September 13, 2010

Mental health takes centerstage in Lagos

By Sola Ogundipe
MANAGEMENT of common mental illnesses recently came into limelight in Lagos and environs as part of ongoing efforts towards ensuring  access to affordable and effective mental care services at the grassroots, as healtcare personnel drawn from all LGAs  in Lagos State recently benefitted from a skills-building training workshop on the subject matter.

The event which was a collaborative effort between the Department of Psychiatry, Lagos State University Teaching Hospital (LASUTH), the Lagos State Primary Healthcare Board, Primary Healthcare Unit, College of Medicine, University of Lagos (CMUL)  and Awele Foundation, was designed to improve  awareness about recognition and management of mental ill health and substance abuse among relevant personnel at the Primary Healthcare level about within the Lagos community.

Among beneficiaries of the capacity building workshop were community health officers, apex nurses, pharmacists from all the LGAs in the State who were expected to  go back and create awareness in their places and work about setting up a  referral system between the community, the health facility and the experts so that people with problem of substance abuse or mental ill health can be easily identified and sent to the right place.

In a statement during the event, Chief Medical Director of LASUTH, Dr. Femi Olugbile stated that the  issue about mental health is not about having the personnel, but about training of personnel to have  knowledge. If we can give them the knowledge and change their attitudes they can actually recognise and treat cases.

“We are starting from the premise that 90 percent of persons with mental illness do not get any care at all and this is unacceptable because it is a major debilitating factor on our society as a whole in every aspect including commerce.  We need a practical way of delivering mental healthcare at the grassroots level.”

On challenges facing mental healthcare in the country, Olugbile said most of the care centres reside in little pockets in the urban areas.

“There is a disconnet in distance terms. The reason why there are so many psychotic people wandering the streets in the urban centres is that they cannot get care where they live so they are dislocated. If care was available it is unlikely that people would become chronically psychotic and wander around.

He argued that by seeking to change attitudes and impart knowledge of people working in all the PHCs of Lagos, “we want that to be a model that other parts of the country can copy, and also to be a foundation for effective mental healthcare delivery in Lagos State.” He said the specialist centres will still have a supervisory role in terms of providing contacts, advice and occasional presence at the PHCs, but by empowering people at the centres we are opening up all the possibilities and opening access to those who otherwise would not have had access and creating the foundation of a comprehensive healthcare system.

“People who need ultimately to be referred to the specialists will still be referred back where they came from because the best place to treat people is within their environment. This is what has been missing from the Nigerian scenario so far and this is what we have been seeking to generate.”

In her contribution, Dr. Olayinka Abosede, Chairman Lagos State Primary Healthcare Board, said the event would go a long way in helping to facilitate the easy identification of  people with problems of substance abuse or mental ill health so that they can be sent to the right place for appropriate treatment.

Abosede who is also a Consultant at the Lagos University Teaching Hospital  (LUTH), Idi Araba, Lagos,  and an  Associate Professor at the at College of Medicine, University of Lagos (CMUL stated that when the experts in mental illness have finished with the acute phase of managing the patient, they would have a place to refer tsuch patients to. “We have a situation where our health workers will work with the community members to have support groups for such persons so that they can live a normal life, and prevent a relapse.

We want to build capacity at the PHC so that even before complications set in, they would have been adequately tackled.  A lot of it has to do with counseling and refererence if the person needs treatment. There is also need to disabuse our minds about stigma on mental health. We are bringing the traditional medicine Board on board because we know many people go to the traditionalists and  we want them to really understand what should be called mental ill health sand to realise the limitations they may have in managing the patients so that they are referred to the appropriate quarters.

Also speaking, Dr. Ajibike Salako Akande, Founder and Executive Director Awele Foundations Lagos said the output of the brain behaviour-wise is the same no matter what causes  the effect whether organic or chemical in nature and it may not necessariliy be mental illness or drug abuse.

She added that Awele Foundation is one of the NGOs at the community level that is assisting with the programme for PHC interventionin mental health care. “We are focused on drug abuse management assistance. We are just adding this to the mental health issue, we are essentially focused on substance abuse. People do not understand it yet and only just recently, the UN warned that we cannot put a time limit on susbtance abuse recovery.

“Unlike other illnesses in which there is a time factor,  for drug abuse there is no such constraint  because there can be a replase at any time because of the way the brain might have been affected. What we are told to do is to leave the brain alone to repair itself while we are assisting the patient and that is why we are focusing on substance abuse, but we are having to add mental millness.”