Ayoola Olasupo writes about the issues contributing to increasing rates of mental illnesses in Nigeria
Life now has a new meaning to an unidentified drug addict in his early twenties recuperating after a visit to a rehab centre. He is glad that the lifestyle which has turned him into a victim of mental illness is gradually ebbing.
During a visit to one of the private psychiatric centres in Lagos, our correspondent observed how difficult it was for some of the drug abuse patients undergoing treatments to compose themselves. Their mannerism was marked by incoherent speeches and restlessness.
Officials at the facility located in the Oshodi area of the state who allowed our correspondent to speak with two of the patients, barred picture taking and requested protection of their identities.
One of the recuperating patients identified only as David narrated to our correspondent his journey into drug abuse.
He said he was an undergraduate of one of the universities in Nigeria before he got associated with friends who lured him into hard drugs.
In what seemed to be a pleasure to David, the persistent abuse of hard drugs unknowingly started having adverse effects on his health which degenerated into a mental illness.
David said, “It all started when I was during tutorials for the Unified Tertiary Matriculation Examination. I met someone there and we became friends. He was the one who lured me into such a lifestyle.”
He further told our correspondent that his family members became concerned when he withdrew suddenly from various social commitments, family contributions and shunned his friends.
There were traces of sluggishness in speech and action noticed by our correspondent while speaking with David.
David said, “My family members were the ones that discovered I had already lost and started misbehaving. They noticed a change in my behaviour. The first thing my family noticed was that at first, I became slow and I stopped talking to people. I kept away from my family, friends and others because I enjoyed what I was indulging in. I saw no need in talking to people anymore so I became more reserved. I never knew they were noticing my actions at the time but I’m feeling much better now. I am taking my medications too.’’
He added that as the illness persisted, it forced him to withdraw from two tertiary institutions, noting that he was in the second year at his first school when it all started. The condition, he added, made him sad, saying he regretted meeting friends who lured him to the lifestyle.
He added, “This is the fifth week I started receiving treatment at this place. None of my friends visited me. It is not as if they were not allowed to visit but they do not know my whereabouts. The only pain I have is that I met those so-called friends through whom I got into this mess. I was studying Microbiology in school before I withdrew from the programme because my mental state then didn’t help my situation. Then I got to 200 level to study Industrial Relations but the situation persisted. My family came once on a Saturday since I got to this place.’’
David’s situation mirrors the several cases of mental illness which many Nigerians, especially youths are undergoing. They are in rehab centres across the country with others marooned to religious homes for treatments. The National Agency for Food and Drug Administration and Control notes that drug abuse is on the rise with over 40 per cent of students abusing one drug or the other.
Disturbing data on mental illness
The World Mental Health Day held on October 10 of every year is for mental education, awareness and advocacy against social stigma.
A data by the World Health Organisation puts the number of people with one mental illness or the other at 450 million globally. It further stated that 25 per cent of the population would suffer from common illnesses such as depression and anxiety at some point in their lives.
Mental illness is a state of well-being in which an individual finds it difficult to realise his or her abilities, cannot cope with normal stresses of life, finds it difficult to work productively and fruitfully, and is unable to make contributions to his or her community.
While it could be caused by severe disturbances in thoughts and behaviour, reports showed that there are more than 200 classified forms. Such common disorders are depression, bipolar disorder, dementia, schizophrenia and anxiety disorders.
According to the National Alliance on Mental Illness, mental illnesses are common even more than cancer, diabetes or heart disease.
A 2017 study by WHO titled, “Depression and Common Mental Disorder; Global Health Estimates,’’ revealed that the prevalence of the illness rates also varied by age with 7.5 per cent of females aged between 55 and 74 years and 5.5 per cent among males.
The report explained that the global population with anxiety disorder in 2015 was estimated to be 264 million which represented 3.6 per cent, reflecting an increase of 14.9 per cent since 2005.
Also, a total of 322 million people were estimated to be living with depression but its rate increased by 18.4 per cent between 2005 and 2015.
Another report by WHO stressed that in 2019, nearly one billion people including 14 per cent of the world’s adolescents were living with a mental disorder.
In February 2021, a coalition of psychiatrists in Nigeria, the United Kingdom and America warned against stigmatisation of mentally ill persons, urging the Federal Government to prioritise the development of quality community-based mental health services in the country.
Also, a Professor of Psychiatry, Taiwo Sheikh, stated in May 2022, that 90 per cent of Nigerians with mental disorders did not consult healthcare providers for proper medical care, urging people to imbibe the habit of caring for themselves via regular check-ups and treatments.
Similarly, President, Association of Psychiatrists in Nigeria, Prof. Taiwo Obindo, earlier in September 2022, raised the alarm that more than 60 million Nigerians across the country were suffering from various mental illnesses, while only about 10 per cent had access to appropriate care. He noted that more than 90 per cent of Nigerians who are unable to access care made up the group called the treatment gap for mental illness.
On October 6, 2022, Director of Programme Management, WHO Regional Office for Africa, Dr. Joseph Cabore, highlighted the number of psychiatrists in the African region, saying there was only one psychiatrist available to 500,000 people in the region. He added that the situation contributed to the highest rate of suicide in Africa compared to other parts of the world.
The causes of mental illnesses are classified into three categories namely; biological, social and psychological factors.
A mental health specialist, Dr. Akeem Adeyemi, explained that although the illness could be genetic yet peer group influence was a major cause of most cases in recent times.
He said, “The illnesses can be genetic but most of the time all the components of causation are always there; the social, and biological and psychological. Mental illnesses as a result of drug abuse are on the rise now. As people are entering 18 years, they will be having more issues.”
WHO noted that consumption of alcohol contributed to three million deaths globally as well as the disabilities and poor health of millions of people.
It revealed further that harmful use of alcohol accounted for 7.1 per cent and 2.2 per cent of the global burden of disease for males and females respectively, while 5.1 per cent was responsible for the global burden of disease, noting that there was a burden of causal relationship between alcohol abuse and a range of mental behavioural disorders, other non-communicable conditions and injuries.
An addict who gave his name only as Ugochukwu for fear of stigmatisation told Sunday PUNCH how his friends introduced him to drugs and alcohol after which he became addicted.
He stated, “It was my friends that introduced me to the habit and I went deeper until it became difficult for me to do without them. Though the first time I took it I felt sick, I continued taking it because I started enjoying it afterward. I don’t even know because I enjoyed it. This is my second week at the centre and I no longer have the urge for alcohol.”
Ugochukwu, who was pensive while narrating his experience, recalled how he lost his business to the habit. He added that he became aware of the effects of excess intake of drugs and alcohol when his health started deteriorating gradually.
He said, “I’m not married yet but I lost my business to alcohol addiction. I did not have time for my business since I was drinking almost every time. I started realising that the excess alcohol is affecting my health. That is when it appeared to me that there was a problem. When it started affecting me, I went for medical care and it was there that I discovered what the problem was.
“The people came to my house one day and picked me up. I thought it was abduction until I found myself at this place. I feel good in this environment because I can take my medications thrice a day. When I started drinking, I never knew it would affect my health until it happened. My family members have not visited me yet. I don’t think they know where I am. I will be happy seeing them again and I wouldn’t feel they set me up for these people to pick me up.
“I am ready to quit drugs and alcohol because it has caused me a lot. I wasted my time. I am here doing nothing when I am supposed to use the time for something meaningful. I advise people not to go near alcohol because it doesn’t pay. All my friends who are still alive don’t know I am here too. Some of them are even dead but it was not due to substance abuse.”
Problem of double-handling
Apart from the causes of drug abuse, double-handling is another problem a child has to deal with while growing up.
Commenting on the situation, a Medical Director at the Federal-Neuro Psychiatric Hospital, Lagos, Dr. Olugbenga Owoeye, explained that double-handling was what children have to deal with at the early stage of their lives.
He stated that children often learnt from their parents, adding that at a point they get confused when their parents do something negating the instructions given to them.
Owoeye said that children tended to imitate what they see and hear, hence they became confused, noting that this often had consequences on the mental health of the children.
He said, “The mind is tabula rasa on which the experiences of life are written. Because of this, most children learn by what we call observational learning and modelling. When they learn this way and you do something different from what they have told them, they may become confused.”
Stigmatisation of patients, doctors
Mentally ill patients and medical practitioners taking care of them regularly suffer different forms of stigmatisation.
Speaking on the issue, a chief consultant psychiatrist at the Federal Neuropsychiatric Hospital, Yaba, Lagos, Dr. Dapo Adegbaju, noted that after successful treatments, the problem most patients face in Nigeria were stigmatisation and abuse by the public. He stated that it was difficult to reintegrate patients back into society.
Adegbaju said, “Due to the stigma associated with mental illness in our society, it can be pretty difficult for patients. They can be ostracised or even laid off from work. Any little disagreement with a ‘supposedly’ normal person can be viewed as a relapse of the illness.”
The mental health policy
Nigeria’s first mental health legislation referred to as the Lunacy Ordinance was enacted in 1916 before it was later revised in 1958 to give medical practitioners and magistrates the authority to imprison mentally ill persons.
However, in 2013 after decades of several moves for the amendment of the law, a new bill was introduced as part of the National Policy for Mental Health Services Delivery to deliver care to people with mental, neurological and substance addiction difficulties. But due to a lack of support, the new bill has yet to come to reality.
The mental health bill still awaits presidential assent before it could be implemented.
In a 2020 report by Al-Jazeera, the Founder and Executive Director of She Writes Women, a women-led movement in Nigeria, Huawei Ojeifo, was quoted as saying Nigerians were unaware of mental health and how to address the issue.
Ojeifo stated that although the Lunacy Act criminalised suicide yet it still allowed inhuman practices.
She stated, “Nigerians are very religious, but at the same time there is a lot of ignorance about mental health. The media, music, and film industries also need to sell stories about mental health from a more informed and humanising perspective. In Nigeria, the Lunacy Act of 1958 still criminalises attempted suicide and still allows inhuman practices.”
Reports noted that some patients were subjected to different forms of physical handling such as chaining or seclusion by their doctors during treatments.
A Human Right Watch report noted that thousands of people with diverse mental illnesses around the world were shackled, chained, held in overcrowded or filthy rooms, sheds, cages, or animal shelters and were more often than not, forced to eat, sleep, urinate and defecate in the same area.
In his view on the development, a Professor of Human Rights Law at the University of Calabar, Cross River State, Abiodun Dada, said that it was constitutionally right for mentally ill patients to be restrained while being kept at medical centres for medical care.
He, however, condemned the chaining of such patients, saying they could only be restrained when they appeared violent.
Dada said, “If a patient is not restrained he or she could constitute a danger to himself, other patients and even the staff of the hospital. That is why it is not only reasonable but also legally permitted for such a person to be restrained but the restraint must be reasonable and must be dependent on the circumstance of the case.’’
He further stated that restraining patients would not be an infringement on their human rights when consent was granted from constitutionally appropriate relatives, noting that extant laws required consent before any therapeutic procedures could be carried out.
He added, “So far it is voluntary through a relative that can give consent such as those that take the patient to the hospital. The law is that any form of therapeutic procedure even if it is to the benefit of the patient, consent is a fundamental requirement and the patient can be restrained in a more civilised manner but not necessarily in chains.”
In her contribution, Anambra State Commissioner for Justice and Attorney-General, Prof. Chika Ifemeje. told our correspondent that the need might arise for doctors to protect themselves by chaining patients especially when they appeared violent.
Ifemeje noted, “If such chaining is necessary to prevent the patient from harming him or herself and the people around him, I don’t see anything wrong in that. But if the patients are not violent and they are chained, it is wrong and an abuse of their movement. It is wrong to chain anybody for any reason unless if it becomes necessary to do so.’’
She noted that other measures could be adopted by medical professionals rather than chaining their patients, adding that though a mentally ill patient could be violent, other means of suppression could be employed.
Some other challenges
Also, a psychologist and member, American Psychological Association, Dr. Mustapha Sambe, said that patients could only be confirmed as medically unstable when a necessary diagnosis had been performed by doctors. He noted that the diagnosis differentiated them from those wandering on the streets without medical attention.
He said, “A mentally ill person is that individual who has been clinically diagnosed as mentally ill. Those that you see on the street picking things may be classified as mentally ill but many things can happen. In this way, those who are found in this state are generally referred to in clinical parlance as vagrants or psychotic individuals.”
He explained that as part of the challenges faced by mental health doctors, relatives of the patients often complicated the treatments especially when they were emotionally involved thus preventing doctors from rendering the necessary medical services to the patients.
Sambe also noted that professional burnout, a situation whereby specialists struggle to get a patient back to a normal state of health, could infuriate them.
He said “Professional burnout, a situation whereby the formal caregivers such as psychiatrists, nurses, clinical psychologists and others struggle to ensure that an individual or general patient gets better. But are either frustrated because they are not getting the desired result and this can emanate from either caregiver, patient or the workplace environment where the patient is. The cost is high to offer psychiatric treatments.”
However, the migration of mental health professionals overseas to seek greener pastures appeared to have decreased the number of mental health workers in the country.
Reports showed that Nigeria had fewer than 300 psychiatrists to cater to its 200 million population, thus driving people to consult traditional or faith-based healers.
Speaking on the issue, a medical doctor, Akeem Adeyemi, decried the massive migration of mental health professionals to advanced countries, stating that it was one of the problems facing the country.
He explained, “One of the recent problems is the migration of health workers to advanced countries. Our nurses are now leaving the country making it difficult for us to employ. If you employ a mental health nurse today, in two or three months, he or she would have migrated, making it difficult for us.”
He lamented that treatments became difficult especially when relatives of a patient lacked proper mental education.
He added, “We need an effective mental policy because a place for the treatment of mental health patients has not been defined. Lack of mental education now makes it difficult when relatives of a patient bring them.”
Contacted for comments on the issue, Deputy Director/Head, Media and Publicity, Federal Ministry of Health, Ahmadu Chindaya, did not respond to questions. He asked our correspondent to visit his office in Abuja.
Chindaya said, “Please come to the office. All these online things are not to the best of the ministry. I am so busy and I cannot concentrate on whatever it is, please. I’m so busy that I cannot keep flowing. That is why we prefer you come to the office.”
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