60 million mental cases
According to the Federal Ministry of Health, 30 per cent of Nigerians suffer from mental illness.
The Permanent Secretary of the ministry, Abdulaziz Abdullahi, says with a population of about 200 million, Nigeria has a high rate of mental illness. This implies that Nigeria has about 60 million persons with mental illnesses.
Nigeria, in essence, has more mental cases than the population of every West African country.
The figure also implies that were all the mentally-ill people in Nigeria confined to a definite territory and classified a distinct country of their own, they would be more populous than Spain, 46 million; Canada, 36 million; Morocco, 35 million; Ghana, 28 million; Australia, 24 million; and The Netherlands, 17 million.
According to Abdullahi, the mental disorders are characterised by a combination of abnormal thoughts, perceptions, emotions, behaviour and relationships with others.
“Mental disorders include depression, bipolar affective disorder, schizophrenia and other psychoses, dementia, intellectual disabilities and developmental disorders including autism,” Abdullahi said.
Also, the Director of Public Health, Dr Evelyn Ngige, said mental illness could destabilise a person more than HIV, heart disease, accidents, and wars combined.
Ngige noted that Nigeria’s mental health statistics was too bad, adding that the high rate of suicide in places like Lagos might just be a tip of the iceberg.
She linked the recent spike in suicide to the worsening state of the economy even as the National Bureau of Statistics noted that over 20 million Nigerians were unemployed.
In 2017, the World Health Organisation said 7,079,815 Nigerians suffered from one of the most ignored and misunderstood forms of mental disorder in the country — depression.
The figure, according to the world health body, was 3.9 per cent of the country’s population, thereby making Nigeria the most depressed country in Africa.
250 psychiatrists in Nigeria
Despite having the largest number of mental cases in Africa, Nigeria has one of the lowest numbers of psychiatrists in the world.
The President of the Association of Psychiatrists of Nigeria, Dr. Taiwo Sheikh, told SUNDAY PUNCH that three out of every five Nigerian psychiatrists left the country after their education for greener pastures.
He said Nigeria had only about 250 psychiatrists providing mental health care.
Sheikh stated, “The important thing is that we are training psychiatrists, both at the West African College of Physicians and the National Postgraduate Medical College, but three out of every five psychiatrists we produce leave the country for greener pastures. One major thing that is eating the field of mental health is brain drain.
“People even use training in psychiatry to get visas to move out of the country. They know, once they have this certification, they can easily move to Canada, Australia or the United Kingdom.
“The UK has even lessened its once stringent conditions to recruit psychiatrists now, indicating that more Nigerians are likely to move to the UK. Today, based on what we have on our own platform, we have about 250 psychiatrists, plus/minus 10 or 20.
“We are still working on our directory, but based on what we are seeing every day, it should be an average of 250 psychiatrists. But you should also know that we have psychiatrists in training.”
The APN president stated that there were also resident doctors training to become consultant psychiatrists at various stages. He added, “We also have medical officers who are working in areas of psychiatry; they are not psychiatrists, but they have the skill to deliver some mental health intervention. We have a ratio of close to one (psychiatrist) to one million Nigerians, which is far from what we expect.”
Archaic laws on mental health
Experts opine that the Lunacy Act of 1958, which has been in operation for over 60 years, is not only outdated but also does not take into cognisance the rights of persons suspected to have mental illnesses.
It is also believed to be at variance with the recommendations of the WHO which prescribes modern approaches in battling mental disorders.
Experts say the legislation makes provisions for the detention of mentally unstable persons by medical practitioners and the courts in designated hospitals. It is, however, blank on salient issues of consent to treatment, appeal against detention and grossly inadequate on important issues on the management of the affairs and property of a person believed to be mentally unstable.
A former Chief Judge of Lagos State, Justice Oluwafunmilayo Atilade, emphasised the need for an urgent and comprehensive review of the Lunacy Act of 1958 to make it current with global standards.
She said, “Currently, the Lunacy Act of 1958 requires a comprehensive makeover, not simply to get rid of the cobwebs or shed the toga of an antiquated legislation but to truly address what is a most serious issue underlying most dysfunctional behaviour in our society, which, due to our misunderstanding, receive the wrong or poor attention.”
A research published on Omni International indicates that the Act confined the mentally ill people in non-therapeutic, overcrowded, unsanitary, and dilapidated facilities.
A bill was introduced to the National Assembly in 2003, but was not passed into law. In 2013, it was re-introduced but was not signed into law.
On his part, the Campaign Director and Communication Officer of Mentally Aware Nigeria Initiative, Jolaade Phillips, stated that promulgation of a new law would promote and strengthen mental health in the country.
He said the rate of stigmatisation and discrimination against mentally infirm would reduce and ultimately improve the nation’s state of affairs if the bill was enacted.
Phillips pointed out that many hospitals in Nigeria had no focus on mental health.
“As a country, we should have a mental health Act if we want to improve the status quo. People should have more access to mental health treatment at a more affordable rate,” he added.
Some states have, however, been able to introduce legal frameworks to make up for the inadequacies in the Lunacy Act.
Attempting suicide is a criminal offence in Nigeria, under Section 327 of the Criminal Code Act, and carries a penalty of up to one year in prison. A holdover from when Nigeria was a British colony, the law was abolished in Britain under the Suicide Act of 1961, which happened after Nigeria gained independence in 1960.
Poor funding and lack of facilities
The Federal Government owns eight hospitals dedicated to psychiatry across the 36 states. They include the Federal Psychiatric Hospital, Enugu; Federal Psychiatric Hospital, Kaduna; Federal Psychiatric Hospital, Calabar; Federal Psychiatric Hospital, Maiduguri; and the Federal Psychiatric Hospital, Benin City.
Others are the Federal Neuro-Psychiatric Hospital, Kware-Sokoto; Federal Neuro-Psychiatric Hospital, Yaba; and the Federal Neuro-Psychiatric Hospital, Aro, Abeokuta.
There are less than 10 state-owned psychiatric hospitals. Although the total amount budgeted for health in the 2019 proposal was N365.7bn, the amount dedicated to the eight psychiatric hospitals stood at N16.2bn which is less than five per cent of the federal health budget.
However, it was learnt that most of the funds budgeted for were hardly released.
For instance, according to the 2017 capital release document released by the Office of the Accountant General of the Federation and obtained by the ICIR, the Federal Neuro-Psychiatric Hospital, Kware, Sokoto, earmarked N89.8m for capital projects but only N44.8m was released.
The Assistant Registrar, Counselling, at the University of Lagos, Mrs. Aderonke Asiwaju, who noted UNILAG had mental health facilities in place, said schools should make counselling centres functional to curb the increase in suicide cases in the country.
Asiwaju stated, “Schools need to employ an adequate number of counsellors and ensure that counselling centres are fully functional. There are three support centres for students which are held in high esteem – medical, sports and counselling centres. Unfortunately, many universities are more interested in sports centres and play down the role of counselling centres.”
The Director-General of the National Agency for Food and Drug Administration and Control, Prof. Moji Adeyeye, said there was a need for parents and religious institutions to do more in discouraging youths from abusing drugs especially controlled substances.
She also called for the creation of more rehabilitation centres to cater for drug addicts.
“We don’t have enough rehabilitation centres for our youths and people addicted to drugs. Right now, we have only 10 centres in the country. We need like 10 centres in each geo-graphical zone. We need to provide more rehabilitation centres.”
The Spokesperson for the National Orientation Agency, Paul Ogenyi, however, blamed the incessant suicide cases on the disintegration of societal values including an increase in mental cases.
He said the NOA, charged with the duty of promoting patriotism, national unity, and development of Nigerian society, was already collaborating with schools and religious centres in the fight against suicide since most suicide cases were recorded among youths.
Ogenyi said in the past, people remained positive even when faced with financial crisis but the new culture of making money through any means and the glorification of money over values had made people to see money as a life or death matter.
The NOA spokesman said, “Societal values have disintegrated and parents have failed. Also, institutions in charge of moulding the minds have also failed.
We have been monitoring these cases and we are trying to see if we can introduce programmes at the level of secondary and university schools; programmes that will promote hard work and patience.”
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