Nigeria is grappling with a staggering mental health crisis, as millions of its citizens suffer from various mental disorders. In an interview with Africa Health Report’s Gom Mirian, the President, Association of Psychiatrists in Nigeria, Prof. Taiwo James Obindo fingers the poor health system, insecurity, and social economic hardship in the country as drivers for mental health issues in the country. He also called for speedy implementation of the recently passed Mental Health Law.
Following available data, over 20 million Nigerians have one form of mental health issue or the other. Why are we having this issue?
Generally, the causes and risks of developing mental health issues are varied and are many. The health indices for Nigeria are poor, and this represents risk factors for developing mental illness later in life. If a mother has issues during pregnancy (infections, bleeding, etc.), this will put the child at risk of developing mental illness later in life. Non-availability of a new mother (physically or emotionally in the case of maternal depression) predisposes her to mental illness later in life since the emotional development of the children is dependent on the emotional responsiveness of their mothers.
A child that develops a febrile illness or any infection early in life; a child that develops neonatal jaundice; and a child that develops any major health issue in childhood are actually predisposed to mental illness later in life. We actually look at the causes of mental illness in two broad ways. Nature and Nurture. Nature is the predisposition and the biological issues, and then we talk of Nurture as the environmental factor. Relationships
The closer a child or an individual is to somebody who has a mental illness, the more likely the individual will develop it. Also, a child is more likely to have a mental illness if both parents are suffering from the same issues. For twins, the risk is as high as 50 per cent if they are identical.
Insecurity is also fueling mental illness in Nigeria. For instance, an individual who witnesses kidnapping or killing will not only develop an anxiety disorder but are also prone to developing post-traumatic stress disorder (PTSD) and can be predisposed to depression also later in life. So, all these added together make the risk of developing mental illness higher in our environment.
What is Nigeria’s rating on the fight against mental illness?
We have not been doing well until early this year when the new National Mental Health Act 2021 was signed by the President. The former law was obsolete and was bequeathed to us by the colonial masters in 1958 and that, in itself, was a transmission of what the British colony was using in 1906 which was handed over to us pre-independence, and that’s what we have been working. The political will was not there and therefore, the management set up of facilities, and access to care had always been very poor, which was often affected by stigma and discrimination.
Some policies that are enacted or given have not been implemented in Nigeria. For instance, the mental health policy was first enacted in 1993, reviewed in 2003, and later reviewed again in 2013, yet they were never implemented. The people involved with the management of mental health do not even have the political will to see the issue of funding Mental Health Care as important in budgetary allocation. Generally, the budgetary allocation for health is often abysmally very low.
The Abuja Declaration talks about a budgetary allocation of 15 per cent for health, yet we have only reached 6 per cent once. Out of this, what eventually gets to mental health is quite minimal. There is no direct budget line for mental health care. The little that goes to mental health is only limited to federally owned psychiatric hospitals and therefore, you will find that management of mental health is more or less out of pocket. One has to pay out of pocket to address mental health issues. The mental health gap (the difference between those who need psychiatry services and those who eventually access it) is as high as 80 per cent.
Mental health care, since the early 1990s, was meant to have been integrated into primary healthcare and is supposed to be the 9th component of the mental health of primary healthcare, but somehow, up to now, we only have it on paper. It has not been fully implemented. This was designed for people to access mental health services at the primary healthcare center closer to their places of abode.
As we speak, how many psychiatric nurses have been employed at the primary healthcare level? How many clinical psychologists are found at the primary level? How many psychiatrists are in the rural areas for those states who even have the Mental Health Act like Lagos and Ekiti? How many of them really have psychiatrists in their employment? These are issues that need to be looked at. So generally, I will say the outlook for mental health in the country is quite poor and then will need more effort by all stakeholders.
Until recently when a mental health program under the Department of Public Health was established, getting a sustainable mental health desk was difficult at the Federal Ministry of Health. Thank God for the new Mental Health Act. We are hopeful that the content will be promptly implemented including the establishment of mental health departments, inaugurating a mental health review board, and the establishment of a mental health fund. We are far, far behind and therefore we need to hit the ground running.
Mental health seems not to be at the front burner of health issues in the country, is this peculiar to Nigeria or Africa as a whole?
This lack of priority is not peculiar to Africa. Ghana has gone far ahead, such that it set up an agency to manage mental health and decriminalisation suicide attempts. Senegal and South Africa have also gone ahead.
Has the recently passed Mental Health Law been integrated into primary health?
Mental health should have been integrated into primary healthcare since the 90s, but politics delayed it. Efforts by the Association of Psychiatrists in Nigeria (APN) to have the Mental Health Bill passed into law started more than 25 years ago. At one point, the bill was passed but was not assented to by President Olusegun Obasanjo at that time, but we can say that we are on the verge of having a new dawn in mental health services with the passing of the bill assented by the president, but we still have a long way to go.
The implementation roadmap is being looked at presently; we should walk very fast and hit the ground running as we are already far behind compared to other African countries.
We thank the World Health Organisation, other key agencies, legislature, particularly this outgoing National Assembly, the health committees in the National Assembly, both at the Senate and the House of Representatives, particular mention will be made concerning the Health Committee Chairman for the Senate, Dr. Ibrahim Yahaya Oloriegbe, and the Health Committee Chairman for the House of Rep, Dr. Tanko Sunnunu for all their efforts in making sure that this bill was not only passed but was assented to by the President.
What does Nigeria stand to gain, or lose from prioritising mental health?
The country stands to lose if the law is not implemented. People said health is wealth and there is also no health without mental health. Mental Health stands at the center of health and of course the development of any country. If we don’t have the full complement of people, harnessing all the people’s potential, we are not likely to advance so much.
If the mental health of a country is not optimal, then you can be sure that it will impact the progress of the nation. I believe prioritising mental health will improve the productivity and effectiveness of a company significantly if given priority attention. I call on the government to do so. A lot will be lost or is being lost by virtue of people who are labouring under mental health conditions and who are meant to be providing or giving their own services to the country.
Can you imagine a situation where a high percentage of our youths labouring under the issue of substance use disorders? The youths are the future and the hope of any nation. Where will the nation’s hope be in the next generation if quite a number of them are involved in substance abuse? You can imagine where the nation will be if we do not have the human capital to lead our country in the near future.
