By Chioma Obinna
Mental illness continues to gain prominence in Nigeria apparently due to increasing awareness. Suicide cases are also on the rise. No month passes without the media awash with cases of young Nigerians taking their lives.
Dr. Ogunnubi Peter, a consultant psychiatrist and World Health Organisation, WHO, certified mental health advocate, looks at some of the challenges of mental illness in the country and why people should see mental illness beyond the man on the street.
What is the truth about mental disorders?
If you look at the statistics from the World Health Organisation, WHO, it states that every 40 seconds one person loses his or her life to suicide and the unfortunate thing is that this suicide can be prevented. That is why it has become a medical emergency. That is why we had 40 seconds of action, raising awareness on suicide. The truth is that mental illness has a very rich history in the sense that it has come of age. People, over the past years, have attributed the causal factors of mental illness to many things, especially evil spirits.
So, because of that mentality, it is still enshrined in people and also in the perception of people whenever they see anyone presumed to have mental illness. Hence, whenever anyone talks about mental illness, the picture that comes to mind is that of the man on the road wearing tattered clothes, eating from the dustbin, laughing and talking to himself or herself; that is to them madness, craziness and mental illness. Because of that perception, people failed to realise that gambling, phobia, depression, anxiety, sexual and Internet addiction, among others, also constitute mental illness. Some who fear about coming out of their houses, feeling that people want to harm them and those hearing voices don’t know that they also suffer mental illness. They tell themselves: ‘’Nothing is wrong with me; it is only the mad man on the road that has mental illness’.
The global body is the custodian of health. It has shown that over 30 million Nigerians have one mental illness or the other. Remember, when I say mental illness, it is not that they are raving on the roads or eating from the dustbins; we are saying they have issues. Just like they always say: it is okay not to be okay; the fact that you say you are okay does not mean that you are okay. So, people who have emotional issues they are dealing with that is hindering them from living qualitative life fall in the purview of mental illness. It is not that mental illness is increasing everyday but knowledge and awareness is increasing. We cannot say we are immune to this scourge.
If anybody has malaria, the likelihood is that he is going to have fever; some will have headache. Some will talk about pains in the joints. Then the person goes to hospital, does a test and it will show malaria parasite. Now, when people have mental illness, what is the function of the brain? The function of the brain will make you know if there is a problem with that brain. I am using glasses now because glasses are for vision but because I cannot see too far, I need glasses to correct the vision error. If my brain is for thinking and for perceiving things rightly; it is for memory: to remember things, for judgment; let us now assume that organ is affected. When I see a man, I can think he is a woman. When I see a man, I can think he is a goat. That brain is for judgment. When I go out, I may just be eating on the main road. Why? My judgment to say Dr. Peter is already affected. Why?
The organ serving that function is already affected or impaired. When everybody is happy and I am sad and I keep to myself; I am not talking to people. People begin to wonder. ‘What is wrong, come on, be a man’. But they don’t tell the one that has malaria to be a man. They will be telling you that have problem with the brain to be a man. Do you tell a man that has fever not to shiver? That is why we are changing the narrative. Some people who have mental illness keep to themselves, not able to sleep and have anxiety. Some have asthma and panic attack as if they want to die. Some will feel as if their breath wants to cease; they will be shaking and palpitating. These are signs of mental illness. Some will go to the extent of hearing voices. Some will see things that others can’t see. Mental illness is not arrow from the village. It is a problem with an organ called the brain that is inside the skull.
Changing the narrative
However, we are changing the narrative; that is why the topic of this year’s World Mental Health Day is ‘Raising Awareness for Mental Health and Suicide Prevention’. So, people need to understand that mental illness is not that ‘mad’ man on the road. Although the stigma is there, the more we educate people, the more we let people know that you don’t have to be stark naked on the road before you suffer mental illness.
Just like the treatment of HIV, anywhere in the world, the treatment of mental illness, because it is a chronic condition and not like malaria which will go within three days, costs more. In fact, under the National Health Insurance Scheme, NHIS, some health insurance companies refuse to include mental illness as part of their coverage; so, individuals have to pay out-of-pocket and that is unfortunate. Today, people will tell you that if they have HIV, they will go to the Nigerian Institute of Medical Research, NIMR, and Lagos University Teaching Hospital, LUTH, and get free medication, but when people come down with depression, anxiety, phobia, inability to sleep, to get the money to buy drugs they have to pay out-of-pocket. It is very pathetic. Are the few federal institutions in our setting equipped to provide subsidised medications? The answer is no. So, you have people resorting to private care. When people who cannot afford to treat the illness realise that they have the illness, what you will see them say is: “Jesus will heal me; Allah will heal me.” They go to churches, mosques, traditional medicine practitioners and herbalists. It’s not that they don’t know that they should go for orthodox care, but when they don’t have money, they begin to psyche themselves and say, ‘’God will heal me.” So, federal, state and local governments should all come to the aid of those suffering mental illness.
Non passage of Mental Health Bill passage
Nigeria needs to pass the Mental Health Bill. This is the 10th year the bill is before the National Assembly. The eighth Assembly was almost getting it right before they left. The ninth Assembly is here now, yet the bill has not been passed. There is need for Nigerians to cry out for this bill to be passed. The Mental Health Bill will support treatment of people with mental problems. This bill will support those suffering from mental illness. It will ensure that they are adequately taken care of in the society as well as ensure their employment. Companies will be forced not to reject anyone with history of mental illness. They will have opportunity to vote and marry. It will help to improve facilities because the bill talks about the establishment of more facilities, subsidising medication. Do you know that some Nigerian patients with mental health go to the Republic of Benin to get free medication and we are the giant of Africa; is it by mouth? The bill will ensure that you don’t just pick somebody and say he is mad and discriminate against the person.
The bill also protects doctors. As we are, we are working under the grace of God because the truth is anyone that has no insight can sue the doctor for providing treatment against his will because there is no law protecting doctors. The law on mental illness that we have at present is the Lunacy Act of the 1950s. For example, that Lunacy Act states that anyone that is suffering mental illness, the state should sell all his property and use the proceed to treat him/her. It is the out-of-pocket payment. It is important for us to know that the Lunacy Act that talks about asylum and use very derogatory terms should be done away with. The Mental Health Bill has been in the National Assembly since the 1980s. When we have Mental Health Law, all the stigma we are talking about, shortage of medication, everything will be taken care of.
Dearth of psychiatrists
We have less than 300 psychiatrists in Nigeria; practicing, may be 200 to 250 in a population of 200 million. So, we have an average of one psychiatrist to one million patients and WHO talks about one doctor to 6,000. The doctors are evenly distributed. They are concentrated in the cities: Lagos, Abuja, Jos, etc. So, what happens to people in rural northern regions and in other parts of the country? In terms of the WHO recommended ratio, we are far behind.
Can mental illness be cured?
The truth is that there are myths around mental illness. People believe that once you are mentally ill, you are ill for ever; it’s a myth. The same way you take care of hypertension, arthritis and diabetes, so also you take care of mental illness. Don’t let us forget that diabetes is affecting pancreas, hypertension is affecting the heart, asthma is affecting the lungs and all these are organs in the body. The same way arthritis will affect the bones, mental illness is affecting the brain.
Where is the brain which is inside the skull is also an organ, but when people have problem with the heart, liver, kidney, lungs, they either go to the cardiologist, the nephrologist, the orthopaedic surgeon, the rheumatologist, among others, but when they have problem with mental illness, they run to churches, mosques and traditional healers. It is abysmal; it is abnormal. It is important to know that mental illness is a problem of the brain. The same way you manage other medical conditions in the body, you can also manage mental illness. Many people treated for mental disorders are okay and doing well in society.