December 31, 2019

SUICIDE: Nigeria lacks National prevention strategy


Experts call for passage of Mental Health Bill

By Sola Ogundipe

Nigeria currently has no National suicide prevention strategy. The country is yet to develop, implement and evaluate a comprehensive and sustainable multi-sectoral suicide prevention plan, for the  populace as a whole and for the vulnerable persons in particular,  as recommended by the World Health Organisation, WHO.

According to the WHO, a national suicide prevention strategy is essential for elevating suicide prevention on the political agenda of every country.

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Such national strategy and associated action plan are necessary to push forward the implementation of suicide prevention.

A review of the National suicide prevention strategies: progress, examples and indicators. Geneva: World Health Organisation; 2018 (Licence: CC BY-NC-SA 3.0 IGO), shows that 28 countries

National suicide prevention strategies are essential for working towards the ultimate goal of suicide reduction.

The absence of such strategy in Nigeria, is not only  stalling the  management and control efforts of suicide, but  fuelling stigmatisation and discrimination of survivors of suicide and their relatives.

According to the WHO, about 3.0 per cent of Nigerians will have thoughts about ending their lives, during their lifetime while some will plan and actually attempt to kill themselves.

With an average of 15.1 suicides per 100,000 population per year, Nigeria is ranked 15th most suicide-prone nation in the world and 7th most at risk in Africa.

It is known that close to one million people die by suicide annually, globally; and for every death by suicide, 20-25 more have attempted. But the Lagos University Teaching Hospital, LUTH, says suicide is underreported in Nigeria due to hiding of suicide deaths as a result of the stigma associated with it. the lack of a national suicide prevention plan also leads to unreliable statistics on causes of death, which is worsened by criminalisation of attempted suicide.

The WHO argues that  suicide prevention is too often a low priority for governments and policy-makers, and aims to reduce suicide deaths by 10 per cent by 2020 through decriminalisation and  the establishment of national initiatives on prevention.

The WHO states that suicide prevention needs to be prioritised on global public health and public policy agendas and awareness of suicide

as a public health concern must be raised by using a multidimensional approach that recognizss social, psychological and cultural impacts.

“A national suicide prevention strategy is important because it indicates a government’s clear commitment to

prioritising and tackling suicide, while providing leadership and guidance on the key evidence-based suicide prevention interventions.

“Governments have a crucial role in developing and strengthening surveillance for both suicide and suicide attempts at the national level and is in a position to lead coordination between multiple stakeholders,” says WHO.

Nigeria is among countries committed  in the Mental Health Action Plan 2013-2020 to work towards the global target

The suicide rate is also one of the indicators for health target 3.4 of the UN Sustainable Development Goals, SDGs.

The target is to reduce premature mortality from noncommunicable diseases by one third by 2030 through prevention and treatment and the promotion of mental health and well-being. But these targets are unlikely to be achieved except the government actively engage in efforts to prevent suicide.

In March 2017, the Lagos University Teaching Hospital, LUTH, established the  Suicide Research & Prevention Initiative and Staff Emotional Care Services, SURPIN/SECS in response to the increasing spate of suicide in the country.

The Coordinator of the SURPIN, Dr. Raphael Ogbolu regretted the absence of a national suicide prevention strategy even when the law frames suicide as a crime.

According to Ogbolu, over 3 percent of people who die by suicide must have told somebody but people wave it aside.

He stated that suicide cases were on the rise in Nigeria with sharp increase from 6.2 per 100,000 in 2012 to 9.9 per 100,000 in 2015 linked most suicide attempt to depression, a mood disorder.

In the views of Dr Taiwo Lateef Sheikh, President, Association of Psychiatrists in Nigeria, APN, suicidality represents a major societal and health care problem; it thus should be given a high priority in many realms.

Sheikh, who spoke in Lagos during the 10th Annual Symposium of the Health Writers Association of Nigeria, HEWAN, said in partnership with the Suicide Research and Prevention Initiative, SURPIN, the Association of Psychiatrists in Nigeria, APN, has found that about one-fifth of suicide cases seen at its affiliated institution  are those aged 13-19 years, and that the majority of the callers were aged 20- 39 years, with 63.5 percent of them having thoughts of suicide at the time of calling; 28.2 percent were students.

“There is always tendency to trivialise suicide and attempted suicide, the temptation of being judgmental, stereotypical, hostile and negative criticism is very high and this leads stigma. Stigma arises from myths and misconceptions, and stigma is a major barrier to intervention seeking and uptake of available services, “ Sheikh noted.

He said since 2000, national prevention strategies have been established in 28 countries; these include primary and secondary preventive strategies in Europe (13 programmes), the Americas (eight programmes, Western Pacific (five programmes), South-East Asia (two programmes), but none in Africa and Eastern Mediterranean

“Prevention means community awareness programmes. These usually imbed helplines and public education at workplaces and schools to increase knowledge and reduce stigma. Programmes draw on lay gatekeepers such as clergy, teachers, and first-line responders who receive special training. Along these lines, involving and training laypersons or non-specialised health professionals is an important means of suicide prevention, assessment, and management.

According to Sheikh, mental health legislation in Nigeria dates back to 1916 (Laws of Nigeria, 1948). “

“With mental health legislation being slightly over a century old in Nigeria at the moment, four critical areas have been identified in previous research as being largely responsible for the archaic nature of the law, namely: socio-political evolution in the country, antiquated terminology, apparent insulation from later and recent developments in medications as well as growing alternatives to custodial care and non-application of human rights.”

Giving a review of the current State laws using the WHO guideline for mental legislation, Sheikh argued that  the law lacks a focus on human rights and non-discrimination, access to services and least restrictive treatment alternatives.

“The most current one is the 2019 “Mental Health and Substance Abuse bill” which has attempted to address many of the lapses observed until then and has included substance abuse.

“Creating an enabling environment for suicide prevention in Nigeria  through legislation requires urgent overhaul of our criminal legal system that will decriminalise suicide and attempted suicide, passage of the mental health bill that will promote mental well-being, prevent mental illness and ensure access to treatment of mental disorders, “ he stated.