MENTAL HEALTH AND THE PEOPLE OF NIGERIA
By Femi Olugbile
It will be World Mental Health Day tomorrow, Saturday 10th October 2020. Every year, there is a main theme for the World Mental Health Day celebration. For this year, it is ‘Mental Health For All; Greater Investment- Greater Access. Everyone, everywhere.’
The words are chosen with a consideration for catching the eye and the ear and sticking in the memory – the sort of advertising and marketing pitch-making more familiar in the circles of those sell Coca-Cola and Nike trainers.
No field of Medicine is as much in need of expert ‘packaging’ and ‘marketing’ as Psychiatry. No category of afflictions other than Mental Illness leaves a millions-strong army of ‘walking wounded’ people occupying Presidential offices and Boardrooms, populating office-corridors and factory-floors, or roaming the streets from Akure to Atlanta, as they grapple with their diminished ability to enjoy life and to function in society.
One out of every four human beings can expect to experience at least one episode of mental illness in the course of their lives. Mental and neurological illnesses, along with substance use disorders, account for 13% of the total global burden of disease. In every forty seconds that elapse, one person somewhere in the world is committing suicide, so that the total number of 800,000 deaths from suicide annually exceeds the numbers dying by war and homicide put together. Suicide is the second most common cause of death among youths aged 15 to 29 years. From Nigeria’s population of two hundred million, up to twenty million may reasonably be assumed to be suffering from a mental illness now, or to have had one in the past twelve months.
The theme for tomorrow’s celebration – ‘Mental Health For All; Greater Investment- Greater Access. Everyone, everywher’ is effectively a call for Universal Health Coverage for Mental Health everywhere in the world – including Nigeria.
It is a tall order. However, given the havoc being wreaked daily on the quality of human existence by Mental ill-health of various stripes, it is a necessary target for all of humanity.
The advent of COVID19 pandemic has further increased the burden of mental illness on people. Apart from the long-term direct effects of the disease, the experience of death or near-death of loved ones, the fear of infection, and the massive dislocations to normal life have led to serious psychological consequences. Many have lost their jobs. Many face an uncertain future. Incidents of domestic violence have spiraled up.
The world-wide push for Universal Health Coverage for Mental Health should provoke a hard look at the situation in Nigeria. How near, or how far, is Nigeria from the dream of Mental Health for All? Universal Health Coverage requires that every citizen should have access to good health services reasonably close to them and should not be deprived of such care because they cannot pay. In Nigeria, many citizens, especially in the rural areas, live very far away from the nearest health facility. The distance is a ‘barrier’ to access.
Apart from that, more than 70% of all citizens’ encounters in health facilities are paid for ‘out of pocket’ and not through insurance, or taxation, as in the United Kingdom. This means people who are ill would often not seek treatment because they have no money to pay for it.
The long-standing drive to build a National Health Insurance system in which every citizen is covered has yielded to date only a coverage of about 5% of the population.
Good mental health care, in current thinking, should start from Primary Healthcare. In Nigeria, most Primary care facilities, public and private, currently do not offer any form of mental health care. Of the small percentage of Nigerians already covered by Health Insurance, most of the insurance contracts exclude coverage for long term mental illness.
It is a bleak picture.
What is the roadmap to ‘Mental Health For All’ in Nigeria?
There needs to be strong Advocacy for Mental Wellness. Good Mental Health may be promoted by good habits, moderation, a healthy engagement with family and other members of society, and avoidance of substance abuse.
Where illness occurs, it needs to be recognized early. One key target of Advocacy is to help people may recognize symptoms in themselves or those close to them and know where to seek help.
Concerning treatment, there is still a disproportionate amount of focus on the treatment of severely ill ‘psychotic’ illnesses, which require the attention of specialists. The vast majority of mental illnesses belong to the ‘minor’ categories of Anxiety and Depression. It is now recognized as best practice all over the world that Primary Care facilities should be activated to be able to recognize most of such mental health conditions and to treat a large proportion of them.
Other complimentary, non-specialised resources in society such as Counselling services can also play a part. However, such services should only be given by trained persons and should be regulated by the bodies of psychiatrists and psychologists, since inexpertly administered psychotherapy may actually cause harm.
The current lack of Mental Health services and capabilities at primary care level is both a challenge and an opportunity. If the workers at that level, public and private, are trained to recognize and treat basic mental illnesses, 70% of the mentally ill in Nigeria will no longer go unattended, as is currently the case.
Finally, the financial barrier would need to be addressed. Health Insurance, whether National or State operated, needs to made compulsory, and to be synchronized in order to ensure that ultimately all Nigerian citizens are covered. And Mental Healthcare should no longer be excluded from the ‘benefits-package’ offered under any of the Insurance schemes.
If the ‘powers that be’ commit to these ‘baby-steps’ at tomorrow’s celebration, instead of the usual official clichés, Nigerians can begin to sing along with the rest of the world about the imminence of Universal Health Coverage for Mental Health. For now, it remains a distant, but compelling dream.