1 psychiatrist serving 1 million populations in Nigeria — Dr Owoeye
By Sola Ogundipe, Chioma Obinna, Gabriel Olawale & Claire Ijeoma
If there is one thing that Vanguard is good at, it is initiating discourse around issues of public relevance that inspire community interest while engaging conversations for sustainable change.
This knack for mobilising change towards enabling a better life for Nigerians, came to the fore yet again Thursday last week at the Banquet Hall of the EKO Hotels & Towers, when Vanguard organised the first ever Mental Health Summit themed: “Mobilising for Systemic Change and Better Mental Health Care in Nigeria”.
The event brought together the best of mental health experts, advocates, educators, faith leaders, and people who have suffered or are suffering from mental illness, among others in the country.
The primary agenda of the Summit, as enumerated by Vanguard’s General Manager/Editor-in-Chief, Mr Gbenga Adefaye, in his opening remarks at the epoch making event was “to initiatie change in the management of mental health in Nigeria by improving knowledge, mobilising leadership, and fostering collaboration at all levels.
The utimate goal, Adefaye noted “was the development of a sustainable national mental health agenda through participatory engagement of all.”
The Vanguard Mental Health Summit was significant for a number of reasons. For several years, mental healthcare in Nigeria has been relegated even before the advent of the COVID-19 pandemic which in itself, has had unprecedented impact on health systems around the world, Nigeria inclusive.
Bad as the effects of the COVID-19 virus (novel coronavirus) was, the emergence of newer and more infectious variants of the virus further complicated the challenges faced by the overstressed health systems.
Experts point out that the threats to mental health undoubtedly, got deeper within communities affecting the millions of individuals who have been traumatised during the lockdowns. Nigerians are not left out.
Today, millions of Nigerians are left vulnerable to vices such as substance use or loneliness; many have lost loved ones to the rampaging virus and are facing heightened anxiety of falling sick while many more are facing dire economic consequences brought on by the deadly pandemic.
Prof Taiwo Sheikh
In this challenging recovery phase of the pandemic, the mental health needs of practically every Nigerian particularly, those on the frontline of the pandemic response, cannot be overlooked in a country in which there is only 1 psychiatrist attending to 1 million Nigerians.
Estimates from the Federal Ministry of Health, reveal that about 20-30 percent of the Nigerian population suffers from mental health challenges.
Worse still the majority of those who need mental health care globally, do not receive treatment.
Sadly, the gap is more in low and medium income countries like Nigeria with 85.4 percent.
Sadly, in Nigeria, less than 300 psychiatrists, mostly located in state capitals are practicing in Nigeria and 90 percent of them can only be found in government employment.
The experts say the COVID-19 pandemic is likely to have exacerbated these issues in the country.
However, numerous factors contribute to elevated stress among people such as heavy workloads, lack of physical or psychological safety, moral conflicts, and workplace related bullying or lack of social support.
Today, many Nigerians are faced with psychological distress which can lead to burnout, depression, anxiety disorders, sleeping disorders, and other illnesses.
Essentially, protecting the mental health of people should be high priority not only in times of crisis, but on an ongoing basis.
These and more were the reasons why Vanguard held its 1st Mental Health Summit which gathered the best health experts and others in allied fields to bring the much-igniored issue to limelight.
The Summit which prioritised the mental health of Nigerians highlighted the need for organisational measures, policies, and systemic changes needed to address the challenges of prevention, treatment and education of Nigerians going forwards on their mental health.
The various experts who spoke at the event, among others, called for passage of the Mental Health Bill, prevention of mental disorders and priorisation of mental health as a public health concern.
Nigeria yet to achieve universal access to mental care — SHEIKH
In the views the President, Association of Psychiatrists in Nigeria, APN, Prof Taiwo Sheikh, mental health has come a long way in Nigeria, but the country is yet to achieve systemic change for universal access to effective, qualitative and affordable mental care.
Sheik who also disclosed that Nigeria lacks a fully-developed, comprehensive and integrated National Suicide Prevention Strategy, said signing of a the mental health bill into law was a critical investment in Menta Health in Nigeria that will guarantee access to effective, compassionate and quality mental health care that Nigerians desire.
In his presentation tagged: “Overview Of Mental”, Sheik who is also a Professor of Psychiatry, Department of Psychiatry, Ahmadu Bello University, Zaria, noted that despite the fact that mental health challenges is huge in Nigeria, there is no clearly defined budget allocation for mental health in the National health budget, allocation for health amounts to only 3.65 percent of 2016 budget and about 3.3 percent of the health budget of the central government goes to mental health, with over 90 percent of this going to institution-based services provided through eight stand-alone mental hospitals; There is enormous inequity in the distribution of mental health services and available resources
“The Nigeria mental health system lack provision for targeting actions to tackle the precise needs of groups whom have been historically neglected such as women, children, elderly, homeless and the very poor. Such specific focus is necessitated by the likelihood of these groups’ having different risk factors, mental disorder prevalence, and help-seeking behaviour.
Dr Olugbenga Owoeye
He said mental health has become one of the most neglected areas of health adding that over 70 percent of patients with mental health problems/ disorders seek unorthodox interventions before orthodox care
Listing determinants of mental health to include societal problems that disrupt optimal mental health, increase risk for and prevalence of
mental illnesses, and worsen outcomes among individuals with mental illnesses, he said: “Our well-being directly affects our actions and emotions. It’s an ongoing circle. Therefore, it is important for everyone to achieve optimal wellness in order to subdue stress, reduce the risk of illness and ensure positive interactions.
“Mental health is important at every stage of life, from childhood and adolescence through adulthood.
Mental health problems occur as a result of life stressors, and are usually less severe and of shorter duration than mental disorders, although they may develop into mental disorders.
He said the Mental Health Bill, currently before the National Assembly was initiated to promote and protect the rights of persons with mental health conditions and persons with intellectual, psychosocial, or cognitive disabilities, and to provide for the enhancement and regulation of Mental Health Services in Nigeria.
“The objectives of the Bill are to provide direction for a coherent, rational and unified response to the delivery of mental health services in Nigeria; promote and protect the fundamental human rights and freedom of all persons with mental health conditions and ensure that the rights are guaranteed; ensure a better quality of life through access to an integrated, well-planned, effectively organised and efficiently delivered mental health care services in Nigeria.
Other objectives are; to promote the implementation of approved National minimum standards for mental health services in Nigeria; promote recovery from mental health conditions and enhance rehabilitation and integration of persons with mental health conditions into the community; facilitate the adoption of a community-based approach to the provision of mental health care services; and facilitate the coordination of mental health services de livery in Nigeria.”
He called for increase in mental health funding through direct budgetary allocation and integration of mental health into primary care.
1 psychiatrist serving 1m population in Nigeria — OWOEYE
The Medical Director, Federal Neuro Psychiatric Hospital, Yaba, Dr Olugbenga Owoeye in his keynote address tagged: “Mobilizing Systemic Change for Better Health Care in Nigeria” said 1 psychiatrist is serving 1 million populations in Nigeria.
Lamenting the treatment gap in Nigeria, Owoeye said majority of those who need mental health care globally, do not receive any treatment and that treatment Gap was higher in Low and Medium income countries like Nigeria with 85.4 percent treatment gap.
Stressing the need for effective policies to address treatment gap among others, he said: “A documented mental health policy provides a general framework, gives priority to mental health, helps to develop mental health services in a coordinated & systematic manner, Identifies key stakeholders and allows different stakeholders to reach agreement.
Owoye said people with mental disorders should not be discriminated against on the basis of their mental illnesses.
“People with mental disorders should receive the same quality and standards of care as other people receive.”
He further disclosed that suicide accounts for about 1 million deaths annually, with psychiatric conditions associated with 90 percent of cases, mental health is grossly under-reported for several reasons, adding that 20 million people attempted suicides annually.
We must normalise mental health conversations to build culture of compassion — Dr Kadiri
In her submission, a Consultant Neuro – Psychiatrist and Psychotherapist, Pinnacle medical services, Dr Maymunah Kadiri said to change stigma associated with mental illness, there was the need to normalise mental health conversations to build a culture of compassion.
In her presentation entitled: “Overcoming stigma and discrimination associated with mental health disorders through rehabilitation”, she said negative attitudes and beliefs toward people who have a mental health condition are common, hence, the need for a paradigm shift.
“Stigma can lead to discrimination. The stigma associated with mental illness can be divided into two types: Social stigma / Public stigma involves the negative or discriminatory attitudes that others have about mental illness.
Self-perceived stigma refers to the negative attitudes, including internalised shame that people with mental illness have about their own condition.
“Institutional stigma is more systemic, involving policies of the government and private organisations that intentionally or unintentionally limit opportunities for people with mental illness. Examples include lower funding for mental illness research or fewer mental health services relative to other health care.”
She regretted that stigma not only directly affects individuals with mental illness but also the loved ones who support them, often including their family members.
She identified harmful effects of stigma to include: reluctance to seek help or treatment, lack of understanding by family, friends, co-workers or others, fewer opportunities for work, school or social activities or trouble finding housing, and bullying, physical violence or harassment, and the belief that you’ll never succeed at certain challenges or that you can’t improve your situation.
Speaking on steps to cope with stigma, she further gave Vanguard the acronym: Verbalise your thoughts, Accept you are going through a challenge, Normalising mental health conversations, Getting guidance and support from loved ones, Understand your triggers and managing them, Ask for help, Rest is Important, Discovery your true potentials and optimising them.
There is no single cause of suicide — Titilayo Tade
Speaking on suicide prevention in Nigeria, the Training Coordinator, Suicide Research & Prevention in Nigeria, SURPIN, Ms Titilayo Tade, who described suicide as an intentional act of taking one’s own life, said suicide is associated with several mental health problems but has no single cause.
Tade explained that several factors can increase a person’s risk for attempting or dying by suicide but having these risk factors does not always mean that suicide will occur.
She disclosed that in 2019, about 703,000 people died of suicide globally and that suicide is one of the top 20 leading causes of death in 2019.
On age group, Stating that 58 percent of global suicides occurred before the age of 50 years, she said 88 percent of adolescents suicides occurred in low- and middle-income countries like Nigeria.
According to WHO 2020 report, men account for nearly three times the number of suicides than women.
Giving data on Nigeria, she said: “Suicide rate in Nigeria is put at 6.9/100,000 up from 6.5 in 2012. In 2019, WHO reported 7.019 suicide deaths, male -5,110 and female – 1,909.
She said at the Lagos University Teaching Hospital, LUTH, over a 5-year study period showed 7.2 percent of cases referred to psychiatry services in the hospital were cases related to suicide.
She further regretted that in Nigeria suicide is underreported or miscoded because it is still a criminal offence.
Other reasons she gave for under reporting of suicide include; shortage of mental healthcare personnel, cultural and religious beliefs about mental health and suicide as well as stigma.
She said globally only 38 countries are known to have fully developed National Suicide Prevention Plans as recommended by the World Health organisation, WHO.
Stressing the need for collaboration in reducing the world suicide rate by one third by 2030, she said there was need to limit access to the means of suicide, fostering socio-emotional life skills in adolescents; early identification, assessment, management and follow up of suicidal behaviours.
She charged the media for responsible reporting of suicide, adding that Nigeria lacks a fully-developed, comprehensive and integrative National Suicide Prevention Strategy.
She further disclosed that the LUTH established SURPIN with the aim to help reduce incidence of suicide in Nigeria, create awareness in the populace, and promote research and improve reporting of suicide
Continuing, she identified poison as most common planned and attempted method of suicide.
“Over 60 percent had underlying mental illness as at time of calling and the top three identified stressors are financial with 26.4 percent, relationship- 20.8 percent, and health with 13.5 percent.
Mental disorders have been largely overlooked — Dr. Adenekan
In the same vein, Lagos Chairman, Nigeria Medical Association, NMA, Dr. Adetunji Adenekan, said: “For too long, mental disorders have been largely overlooked by health system, and by this I mean all stakeholders involved, such that the millennium and development goals, MDGS, conspicuously omitted mental healthcare and it took the introduction of sustainable development goals many years later for mental health to be given its rightful place of recognition.
“This is despite the fact that mental health disorders are found in all countries, affecting men and women in all stages of life, the rich and the poor, rural and urban settings. Lack of political will and up-to-date legislation, inadequate resources, overburdened health services, resistance from policy makers and health workers, cultural as well as religious beliefs and practices have hindered the development of coherent mental health system.
“Also the misunderstanding about the nature of mental disorders and their treatment has also complicated the progress. Some people assume people with mental disorders are violent and unstable and, therefore, should be locked away, whereas majority of them are nonviolent and capable of living productively within their communities.
“There are several factors that are critical to ensure better mental health care in Nigeria and this includes building of community mental health services, developing mental health services in general hospital, integrating mental services into primary health care, building informal community mental health services, employment of trained and skilled practitioners, among others.”
Suicide helplines
Nigerians needing help for mental health ssupport can call 09080217555, 09034400009, 08111909909, 07013811143 and for Hausa language – 08142241007
