systems for mental health and social care as well as implement concrete strategies to promote mental health. According to Abiola Owoaje, there is a need for the government, as a matter of urgency, to consider the establishment of six new federal psychiatric hospitals within the six geopolitical zones of the country, saying that the current eight FG-owned neuropsychiatric hospitals are not adequate to take care of the mental health care needs of her over 180million population.

 

He said: “There should be an accelerated transition to mental healthcare in the community, with increased investments in the training of more specialists, and psychiatric wards, especially in general hospitals. Failure to invest specifically in mental healthcare services as a matter of urgency has huge health, social, and economic costs. “Governments at all levels and every concerned individual or group must scale up advocacy on mental health education to raise awareness and reduce social stigmas.

 

Let us be our brother’s and sister’s keepers by discouraging stigma and working collaboratively to improve mental awareness in our communities. “The Federal Ministry of Health must collaborate with security agencies to move round available local and government mental health institutions in the country to discourage chaining of people with mental health illness, unshackle all people restricted with manacles and encourage the use of straitjackets in their stead, where necessary.” Lending its voice as well, the Association of Psychiatrists in Nigeria (APN) raised the alarm on the increase in the rate of mental illness in the country, noting that the COVID-19 pandemic has further pushed the prevalence rate from 25 to 40 per cent. President of the Association, Prof. Taiwo Sheikh, disclosed this in a statement to commemorate the 2020 World Mental Health Day, saying “this is coming when our daily lives have changed considerably as a result of the COVID-19 pandemic.” He said, “There is a high rate of mental illness in Nigeria which is of greater concern with the COVID-19 pandemic pushing the prevalence

from 25 per cent to about 40 per cent. “The rates of suicides, parasuicides, depression, anxiety disorders, rape and other violent behaviours are very disheartening with substance abuse challenges amongst teaming youth almost getting to a state of real emergencies in our society.” He added that Nigeria, a society with many cultural and religious beliefs, has misconceptions and misbelieves about mental illness which needed to be corrected through awareness campaign.

 

Sheikh lamented that there were about 350 psychiatrists in Nigeria to over 200 million people and most recently, these thoroughbred professionals are leaving en mass to developed countries for better job offers. He also disclosed that the country is facing acute shortage of psychiatric nurses, clinical psychologists, medical social workers, occupational therapists and other mental health professionals.

 

According to him, the issue of mental health is hardly discussed in the country despite the increase in cases of mental illness, adding that mental health is seen as a taboo.

 

“Unfortunately, the attention given to mental health disorders in Nigeria is at best, fleeting; the level of awareness of the Nigerian public on mental health issues is also understandably poor, and the misconceptions regarding mental health have continued to flourish,” he added. Recommending the way forward, the APN president said,

 

“We need to raise awareness and dispel stigmas that exist around mental health issues in Nigeria. “There is, therefore, more than ever before the need for all stakeholders in health to show greater commitment to mental health issues in our society. The government should implement mental health policies within their domain and truly make it one of the components of primary healthcare at the grassroots level.

 

“The government should engage relevant  stakeholders such as non-governmental organisations, civil society organisations and developing partners to invest more in mental health to increase access to effective and qualitative mental health services. “Mental health care must be available, accessible and affordable with the promotion of mental well being through awareness programmes using the media.”

 

Prof. Sheikh also called for support to ensure the speedy passage of the Mental Health Bill, which is currently awaiting third reading at the National Assembly, saying this action alone will revolutionalise mental health care services and practices in the country”, he said.

According to Dr. Cynthia Obiora, the world is facing the COVID-19 pandemic at a period when there are global recession and economic downturn, wobbling political structures and engagement to mention but a few. She said: “And this is to say nothing of managing the grief of losing a loved one, sometimes without being able to say goodbye.

 

The magnitude of these losses is not only traumatic but scary to close associates and relatives. “The economic consequences of the pandemic are already being felt, as companies let go of staff to save their businesses, or indeed shut down completely.

 

“Most companies are not replacing the ones who have left their establishments while some were simply not paid any salaries or allowances during the pandemics.

 

“Given the experience of emergencies, it is expected that the need for mental health and psychosocial support will substantially increase in the coming months and years. “Investment in mental health programmes at the local, state, national and international levels, which have already suffered from years of chronic underfunding and neglect of this critical sector, is now more important than it has ever been.

 

This is why the theme of this year’s World Mental Health Day is very apt and relevant.” According to a Consultant psychiatrist, Dr. Ibironke Thomas, COVID-19 has impacted each person significantly in some ways; hence, she suggested four major ways to stay healthy and mentally safe during this period. She said: Taking care of yourself, eating right, catching enough sleep, exercising one’s body and doing what makes one happy, makes one feels more relaxed and enjoying oneself, are important to staying mentally balanced in this period.

 

“Don’t read too many negative stories or news. Take caution about what kind of information you are listening to and watching, especially on social media because they are not always authentic. “Reach out to others. It’s very important to keep connected to your friends, family members, colleagues in whatever way you can. “Make the most use of your time.

 

If you can, if you are at home or isolated, this is a great time to explore opportunities, experiment with cooking, do some gardening or learn a new skill online that will prepare you better for your work or for the future.”

 

However, it has been said that difference between Nigeria’s need for better psychiatric care and the resources available, is illustrated by the healthcare gaps at Yaba Psychiatric Hospital, which had a 2018 budget of N133 million ($372,000), but only N13 million ($36,000) or less than 10 percent of that amount released by the FG. It was learnt that as a result of financial deficits and other challenges, Yaba Hospital lost 25 – roughly half of its resident psychiatrists over the past four years.

 

According to reports, some left to find work in other countries, while others went to private hospitals and few others simply quit. The facility, it was learnt, has 33 resident doctors and 22 consultants jostling to address the needs of the over 5,000 patients being treated every year.

 

Each doctor is said to now tend to between 50 and 80 patients per day including the 535 who fill the inpatient beds, and the 100 or more emergency cases who are rushed to the hospital each week.

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