Reproduced here is a piece from my newspaper column ‘From the writer’s perch’ (The Nation newspaper) published 10 years ago.
Not a lot has changed since then, sadly.
The Press and the Mental Health of the people
– Femi Olugbile
Just the other day, there was a gathering of stakeholders from all across the nation in Lagos to discuss the mental health of the nation.
It was an assembly of people from all works of life. Many of them worked in diverse areas of mental health care, such as Nursing, Social work, and Occupational therapy. Others worked for Non Governmental Organisations, and bodies such as the Church Blindness Movement- an international charity which carried out advocacy and direct intervention for people with diverse disabilities.
It was the second such gathering within the premises of the Teaching Hospital in Ikeja, the first having occurred two years ago during the conference of the Association of Psychiatrists.
But one major group of stakeholders was participating in the forum for the first time. This was the fourth estate of the realm – the Press.
There were representatives from a wide swathe of print and electronic media in attendance in the rather posh auditorium. You could tell they were unaccustomed to being participants in serious deliberation.
The programme started an hour behind schedule. The Press, with their short attention spans, were already fidgety. Some approached various important-looking persons in the hall, wielding their cameras and microphones. They wanted interviews, sound-bites that they could record and report, and once they felt they had enough material, they clearly intended to dash off to the next assignment, or to their editorial suites.
One and all they were encouraged to wait. They were informed, gently, that they were part of the show, not just reporters of it. Temporarily pacified, they strolled over to the hospitality station at the back of the hall and helped themselves to tea and coffee and snacks. Then they hunkered down in their seats grimly, waiting to see what the day would bring. Their body language seemed to shout out –let’s see what you guys are up to!
It had been designed to be an interactive forum. Everybody would be invited to participate in lively discussion, and such didactic material as was presented would only be the minimum information necessary to have an informed discussion on the topic.
One of the myths of democratic society is the notion that the Press does no more than report the news. In reality nothing could be farther from the truth. The Press both reports the news and makes the news.
After the usual courtesies, including a brief welcome speech by head of the Institution, who was the Chief Host for the day, it was time to get down to business. Oye Gureje – Professor of Psychiatry and President of the Association of Psychiatrists in Nigeria, set the ball rolling with a thought-provoking presentation. The thrust of his talk was that the situation in the Nigerian nation for the mentally ill was truly grim. Something urgent, drastic and fundamental needed to be done.
By the time the Professor was halfway into his thirty minute pitch, everybody – including the journalists, was listening with rapt attention.
He was a man of facts and figures, and he reeled out the statistics with impressive regularity. There were one hundred and thirty psychiatrists to minister to a population of one hundred and forty million Nigerians, whereas in some other countries, they had one psychiatrist to twenty five thousand citizens. Thirty million Nigerians had mental illness or would develop it at some point in their lives. Everybody had mental illness, or knew someone who had one, or was closely related to someone who had one, or would get it at some point in their lives. Ninety percent of the people who had mental illnesses – mostly of the ‘neurotic’ variety, currently in the nation, did not get any treatment at all for their illness. There was no formal budget in any level of government in Nigeria for the pursuit of mental wellness of the populace.
Sola, a petite Psychiatrist from Abuja took over from the professor. She went into some detail about the Mental Health law of the Nigerian nation. Nigeria, people quickly learned, operated under one of the most antiquated mental health laws in the whole world. It was a relic of the pre-scientific past of Western psychiatry, and was copied from the British at a time when they had no effective treatments for major mental disorders. In those dark old days, they still spoke about ‘lunatics’ and ‘asylums’. The Nigerian law, such as it was, was aptly named Nigerian Lunacy Ordnace, and was more than half a century old.
And yet nothing more accurately depicted the quality of a nation’s sensibilities and civilisation than its approach to mental health legislation, and the details of its mental health law. In British society, their law was frequently updated. Every effort to update the law usually involved very passionate debate among professionals, law makers and the general public. All stakeholders – religious leaders, advocacy groups, politicians, and the mentally ill themselves, argued over the most minor detail. The hottest debate that raged before the latest revision of English Mental Health Law was what to do with people with personality disorders, who were not ‘insane’ in a conventional sense, but who were prone to committing offences, such as murder and rape. The most problematic situations arose when they had not actually committed an offence, or had committed one and been punished already. Government statistics showed that such people often reoffended, and government wanted the psychiatrists to keep such people away from the streets because they were a danger to society. The psychiatrists, for their part, argued that they were no prison warders or ‘social gate-keepers’. There was a paucity of effective interventions for changing persons who were relentlessly, incorrigibly bad, and there was little evidence that keeping them locked away for several years would make a great deal of difference to their criminal behaviour.
It was, and still is, a finely balanced argument, and the English Mental Health Law of 2007 with its copious protections for the rights and privileges of the mentally ill has passed that litmus test of balance – none of the contending stakeholders is fully satisfied with its provisions. In very short order the momentum will arise for a new mental health law.
This was to be contrasted to the Nigerian scenario. There was an attempt in 2004 to introduce a new Mental Health Law, a document which was actually drafted in 2003. The draft was presented as a Private Members Bill before the Senate by a Senator who was himself a psychiatrist. It had a first reading. Subsequently nothing more was heard of it.
People who liked to joke, and such jokes are usually not without a gem of truth, have said that the Law died because psychiatrists did not master the art of lobbying in the Nigerian way. They described how more ‘determined’ interest groups would go to the legislature with finery and fanfare, and some stuff in ‘Ghana-must-go’ bags, if they wanted their bills to see the light of day. By such devices, said the jokers, some other professionals from within the medical team had taken their issues from the bottom of the drawer to the front burner. One or two had actually succeeded in getting laws passed that made them autonomous professional bodies sui generis, throwing whole areas of hospitals into chaos as people refused to accept the authority of their higher professional colleagues. This was law-making, a-la Nigeria.
It was not all doom and gloom. There was a move afoot now to get the Yar Adua government to agree to re-present the 2004 draft as an executive bill. The crying need for this had been laid clearly bare to his Minister for Health. The government, not the professionals, in that case, would be the ones to lobby, with or without ‘Ghana must go’.
After this, it was time to address the role of the Press. The host himself took this on. What did the mentally ill, and the people who looked after them, want of the Nigerian Press?
The catalogue of issues was rolled out, one by one.
First was understanding. And the nuance was stressed – understanding, not ‘sympathy’. For sympathy, in such a context, was supercilious, and patronising. There simply was nothing to be sympathetic about. These were facts of life. All over the world, people were compelled to accept the reality of illness, including mental illness. People in all societies were required to accept the one-in-four rule, that they themselves, or someone close to them, would at some time suffer a mental health syndrome.
Then there was information. This was a major point. The one thing which the Nigerian press lacked, above all others, when it came to the subject of mental health, was genuine, accurate, and useful information. Oh, a lot of information was regularly put out in the press, on the health pages of newspapers, and on the airwaves, on the subject. Mental health features, and human angle stories supposedly centring on mentally ill persons, regularly made the front and back pages of the regular press. However the information was usually tendentious, and all too often plainly wrong. Much of it was sensational, and meant to amuse or shock people. Much of it played to the ignorance and prejudice prevalent in the environment from which both the doctor and the pressman emerged. Nigerians, never people to hide their feelings, often expressed very strong feelings on subjects that interested or concerned them. Journalists, like other Nigerians, were prone to expressing strong, even passionate standpoints about matters, including mental health matters, and were often motivated by concern over the welfare of those they saw as mentally ill.
The problem was that much of the passionate opinion was often based on inaccurate information on the issues. There was nothing more dangerous to society, averred the speaker, than an uninformed person who was utterly, passionately convinced of the rightness, and justice, of the cause he was pursuing. Information did not mean agreeing with the professionals. It just meant at least knowing the rudiments of what they knew. It was good, said the speaker, that all the journalists in the auditorium had listened to Gureje earlier on, had heard him talk about the broad spread and varied nature of mental illness, had heard him state how common it was and how the most common illnesses were Depression and Anxiety, eminently treatable illness conditions experienced by almost everyone, not the florid ‘insanity’ of naked people on the streets which was the conventional view of illness. They had heard that the overwhelming majority of their countrymen who needed assistance for mental health problems were not getting any treatment at all. They had heard also, from another speaker, how important the Mental Health law was, and how it needed to be modernised urgently. All of this made them possibly the most informed media practitioners in the country as it concerned mental health. They were now in a position, to write and express informed opinion in their columns and pieces.
The speaker was not done. There was a widespread negative attitude that the mentally ill in Nigeria had to live with. The stigma was conventional, unabashed, and pervasive. Nobody wanted to associate with anybody who had a history of mental illness. Marriages regularly broke up if a partner became mentally ill, even if the affected person received treatment and recovered fully. People regularly said and published things calculated to be hurtful to anybody who had mental illness. Employers often terminated the employment of anyone known to be ill. In that climate it was not difficult to understand why people would often deny their symptoms, and choose to suffer in silence. Being asked to see a psychiatrist was like a death sentence in the eyes of many. The press had to see that they had a major role to play in combating stigma, and helping to create an attitude-change in their society.
By now it was easy to tell that the pressmen – including several ladies, had their ears full. But there was still more to come. Once having caught the bug, which the speaker hoped they had by now, they were required to participate in advocacy, and to help in mobilising resources for the care of the ninety percent of their mentally infirm countrymen, ninety percent of thirty odd million, who would not otherwise receive care for treatable mental disorders. They were required to ‘get it’, and to spread the message, that civilised societies had found out the hard way that because of the great cost in ‘Disability Adjusted Life Years’ suffered by citizens as a result of Depression, Anxiety and such disorders, it was cheaper for a society to treat its citizens who were ill, than not to treat them. This, of course, was turning conventional Nigerian logic, confident in its ignorance, on its head. They, the Press, were going to be part of that change.
The engagement started in earnest then, and it was full of energy and zest. One lady from among the journalists seemed to capture the essence of the sea-change that was going to need to take place, and how tough it would be on all of them.
‘We have all grown up in this society’ she said, ‘even I – I need to purge myself. It starts from my language. I can’t now talk or write about ‘mad’ people…’
It was a farewell to innocence.