THE tricycle undulated each time it climbed over a porthole.
Passengers slowly swung from left to right as the rider stealthily
applied his expertise in order to avoid the bad patches on the road and
seek creative ways to evade the traffic jam.It seemed like a fairly jolly ride for the four passengers – a nursing mother seated at the back with her two children aged 5 and 9 years, and a formally-dressed male passenger probably in his mid-thirties seated next to the tricycle rider in front.
And like a rain that torrentially beat down on you without warning signs of dark clouds and cold breeze, they had barely reached half the distance to their destination when the gentleman in tie started to scream at very high decibels and struggled vehemently with the tricycle rider for the steering wheel for no good reason.
This caused the rider to lose control, sending everyone to the ground with injuries, peeled skin and excruciating pains. It was a ghastly scene of sorrow, tears and blood.
The major culprit in this whole story quickly jumped to his feet like nothing happened. He grabbed the already injured rider by the jugular, and began to pummel the innocent man in the face. If not for the timely intervention of passersby, he would have murdered the rider.
He was overpowered and subdued by those around, who eventually tied and bundled him to God knows where. This was a man who looked very alright and put together on the outside but had a volcano erupting from his inside.
In March 24, 2015, the Airbus A320 airplane conveying 150 passengers and crew members from Barcelona to Dusseldorf was deliberately crashed into the French Alps by the first officer Andreas Lubitz, expert reports revealed. The pilot was said to have been battling mental challenges of depression and suicidal tendencies.
In fact, global statistics have it that at least 393 people have been killed in suicidal plane crashes in four years. If this does not make you sit up, then nothing will.
This is the kind of situation that a lot of us potentially have to deal with. Whether you are in an airplane, in a car, or on a bike; your mental health and that of everyone interacting with your space is very critical to your own survival.
Imagine entering an airplane and committing your entire life to a mentally unstable, depressed and perhaps suicidal pilot? Your guess is as good as the writer’s. This cuts across every sphere of profession from the teachers in classrooms, judges in courtrooms, to even doctors surgically operating patients in theatre rooms. Everybody needs their sanity to function.
That mental disorders like depression, anxiety, and substance abuse-related disorders, will have disabled more people than complications arising from HIV/AIDS, heart diseases, accidents, and wars combined by the year 2020 is a very troubling statistics.
The above is according to the World Health Organisation (WHO) report on mental health system in Nigeria, and it bears credence to the fact that as a country we are not even paying a ‘mustard-seed’ attention to issues of mental health.
Stories abound of lovers murdering each other with flimsy motives, celebrities taking their own lives for mundane and unfounded reasons, students downing full bottles of pesticides like snipper in the bid to end their depressed lives; in short our society is slowly choking on its neglect and nonchalance with regards to how mentally ill it really is.
It is a fact that mental health is a concern not only in Nigeria but the world over. However, the difference lies in the way, strategies, and systems put in place to mitigate its debilitating blows by countries of the world.
Mental illness not the exclusive preserve of ‘mad people’
In Nigeria, an estimated 20% – 30% of our population are believed to suffer from mental disorders. This is a very significant number considering Nigeria has an estimated population of over 200 million.
Gone are the days when mental illness is attributable to someone who behaves consistently incoherent, walks about naked or almost naked, looks totally unkempt, and takes abode in dunghills.
Today mental illnesses disguise in shirts, ties and suits; lives, plays, and maybe takes care of your children when you are out seeking daily bread. You find people with innate and building mental illnesses cover up there struggles with Queens English and ‘gentle-manly’ manners.
Mental illness does not show on the face, and sometimes takes time to become fully manifested in behaviour. Like malaria and other kinds of sickness, mental illness can happen to anybody with the right situations and triggers.
Mental disorders or illnesses, according to WHO, comprise a broad range of problems, with different symptoms. However, they are generally characterized by some combination of abnormal thoughts, emotions, behaviour and relationships with others.
According to the President of the Association of Psychiatrists of Nigeria (APN), Prof. Taiwo Lateef Sheikh, “Mental illness is the cause of certain impairments or disability or handicap that can be attributable to the functioning of your brain. When it is not allowing you to fulfil your role within your socio-cultural setting, then we say that the individual is mentally ill.
“While mental health is about looking after the totality of your wellbeing in terms of physical, emotional and social in relationship with the adjustments in your life, mental wellbeing is not the same as freedom from mental illness.
“It means the ability to be able to relate in a very good equilibrium with your environment; to be able to have your own aspirations, pursue them in a very meaningful manner and contribute effectively to the society you are living.”
Speaking with The Nation reporter, Prof Sheikh said, “Truth is, you may not enjoy good mental wellbeing even in the absence of mental illness.
“A lot of people are carrying this around even if they have not broken down to be mentally ill. This can degenerate to mental illness because it predisposes you to a very high level mental disorders.”
“A person may be meeting up with his or her family, relational or occupational roles but with a lot of struggles.
“The fact that an individual has not broken down, be admitted to a psychiatric ward, or showing signs of mental illness, does not really mean they are enjoying adequate mental wellbeing. It is a danger because people don’t know you have a problem.”
There are more than 200 classified forms of mental illnesses. Some of the more common disorders are depression, bipolar disorder, dementia, schizophrenia and anxiety disorders. Symptoms may include changes in mood, personality, personal habits and/or social withdrawal.
A tale of unimplemented policy and pending bill?
In 1991, Nigeria formulated a Mental Health Policy document which was to addressmental health issues, and its components include advocacy, promotion, prevention, treatment and rehabilitation. It was later revised in 2013. Till date, the policy on mental health is seated somewhere in the ministry of health gathering dust.
According to Prof Sheikh, “We have a policy of 1991 which was revised in 2013. So we are using that 2013 revision. It is there on the shelf of the federal ministry of health and some state ministries, nobody has touched it.
“All the things incorporated in the 2013 policy that was adopted by the federal government of Nigeria has not been implemented. So we have a 2013 national mental health service policy and everything contained in that policy has never been implemented.
“No desk exists in the ministries at any level for mental health issues and only about four per cent of government expenditures on health is earmarked for mental health.”
For the President of the Nigerian Medical Association, Dr. Francis Faduyile, “We do not have any mental health policy in Nigeria, and it is because Nigeria’s health system is still in its rudimentary stage. Up till 2014, there was no particular policy of what the government needs to do in terms of health generally for Nigeria.
“It was the Nigerian Medical Association (NMA) who fought and got the National Health Act in place. And that is the only thing that stipulates what the government needs to do in terms of health generally.”
Over twenty years now, no passage of Mental Health Bill
Concerning the Mental Health and Substance Abuse Bill, the APN President told the Nation reporter that: “We are pushing for a bill – Mental Health and Substance Abuse Bill for Nigeria.
“The mental health and substance abuse bill is a bill that seeks to address the problem of universal access to mental health care. It seeks to establish the national agency for mental health and substance abuse.
“To increase funding for mental healthcare. To create integration of mental health care into various levels of healthcare delivery services. To guarantee the human rights of the mentally ill. To protect the properties of the mentally ill. To treat the mentally ill in a very humane and compassionate manner such that there will be stringent measures on who is to do what where for who. If you abuse the mentally ill, then you will be culpable.
“It is a comprehensive bill that is supposed to address the issues of lack of care for the mentally ill and our young people who are under the burden of substance abuse.
“The bill is likely going to enforce the policy. So the policy comes with strategic plan and implementation plan whereas the bill commits the government to implement that policy.”
He further said, “We have been on this for the past 20 years and not 5years. Last year we got a Senator who sponsored the bill and it got two readings but couldn’t get through the third before the end of the last Assembly.
“We have gotten Dr. Ibrahim Oloriegbe who is the Chairman of Senate Committee on Health. He has taken over the championing of that bill and has assured us that it will get to their legislative agenda and we hope that this particular national assembly will be able to pass the bill to the president for acting.”
Dr. Francis Faduyile added: “The Nigerian Medical Association (NMA) and the Association of Psychiatrists of Nigeria (APN), are pursuing the mental health bill, which will now give a policy towards how we treat mentally challenged people, how we take care of them, what we need to put in place, and how the government needs to interact.
“It is until we have that, that we will say we have a policy about the treatment or management of mental health in this country.”
Hemorrhaging number of Psychiatrist in Nigeria?
In the ongoing struggle to rescue the wandering minds of Nigerians away from the deadly claws of mental illnesses, the numbers of our frontline soldiers are increasingly becoming smaller. Our mental health soldiers include Psychiatrists, Clinical Psychologists, Mental Health Nurses, Mental Health Social Workers, etc. Their combine strength is still less than 1,000 personnel. This is very ridiculous, and no thanks to the infamous ‘brain drain’.
Prof Taiwo Lateef Sheikh, while speaking with the Nation Reporter, explained that for a population of about 200 million, we have just about 250 psychiatrists in the whole of the country. Which means it is one psychiatrist to about 800,000 people. This is about the greatest disparity in the world. It is a huge problem.
According to him, “We have triple number of psychiatrist of Nigerian extract outside the country today. In America alone we have over 300 psychiatrists that are Nigerian born. In Europe, Australia we have the same. We have more than three times the number of psychiatrists outside the boundaries of Nigeria than in Nigeria.
“Over 90 per cent of the psychiatrists you have outside Nigeria were trained in Nigeria; they were trained in our primary, secondary, university, and residency to specialisation in Nigeria, mostly using public money. Yet we allow them to go. It is as a result of brain drain.
“They are leaving because of economic matters; when there are no incentives to keep them here. Psychiatrist are not enough all over the world, so other countries readily absorb them.
“Psychiatrists are not the only mental health providers. We also have clinical psychologists, mental health nurses, and mental health social workers who are even less in number compared to psychiatrists. In fact, if you qualify as a mental health nurse today it is like a visa to go to Australia.
“We have serious dearth of professionals. That is why a lot of our people who have problems end up in the hands of quarks or traditional or spiritualists – unorthodox medicine. Manpower is a serious problem.
“The way forward is to integrate mental health into all levels of health care service. We want every Primary Health Care centres to be able to render some mental health services. We want every general hospital to render mental health service.”
Stigmatisation and human rights issues abound
It is not a rare thing to see people being chained, beaten, and manhandled because they are mentally challenged. All these are things that should not be.
“There is so much stigmatisation on those who are mentally challenged. In developed climes, that you are mentally challenged does not mean you cannot function in the society.
“It does not mean that you have to be stigmatised or segregated from the general society. Mental illness is taken as anybody who has malaria or any other form of diseases that you use drugs for and you can work effectively within the society,
“There is a lot of stigma and discrimination towards the mentally ill. There is a lot of stigma that embedded even at the highest level of policy making in Nigeria. This is reflected in budgetary allocation to mental health, even within the federal ministry of health.
“Today we don’t have an agency that looks after mental health in Nigeria. It is a shame.
“Ghana has mental health authority which is a stand-alone agency that is responsible for mental health to the country and advices the government on issues of mental health. We forget that mental illness has no vaccine. Our policy makers tend to forget this because of the issue of stigma and discrimination,” Prof. Sheikh explained.
Also, Dr. Faduyile decried the lack of attention that mental health is facing as evident in its exclusion from the Nation Health Insurance Scheme (NHIS). According to him, “Mental health is not included in the NHIS. A lot of things that should be included are not there, until we do a review of the Act.
“The first thing we need to do is to have the Mental Health Bill. When we have this then we can now ask for a particular budget to take care of mental issues and mentally challenged people. The bill is currently with the National Assembly and we hope they will be able to pass it.”
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