Patients are often handcuffed to prevent violence to others and themselves. Photo: JULIAN EATON
.....By Julian Eaton and Terfa Tilley-Gyado
Another traffic jam in Lagos. A ‘madman’, tattered and unkempt, strolls casually to a couple in a black jeep. With little ceremony, he extends his arms and demands money. The couple look straight ahead and ignore his request, the driver moves the car forward slightly.
The madman follows them, this time pounding against the glass and threatening to break the window. Still they attempt to drive on, failing to acknowledge him. He retreats as the traffic begins to pick up and the couple heaves a huge sigh of relief.
Hundreds of cars pass and no reports are made neither to the police nor to any mental health authorities. Weeks later, the ‘madman’ is still there, still demanding money.
Stigma
Mental health problems remain a huge stigma in Nigeria with most people, even families of victims, choosing to ignore them in the hope that the problems will simply go away.
The problems, however, rarely vanish and whether an individual’s problem is severe or mild, if not treated, it can result in exclusion from society, loss of work, and breakdown in relationships. Families usually struggle to find help, but in Nigeria today, that search is often in vain.
The result of this is that many people are suffering unnecessarily, and in the worst cases are subjected to being chained, beaten and subjected to terrible abuse, sometimes at the hands of those who they have turned to for treatment.
In spite of highly effective and affordable treatments which have become more readily available, Nigerian citizens are still not fully benefitting.
Lazarus Nwajei, whose wife suffers from schizophrenia, says mental illnesses still attract shame to many families in Nigeria.
“My wife’s mental illness started after the birth of our fourth child in 1993,” he says. “At first I thought it was high fever but when it degenerated to the point of her making trouble with everybody in the neighbourhood and going nude at times.
“It has been hard for us, especially me, the husband, because of the costs, work and shame that I have to bear.”
Mercy Agbedion, complains that treatment is expensive for her brother, Leonard, because the drugs are still so scarce.
“My elder brother’s mental illness started about 10 years ago at Lokoja, when he was working there,” she says. “Since then it has not been easy for us his family members. We have learnt to live with the stigma of being related to a mad man but the fact is that his illness is eating deep into our purse.”
Mercy, like so many other relatives living with mental health, exhibits little faith in Nigeria’s mental health institutions and sees little point in taking her brother to a psychiatric ward.
“We refused admitting him in a psychiatric hospital because we believe he will be better with us than keeping him in the midst of other mentally derailed persons.”
Nigerians have not always been so faithless when it comes to dealing with mental illness.
A proud history
Prior to the colonial era, there were healers in all the various ethnic groups in Nigeria, whose expertise was the treatment of mental health problems.
The fathers of modern psychiatry in Nigeria trained in Britain in the 1950s and on their return, set about transforming the few colonial-era asylums in the country.
The first indigenous Nigerian psychiatric professional was a psychiatric nurse, Mr Abraham Ordia. He was the first Nigerian to hold a senior position in what was then called the Asylum at Yaba in 1952.
The first Nigerian doctor specialising in mental health as a Psychiatrist, was the late Professor Thomas Adeoye Lambo. He was trained in Britain, and returned to Nigeria in 1954, making an international name for himself in Aro Hospital, Abeokuta with his renowned Village System of care.
He realised that people who are taken away from their home communities to be treated actually find it harder to be independent when they go home than those who receive care in the community.
This era also saw a revolution in medical treatment for mental illnesses. It was only with the discovery of effective medication in the 1950s that the most severe symptoms could be effectively controlled.
Even people with very disturbed behaviour could recover and return to their communities.
Sadly, the system in Nigeria has not kept up with these early advances. Recent studies based in Nigeria have shown that only around 10% of people with severe mental illness receive the care they need.
The specialist hospitals in big cities like Lagos, Ibadan, Enugu, Calabar and Sokoto are not sufficient to provide care that is affordable and accessible by the majority of the population that needs it.
Lack of human and financial resources
Nigeria only has about 130 specialist psychiatrists, less than one per million of the population compared to a typical figure in European countries of one per 10,000 people. There are more Nigerian psychiatrists in Britain alone than in Nigeria.
We are slightly better served with psychiatric nurses, who would form the basis of a primary health-care based service. Nigeria in fact trains significant numbers of these essential staff, though many are also lost to the brain drain.
In Nigeria less than 3% of Gross Domestic Product (GDP) is spent on health, and of this less than 1% is allocated to mental health.
The figure recommended by the WHO for mental health is 5%, and in many countries it is nearer 15% The low level of expenditure means that even if services were well organised, the majority of cases could not receive the care they need.
The most severe mental illnesses require long-term treatment. Although this treatment when given in the community is not expensive, the system of paying out-of-pocket means that many families find it hard to afford the care their loved ones need month after month.
It is unclear whether the National Health Insurance Scheme will adequately cover mental ill health.
Policy and legislation
In Africa overall, less than 50% of countries have a mental health policy. In Nigeria, the progressive 1991 primary health care policy states that mental health should be integrated at the primary care level.
In response to the international priority being given to mental health, there are now plans to update Nigeria’s legislation.
At present, the existing legislation dates back to British colonial laws of 1916, later adopted as the Lunacy Act in 1958. The legislative process has not responded effectively to the need for radical reform of the sector.
A 2003 bill for a mental health act passed a public hearing and was adopted by the Senate, but was not able to pass the House of Representatives and be adopted into law before the end of the last administration.
With support from the WHO, the Federal Ministry of Health has brought together a team of experts to make recommendations for laws that will safeguard the interests of people with mental health problems in the country, and a policy that will allow for services to reach those whose needs are currently not met.
If these plans are to be implemented, significantly higher levels of resources will need to be devoted to this neglected area.
e-mail: mhlagng@gmail.com
twitter: https://twitter.com/#!/LagosMHTeam
You tube: mhlagng@gmail.com
For more info call:
*Dr. D. Fasawe (Lagos State Ministry of Health)-08033228096
*Dr. Coker Rotimi
*Mr. Owoyemi Emmanuel (CEO/MD, Mental HealthFoundation)-08033236814
*Mr. Jude Watchman- 08036998263
*Mr. Richard A. Uwayzor (Cordinator- The Aart of Life Founation) 08053264041
Reader Comments (14) …. as at Friday, September 16, 2011
Posted by Demilade Omisore on Apr 05 2009
'Nigeria only has about 130 specialist psychiatrists, less than one per million of the population compared to a typical figure in European countries of one per 10,000 people.'... THIS IS UNBELIEVABLE STUFF. Im still stuck on that. However 'Hundreds of cars pass and no reports are made to the police nor to any mental health authorities. '...this statement has much more power in theory than in actual practice. What mental health authority has any widespread awareness? And do we actually believe that there would be a picking up of all the mentally instable men in Lagos?? It tough I agree to see these people on teh streets with no help but the issue then diverts to numerous issues...The government basically DOES NOT WANT TO OR FEEL THE NEED TO cater for these individuals..The idea being that we have 'much more important' things to deal with...Do I agree??...Well in Nigeria do you need to really...My point is this issue basicall underpins a larger one...We sincerely have problems with our health sector if only 5% of our budget is allocated to Health. May God help us all.
Posted by Taiwo on Jun 04 2009
I wonder if Nigeria has mental health Acts at all and even there is, the positive effect hasn't been glaring because you find mad person all over the place, on the street, under the bridge even at people's home. I think the people in our government should stop being short sighted and stop thinking of themselve for a while. They should think of the generation coming after them.
Posted by Jegede, Charles Obafemi on Jul 01 2009
The over concentration on western paradigms in psychiatric practice will not help matters. Before the advent of colonial healing system, the void was filled by some people. It is important that we begin to see the need to mainstream this category of mental healh providers in to the over all struggle for mental health in Nigeria. Though they are not receiving adequate suppost, their contributions are enomous.
Posted by esegbue friday azenubi on Aug 05 2009
iam apsychiatric nurse ifeel the only way to touch those life is by mental health advocay and care support group which is sadly lacking in nigeria iequally have an ideal on the way forword religious organisation and company can play arole
Posted by Steve Ogbedobor on Sep 30 2009
It is sad reading the article above and in this 21st Century, Nigerians still are not educated about mental illness and we some how believe that people could not function at all hence we decide to chain them. It is a shame the Health Department and Government cannot educate the mass as to what mental illness is all about. I hope the Nigerian Government knows that physical health problems also sometimes leads to mental health issues so I beg the Government and Nigerians to educate themselves as to causes of mental health issues in the country. Look at the above article, our ignorance made us to believe that mental health problems will disappear without treatment. We should think again. I will like to point out that mental illness will not just disappear; we as Nigerians and health professionals have to work hand in hand to make people aware because this is the only way that we can start to deal with the issue at hand. I really don’t know why we believe that people with mental health cannot function in society. I promise you that with good planning and treatment couple with education/health promotion people with mental illness can be helped to still hold good position in society and live their life. These days in the UK, mental health service users sits as one of the interviews panel and this does not stop them from asking reasonable questions from the interviewee. United we stand and divided we will continue to fall with regards to mental health issues. We have a lot of work to do so I do not expect us to get to the above position overnight.
Posted by Steve Ogbedobor on Sep 30 2009
It is sad reading the article above and in this 21st Century, Nigerians still are not educated about mental illness and we some how believe that people could not function at all hence we decide to chain them. It is a shame the Health Department and Government cannot educate the mass as to what mental illness is all about. I hope the Nigerian Government knows that physical health problems also sometimes leads to mental health issues so I beg the Government and Nigerians to educate themselves as to causes of mental health issues in the country. Look at the above article, our ignorance made us to believe that mental health problems will disappear without treatment. We should think again. I will like to point out that mental illness will not just disappear; we as Nigerians and health professionals have to work hand in hand to make people aware because this is the only way that we can start to deal with the issue at hand. I really don’t know why we believe that people with mental health cannot function in society. I promise you that with good planning and treatment couple with education/health promotion people with mental illness can be helped to still hold good position in society and live their life. These days in the UK, mental health service users sits as one of the interviews panel and this does not stop them from asking reasonable questions from the interviewee. United we stand and divided we will continue to fall with regards to mental health issues. We have a lot of work to do so I do not expect us to get to the above position overnight.
Posted by Wale on Oct 21 2009
I`m a medical student and I`ll be taking a seminar on mental health challenges of public health importance. Its been a hard getting good literature, I hope this article would help me out.
Posted by aluya on Oct 28 2009
I and a qualified mental health worker and work in mental health care in the UK. How can I help?
Posted by Chinenye Madu on Nov 08 2009
It is very sad. Reading this article has opened my eyes to see the great need of mental health facilities in Nigeria.Here in the Uk it is given top priority and patients are being friendly and warmly cared for.I live in the UK and currently training as a mental health nurse in a Uni.Please how can I help?
Posted by Amire Vincent Akindele on Dec 20 2009
short of words, if the madman in view have had rendered valuable or irrevocable damage to the couple's "precious jeep" i think the reality would have dawn on them. that aside mental health challenges should of course be given priority to and as a matter of urgency a national call to the house of senates and representatives for effective deliberation and implementation. I rest my case! COURT!!!!!!!!!!!!!!
Posted by mr peter ogbaji on May 11 2010
I believe that a review of the mental health laws and government commitment to providing standard facilities and empowering the health care providers will make a deference.
Posted by Akpofure OvireTT on Jun 30 2010
Come on Nigeria and Africa in general.. In the 21st century we still have these ancient views and thoughts on our fellow human beings. Until there is 'significant' change towards the issue of mental health, the stigma, fear and regressed attitudes of the majority will always prevent forward movement
Posted by HILARY on Aug 10 2010
I guess that the issue of mental health is not the the issue of movement of "ghana must go bags or the usually exchange of blows that go on in the legislative houses that is the reason why the passage of the mental health laws has not been able to scale through.One thing is apparent and that is that a healthy nation is a wealthy nation and as ling as we keep neglecting mental health in our country we are still poor. After all WHO definition of health is all embracing, meaning that mental health of the citizens of this great nation must be given urgent,necessary and desired attention before we can talk of being healthy and wealthy nation.No body is immune from mental illness the illness is at the door. If we shall relay the ugly events that took place in the House of Representative one can never be wrong to say that the legislatures are all mentally sick and must be taken to the Psychiatric Hospitals for examination to determine the soundness of their minds. Their actions depict the level of mental disorders existing in our country today.May God send a messiah to rescue our country from total mental break down. HILARY.
Posted by owoeye isaiah dada on Mar 18 2011
Neglect of mental health by the Nigerian government is a reflection of the rate of stigmatization of mental illness in most Nigerian culture. Prof. Gureje, President Association of Psychiatrist in Nigeria, said, 90 percent of Nigerians with mental illness had no access to treatment. Only 10 percent of mentally Nigerians receive treatment. With the country still using 1916 British Lunacy Act,psychiatrists believe that mental health is the most neglected aspect of the health sector. Duro Onota,a CBM International (NGO)officer, disclosed that there was one psychiatric nurse to 25000 Nigerians. THIS IS A CHALLENGE!
No comments:
Post a Comment