Say Mental Health Bill should be signed into law
By Sola Ogundipe & Chioma Obinna
LAST Tuesday, we published recommendations of two specialists in suicide treatment and prevention on steps Nigeria should take to stem the tide of suicide in the country.This week, a Medical & Social Health Worker at the Lagos University Teaching Hospital, Ms Titi Tade, and Consultant Psychiatrist with the Suicide Research and Prevention Initiative Nigeria – Lagos University Teaching Hospital, SURPIN-LUTH, Dr Kafayah Ogunsola, continue the discourse. Excerpts:
What is your experience dealing with relatives of people who died by suicide and suicide survivors?
For family members irrespective of whether the person completed the suicide or attempted and failed, there is a lot of guilt but sometimes it is anger. Guilt as in what is going on here? There is anger at the person. People wonder why would you want to take your life and what will be so bad? There is also denial. It is not that there is a mistake that the person did not actually want to take his life. Something must have happened.
In a recent case in Abuja, the family felt it was not a case of suicide even though it has been established as a case of suicide. So there is always reaction because nobody wants to accept. There is also the religious aspect – that the person has lost faith. There are many angles to it.
For the victims of attempted suicide, there’s what we call survivor skills, they can see the pain it caused their family members, they feel bad that they survived, and that if they hadn’t survived, the people would get over it.
Truth is, if you attempt suicide and survive, it doesn’t end there. There are so many things that will come after; questions will be asked.
If you’re in a setting where there is access to a mental health professional, you’ll go see the professional and have several sessions which may involve the family members and the victim will be wondering ‘why am I putting my family through all this, why me? It’s me again.”
And when you are in a situation where it is like a vicious cycle to try and remember where the person was when he/she attempted suicide and continues remembering until that point. So as social workers, these are some of the issues that arise and we have to deal with.
What is most important for rehabilitation of survivors of suicide?
As a social worker, I think there has to be a very strong social support system for the individuals because when someone attempts to take his/her life, the person at that point doesn’t need to feel judged. He/she doesn’t need to feel like he/she is being blamed. He/she needs to know that they love him/her, support him/her and that whatever he/she is going through they’re there for them.
That whatever the problem is there is a solution and we’ll help you get there. So it might be professional support, it might be from the family. People usually rely on religious institutions, on family, etc. so we need the religious institutions to be a little more sensitive about such issues and should be able to respond when they have members who are going through such and respond to them.
How should the public relate with people who have survived or died by suicide?
I think as Nigerians, we need to be a little more caring, we need to be a little more concerned, we should ask questions, talk to people, help those going through emotional trauma, direct them to health care facilities, talk to them about it and if possible help them see a professional.
I think they should just support them, it is just a problem and everyone goes through problems and it is just one of those bumps in life that you hate.
There have been calls that Sniper should be banned. What’s your take on this?
We know that Sniper is one of the means that people would go to, and I think that the way suicide cases have been reported also contribute to a lot of people finding out about Sniper. I didn’t even know Sniper is for killing bugs in the house until I saw it in the hospital and it is the same thing with many people.
There are reports of cases of suicide with a picture of the Sniper so that people who are looking for the means have an idea of what it is.
Instead of saying that Sniper should be banned, rather, there can be more control over it. It is not something to be banned because there is also a need that it fulfils, but there has to be stricter measures on how it can be obtained.
And we also need to realise that Sniper is somebody’s means of livelihood and calling for a total ban will leave those people without a means of livelihood. So let’s not create another problem because we’re trying to solve one. So there is a need to ensure balance.
A senior colleague recently mentioned that he purchased Sniper to kill bugs in his house and the market woman looked at him suspiciously and demanded to know what he wanted to use it for. He was able to further sensitise her about the hazard.
Do we have enough psychiatrists in Nigeria?
There is no doubt that the strength of psychiatrists in Nigeria is not up to the records. If I recall, the ratio of psychiatrists to the population should be about 1 psychiatrist to about 10,000 of the population, but I tried doing the calculation recently and I found out that it is about one psychiatrist to possibly two million Nigerians or so. Because of the figures being quoted right now, we have less than 250 psychiatrists in Nigeria for a population of over 200 million. So definitely, we don’t have enough psychiatrists in Nigeria. The brain drain has really eaten into the number of psychiatrists on ground to service the population.
So what is the short term measure for this, what is the remedy for this?
This is something that needs to be addressed. According to statistics roughly 60 million Nigerians are living with mental disorders and therefore we need the professionals to help manage this. We need definite government support to checkmate the concerns of doctors leaving the country,
What first comes to mind is that they want to go to areas with better infrastructure, equipment, standardised techniques, etc. And we cannot underrate the fact that there are also problems of financing because they want to earn more, live better and more comfortably, so all these things are issues that need to be addressed so that everybody doesn’t leave and there’s nobody to attend to the populace because more people are going to come out with mental disorders. People that already have these disorders will continue to experience the symptoms, and if they are not properly managed, there is going to be continuous rise in suicide.
How will signing the Mental Health Bill help in reducing suicide cases?
It would definitely make the lives of Nigerians in general better because it has so many clauses that deal with issues of people as a whole. It comes down on people who live with emotional disorders. It talks about the funding of those who live with emotional disorders and need help.
But right now we are operating out-of-pocket system and it is very costly to obtain mental health care in Nigeria. So it is going to handle issues relating to their funding either it is going to be subsidised care or certain people will benefit from free care and all that.
It talks about the establishment of many more hospitals, it talks about the provision of psychiatrists who would work in those mental hospitals. It talks about the continuous training of people who work in those hospitals, it talks about stigma, right of the patient, confidentiality issues, etc. and it is for the benefit of everybody and in the long run, there is no doubt that it is going to have that stimulating effect needed for those in the state of suicide.
How should the media report suicide?
When we talk about sensible media reporting, it is to prevent copycat suicide because the first time we witnessed this high surge in copycat suicide was when a particular doctor had attempted to end his life by jumping off the 3rd Mainland Bridge into the lagoon and then so many people came to do the same thing.
So if the media had kept that sensitive information, people wouldn’t know about it. The same thing goes for Sniper. A few days ago, a young man streamed his own attempt of suicide and it went viral overnight. The name of the person who attempted the suicide shouldn’t be mentioned.
We have to be compassionate. Also, the means of the suicide shouldn’t be mentioned. The media should tell the people symptoms of suicide and places to get help and how to avoid emotional disorders.