November 29, 2022

2nd Vanguard mental health Summit: Experts set agenda for Nigeria, decry stigma, drug use

mental health

By Sola Ogundipe, Chioma Obinna & Gabriel Olawale

Mental health took centre stage last Thursday at the Iris Hall of the Eko Hotel & Suites in Lagos as the 2nd Vanguard Mental Health Summit kicked off.

Themed “Mental Health in a Depressed Economy” the event featured a long line of renowned speakers and panellists who focused on current issues prevailing within the system to work out.

Holistic approach way forward — Prof Francis Aina

Setting the tone for the discourse, the Keynote Speaker, Prof Francis Aina, a professor of Psychiatry at the  Lagos University Teaching Hospital,  in his presentation, lamented that 20-30 per cent of Nigerians suffer from mental disorders.  Quoting the World Health Organisation, Aina said in 2020 about 30 per cent of Nigerians had one form of mental illness or the other; translating to about 60 million Nigerians suffering from various mental illnesses.

On the issue of mental health in a depressed economy, Aina said, “The health of any given population is shaped by socio-economic context, employment, public policies, socio-demographic characteristics and social welfare system of the country.  There are strong research findings to show that changes in these key socio-economic determinants may be reflected in the mental health of the populace. Thus, the mental health of the people is vulnerable during economic distress or recession.

On the maintenance of mental health in a distressed economy, Aina called for a holistic approach. He said, “Factors that determine good mental health are often outside the remit of the health system, and all government sectors have to collaborate to promote mental health.  Maintaining good mental health, particularly in a challenging time like this requires a holistic approach by the government, NGOs, and individuals.

Tasking the government, Aina argued that it entails the maintenance of Security of life and property, provision of infrastructure such as good roads, electricity and power supply, good health care services, and food security.

Prescription medicines not for recreational use — Eimunjeze, NAFDAC Acting DG

Speaking, Acting Director of the National Agency for Food and Drug Administration and Control, NAFDAC, Dr Monica Hemben Eimunjeze, in her presentation tagged: “Challenges of Tackling Drug/Substance Abuse and  Drug use in Nigeria”,   who noted that a drug is any chemical substance that causes a change in an organism’s physiology or psychology when consumed, said prescription medicines should only be used on prescription and in accordance with the prescription.

Eimunjeze appealed to Nigerians to desist from using drugs and other substances for recreational purposes.

According to her, drug abuse weakens the Immune system, affects socio-economic activities, increased crime rates, causes chronic diseases as well as leads to occupational loss and overutilisation of emergency care.

“It can also lead to accidents and even death.  Substance use can lead to changes in some of the same brain areas, exacerbate pre-existing mental health conditions like schizophrenia and alienate the mentally ill from society increasing risk factors.”

Stating that substance use disorder and mental health conditions are often closely related, the Acting D-G said there was a link between mental health and substance abuse as in most cases one may cause the other, or they may occur at the same time.

“NAFDAC is very focused on combating this scourge of drug abuse. We also appeal to all Nigerians to join us in this fight and realize that this issue is a common and joint responsibility as NAFDAC cannot do it alone.”

She listed some of the challenges faced by the agency in its regulatory activities including; lack of affordable rehabilitation centres, stigmatisation, lack of coordination and integration, limited advocacy for access to substance misuse services, competing priorities and a shortage of providers and resource limitations.

Abolish criminalisation of suicide —FADIPE

A  mental health physician at the Lagos University Teaching Hospital, LUTH, Dr Babatunde Fadipe, in his presentation titled  “Suicide, Medical Challenge, Not Crime”,  said up to 90 per cent of persons who die from suicide have some form of mental disorder at the time of death even as he called for the abolishment of laws criminalising suicide in Nigeria.

According to Fadipe,  there was an absolute increase of 75 per cent in deaths from suicide between 1990 and 2017 in Nigeria.

Querying if suicidal behaviour was a medical challenge, he explained that though not specifically listed as a separate medical condition in classificatory systems, however, they are symptoms of psychiatric conditions such as depression.

“Every adult is assumed to have capacity until proven otherwise. The link between psychiatric disorders and suicide is well established because up to 90 per cent of persons who die from suicide have some form of mental disorder at the time of death. Among those with psychiatric disorders, 40 per cent are at risk. Among those with depression about up to 10 per cent will take their own lives. “

While lamenting the lack of political will to guarantee access to treatment for the population at risk, he decried the lack of enabling mental health laws and suicide labelled as a crime in Nigeria.

He said Section 327 of the Criminal Code: states that:  “Any person who attempts to kill himself is guilty of a misdemeanour, and is liable to imprisonment for one year”  and  Section 231 of the Penal code:  “Whoever attempts to commit suicide and does any act towards the commission of such offence, shall be punished with imprisonment for a term which may extend to one year or with fine or with both”.

“Attempted suicide is criminalised in Nigeria, yet the rate of suicide (2019) is approx 6.9 per 100,000.  A lot of cases are unreported.  There is a need for improved political will, creating enabling mental health laws, National policy on suicide prevention, improving funding to health (mental health), and establishing proper surveillance systems to aid data collection (e.g. registration of deaths) and research.”

To successfully achieve these, he said barriers such as laws criminalising suicide should be abolished.

Stigma major challenge to mental health treatment — TADE

The Deputy Director, of Medical Services at LUTH, Ms Titilayo Tade, in her presentation: “Coping with Mental Health Stigma-The LUTH Experience (The SURPIN STORY)”, identified stigma as a major challenge in access to treatment.

Tade also disclosed that between January and September 2022, SURPIN hotlines received 163 Calls and 44.8 per cent of the callers received counselling support, and 19.6 per cent were referred for follow-up services across 30 states in Nigeria.

She explained that to improve access to treatment, care and support, the SURPIN Hotline was created to provide information, anonymous counselling, and referrals.

Describing social stigma as hurtful attitudes and behaviours of society towards people with mental illness, she also stated that there is also another type of stigma -Self-stigma – the stigma that is felt by a person who has a mental illness- (A sense of shame).

Tade traced the causes of stigma to fear, ignorance, intolerance, denial, misinformation,  and contributing social factors such as misrepresentation in the media, culture, and religion among others

 She said to reduce mental health stigma, LUTH’s primary mandate is to provide treatment and care to patients and education of Healthcare practitioners.

Children can develop mental health conditions as adults — OGUN

 The immediate past Medical Director of the Federal Neuro-psychiatric Hospital Yaba, Dr Oluwayemi Ogun said that children can develop the same mental health conditions as adults, but their symptoms may be different.

She hinted that 50 per cent of mental health problems become established by age 14 and 75 per cent by age 24, “yet 70 per cent of children and adolescents who experience mental health problems have not had appropriate interventions at a sufficiently early age.”

She disclosed that some of the early warning signs include persistent sadness that lasts two weeks or more, withdrawing from or avoiding social interactions, hurting oneself or talking about hurting oneself, and talking about death or suicide.

“The situation can degenerate to changes in eating habits, loss of weight, difficulty sleeping, frequent headaches or stomachaches, difficulty concentrating, changes in academic performance, avoiding or missing school among others.”

Ogun said that parents can help a child cope with mental illness through psycho-education, learning about the illness, and enrol in parent training programmes, particularly those designed for parents of children with a mental illness.

“Parents should explore stress management techniques to help them respond calmly to the child’s situation. Seek ways to relax and have fun with your child. Praise your child’s strengths and abilities. Work with your child’s school to secure the necessary support.”

Holistic approach way forward — Prof Francis Aina

Delivering the sub-theme entitled: “Growing problem of Drug Substance Abuse: The NDLEA Experience”, Brig. Gen. Mohammed Buba  Marwa (Rtd), Chairman/CEO, of NDLEA, blamed rampant substance abuse in Nigeria on easy access to pharmaceutical opioids, the emergence of new ones and unrestrained alcohol consumption.

Represented by the Zonal  Commander, NDLEA Lagos, Dr. Segun Oke, Marwa said the easiest way to wean a populace off illicit substances was to effectively cut off the supply chain by targeting the masterminds of drug syndicates.

He said the new Pharmacy Council of Nigeria ACT will help them to plug holes in the distribution of pharmaceutical drugs, adding that the new regulatory law will put drugs out of reach of citizens, and help curtail the incidence of abuse and dependence.

He disclosed that following their Offensive Action, in 22 months, NDLEA arrested 20,000 offenders and convicted 3111.

“We have seized 5.5 million kg of illicit drugs, destroyed 900 hectares of cannabis farms and dismantled two illicit methamphetamine laboratories. Next year will be tougher because the amended NDLEA Act will pave way for convicted traffickers to spend long years in jail without the option of a fine.”

He pleaded for seamless access to treatment for existing users as they have created a new order where treatment is available, accessible and affordable to those who are suffering from drug use disorder.

“It is to this end that we established the 24/7 toll-free drug abuse call centre where mental health specialists are but a phone call away, and callers can start teletherapy. The call centre provides safety from stigma and therefore no one has an excuse not to seek treatment.

We made the service easy in the local languages of Hausa, Igbo and Yoruba in addition to English and pidgin. The teletherapy service is in addition to the ones offered in the 26 NDLEA treatment facilities where people who walk in are attended to promptly.  The Agency has counselled and rehabilitated 14, 000 persons in 22 months.”

He said another enabling factor of drug abuse in the Nigerian context is the continuing emergence of New Psychoactive Substances (NPS).

 These substances of abuse, whether in a pure form or a preparation, are not captured by any of the drug conventions, but, they, nevertheless, pose a threat to public health.

Some of them are known for a long time, and others emerged recently. But they are as dangerous as controlled substances and are capable of causing psychosis or the potential development of dependence.

He said the chaotic retailing of drugs creates easy access to prescription-only drugs including benzodiazepines, Rohypnol and Pentazocine.

 We have charlatans who have no business dispensing pharmaceutical drugs, selling by the roadside and operating patent medicine stores. Some even hawk pharmaceutical drugs on the street.

In the evening, people go out to the street and say to roadside hawkers of pharmaceutical drugs: “Give me something for headache and body pain.” Some of them are given a mixture of psychotropic drugs that could be lethal or leads to overdose which in turn precipitate dependence. This is the dynamic behind the addiction to higher doses of tramadol.

Vanguard advocating change through summit series — ADEFAYE

Earlier, welcoming guests to the event, Vanguard’s General Manager/Editor-in-Chief, Mr Gbenga Adefaye, said with the second edition of the summit, Vanguard was taking the discussion to the next level.

According to Adefaye, through the mental health summit series, Vanguard has given a new orientation and purpose to the discourse, by educating and informing the general public to make informed decisions and commentaries on one hand, and strengthening the hope and expectations of those directly affected on the other.

“Our determination is that things must change and change for the better. We are proud advocates of that change through the Vanguard mental health summit series.

Last year when the summit series was launched, it was in the middle of the COVID-19 pandemic, which although was a challenge, also served as an opportunity. It served as a window for us to integrate the mental health agenda into pandemic response and recovery plans.

“We know that in creating better understanding, we are helping to open up the hidden opportunities with which to respond to the nation’s crucial need for sustainable mental health support and services.

Quoting the World Health Organisation, WHO, that ultimately, there is no health without mental health, he noted that Vanguard was not unaware of the importance of a resilient health system which is required to meet the mental and physical health needs of the population.

“By agitating for a sound mental health system, Vanguard is indirectly advocating for a resilient health system. This is just our own way of giving back to society, our own way of supporting the system for the benefit of all.

“Our vision for Nigeria is an effective and comprehensive mental health system that is affordable, accessible, and provides at least the minimum required services and psychosocial support for every Nigerian.”