DEPRESSION AND SUICIDE IN LAGOS – WHAT THE ROTARY CLUB CAN DO
– text of an address delivered at the inauguration of a new chapter of the Rotary Club in Lagos
WHAT IS DEPRESSION?
Depression is a state of low mood, usually accompanied by loss of interest in the individual’s usual activities. More than 300 million people of all races and ages suffer from Depression world-wide. It is the leading cause of disability world-wide, and a major contributor to the overall global burden of disease. It is an ILLNESS, and is different qualitatively and quantitatively from the transient emotional upsets experienced following routine day to day challenges.
It is very common in society, mostly in the adult population.
It affects both males and females. It may also affect children and the elderly.
Although Depression may occur ‘out of the blue’, it is more likely to occur (or to recur in someone who has already had an episode) in persons who have recently undergone adverse life events, such as bereavement, loss of job or prolonged unemployment, psychological trauma of other sorts eg kidnapping. It is also more common in people suffering from long-term or life-threatening physical illnesses eg Alzheimers, CVA (Stroke), There is some genetic basis, with the tendency to illness being more common among certain families.
Effective treatments are available for depression, in the form of drugs known as SSRIs and (older) Tricyclic antidepressants. Psychotherapy of various sorts, such as Cognitive Behaviour Therapy also have a place in treatment. PREVENTION This is an area of intervention that is more economical and is destined to be more beneficial to society if implemented. Creating conducive living environments for citizens, ensuring that stressful factors such as traffic logjams or long travel times are kept to a minimum in the design and operation of cities, measures by employers to create conducive working environment for their staff all have the potential to reduce the frequency with which citizens will come down with depression. Employers need to take up more of this line of thinking because high rate of depression leads to frequent absenteeism by workers, or to another phenomenon known as ‘presenteeism’ whereby the staff member is present but is clearly not performing to expectation because he is unwell and unfit.
This is ‘behaviour that is deliberately injurious to self, leading to death.’ Globally about 800,000 people die through suicide every year. It occurs in all age groups, but is the second leading cause of death among15-29 year-olds. Most people who contemplate suicide do not go on to ‘successfully’ carry it out. Suicide is most commonly associated with Depression or some other mental illness, though a situational reaction to a catastrophic event, such as business loss may lead to impulsive suicide.
The Lagos State Mental Health Survey, carried out in 2015, came up with the following statistics 5.5% of the Lagos population suffer from Major Depressive Disorder 3.5% have Generalized Anxiety Disorder 1.2% suffer from a combination of Anxiety and Depression Symptoms are more common in females who are single and unemployed. The same survey in Lagos State showed for Suicide 7.3% have considered suicide, at least briefly in the past one year. This rate is higher in people who are older, single, depressed and of low socio-economic group.
EXISTING LAWS AND SERVICES
There is a bizarre law in the statutes of Nigeria which makes Suicide a criminal offence. This means that a person who attempts to commit suicide but does not die may be arrested and sent to prison. This is an anachronism! It may increase the desperation of the suicidal, and make them more determined to ‘succeed’.
Very limited. A few government run psychiatric hospitals, and a number of acute university psychiatry departments. More and more private mental health facilities coming on board eg Synapse, The Retreat.
CURRENT PATTERNS OF HEALTH-SEEKING
More than 90% of people who suffer from Depression in Nigeria, as will othr mental health syndromes, do not seek or are not able to access mental health care. General Practitioners, who provide most healthcare encounters in Lagos State, are often not interested in mental health, and are usually unable to recognize mental health syndromes, except in the most extreme psychotic manifestations.
ISSUES IN THE WORK PLACE
A lot of the challenges leading to, and impacted by the existence of Depression are located in the work place. This is why enlightened employers of labour create systems to look after not just the physical health, but also the psycho-social well-being of their employees. This is the logic behind the concept of Employee Assistance Programme (EAP).
CURRENT NGO INPUTS
Some NGOs, such as MindTrust are involved in Mental Health Advocacy and in targeted interventions such as School Mental Health.
There are gaps everywhere, as far as the eye can seen. Government is embarked upon a number of improvements, including a concerted effort to take recognition and basic intervention for mental health care down to level of the Primary Health Clinic. Lagos State is hoping soon to be able to offer such basic services in 57 flagship PHC located in every LGA/LCDA. Government is also setting up a psychiatric unit in a General Hospital in each of the five ibiles of Lagos State, so that no citizen is too far away from specialist care. However government will never be able to do it all.
WHAT COULD ROTARY DO?
It is important that Rotary should get involved in Mental Health Care. Given its record of humanitarian service across the world, it is surprising that it is yet to do so. Everybody is realizing the importance and widespread nature of Mental Health issues, and seeking to involve themselves. Even the Royal Family of England is digging into anti-Stigma and Depression Awareness campaigns. The United Nations itself through its organ the WHO dedicated its 2017 World Health Day to focusing on the debilitating effects of Depression on people all over the world. It is time for Rotary Club to get involved in a battle that involves us all. Everybody here either has a mental health problem, or has a child or close relation who has one. It is not going to go away if we ignore it, as we have been doing all these years. Mental Illness is as ‘REAL’ as any of the physical challenges such as Polio which you have so ably challenged in your noble history. You may wish to look at the following areas to develop your intervention strategy: Legislation: Nigeria has the most outdated mental health laws in the world. Efforts to create change have met with resistance and government apathy. Depression: Advocacy to create awareness about the rampant nature of the problem in society. Sponsoring screening exercises among the general population. Providing access to care for people identified to be in need of specialist treatment. The cost of treatment is often a major barrier for the average citizen even when he recognizes he has an illness. Work place: Since most members are employers of labour, they should mount advocacy to encourage good work-place practices where the employee is valued. They should also encourage the embrace and practice of the modern-day innovation of Employee Assistance Programme (EAP).
Thank you for your attention.
Dr Femi Olugbile FRCPsych FNIM