Suppose you are in a queue- say the ATM queue that has become unavoidable these days. Look at the next person to you, he looks okay and fine. Take a look at the next person to him- is he also fine? I bet you would say yes. Except that they may be a bit anxious to withdraw their money from the ATM.
Now imagine that you cannot physically know if they are fine or not. As a matter of fact, every 4th person on that queue is not fine. He isn’t okay at all. He has got a mental disorder and this does not mean he has to show signs or present to be physically sick.
Just two days ago at road walk for World Mental Health day, I asked my friend and brother Honorable Oluwadamilola Apotieri “Why is mental health poorly funded globally?” This led us to a series of conversations that I will share a bit in this piece.
His answer to me –“because there is no awareness of mental health cases in Nigeria” – left me with deeper thoughts. If one of every 4 persons has a mental health disorder globally, one of every 7 persons is mentally sick in Nigeria and we do not consider these alarming, we have a problem. Besides, he was right on his answer.
The logic of his answer is that funders respond to diseases of high prevalence and importance, provided there is enough data to justify them. But how do we measure prevalence of mental health disorders when people, particularly Nigerians do not consider mental disorders something to worry about. We even deny that some of these apparent misbehaviours we exhibit are normal. We excuse them away by attributing them to environment and other obvious sicknesses.
In case you doubt how prevalent and alarming mental disorders are, how do you justify your senators throwing tantrums, exchanging fisticuffs and breaking chairs in their hallowed chambers?
How do you explain a father consistently sleeping with his daughter? How do you explain the obsession of the rich and royal with underage girls, most times leading to child marriage?
What about the man who undressed himself in front of his debtor’s house, laying curses and invoking the wrath of the gods on his debtor? It would have been fine at that stage. What do you say to him recording same footage and sharing virally on social media, videos of these obscene act?
How do you explain cases of paranoid, extreme aggression, suicide, depression and anxiety that have scaled up in response to economic recession?
You see, we take our mental health lightly in Nigeria and that is worrisome. What percentage of the Ministry of Health’s budget goes to mental health?
In year 2012, just about 3.3% of the health budget was earmarked for mental health, 90% of which was directed to the 10 psychiatric hospitals in Nigeria. As at 2012, Nigeria had less than 200(precisely 150) psychiatrists practicing within its borders. This translates to the fact that one psychiatrist would be responsible to 1, 400,000 persons in order to cover our 140 million population.
If you are looking for export of knowledge economy/human resources out of Nigeria, this sector might interest you to research. Government cannot pay their fees. Thank God for people like Dr Maymunar kadiri and many others who stayed behind to enhance the mental health of our dear citizens.
Even though I am delighted about the universal health coverage plan and inclusion of mental health in primary health care, access to mental health services is still very low(almost unavailable) in our primary health care centres.
At a prevalence of 20%, mental sicknesses should be considered very important to be accessed at primary care centres, if HIV with a prevalence of less than 5% can be accessed at this level. I am hopeful that the news of the World Bank facility being granted government for building primary healthcare centres across the country would be sustained by the provision of essential services like mental health at local levels.
As soon as this is going on, a robust social and behavioural change marketing communication campaign, focused on removing stigmatization, increasing service uptake and awareness should spiral throughout the country.
Perhaps, next to infrastructure deficit and lean human resources, the most daunting challenge to mental health in Nigeria is stigmatization. My friend –Sola Olododo– was sharing with me how, in the US, people self-report at hospitals to complain of speaking to themselves.
I mean –“speaking to yourself” in my country is greeted with spiritual attention that it is given medical attention. It must be the voodoo work of the old man from your village or the girlfriend you jilted.
Most psychological interventions have been thrown at pastors and imams basically because government has failed to make available and accessible, mental health services. Not every pastor or Imam is trained in psychotherapy or any such skilled counseling approach.
As I close, let me let you know that visiting a psychiatrist is nothing to fear or worry about. Seeking psychotherapist like @lanreolusola @lekealder, Tylor Tayo-Ilori, Samuel Babatunde Obafemi and Usar Innocent for psychological first aid is not shameful nor deserving any stigma.
And for those doctors (General Practitioners) who would rather not refer to psychiatric hospitals for shaming and stigmatization reasons, you are doing more harm than good to our country. You should even do what is called provider-initiated screening as it is obtainable in HIV prevention system.
We should have a mental sickness prevention task-team and technical working groups. National Health Insurance and Community Based Health Insurance should cover mental health as an essential service.
I would hold my thoughts at this point.