27 October 2009
Florence Udoh — The issues militating against mental health care has always been availability and access. Most mental health care institutions and units are located in urban areas, whereas, most of the people who have mental disorders are located in rural areas.
According to Dr. Olufemi Olugbile, Chief Medical Director, Lagos State University Teaching Hospital (LASUTH); "It has been estimated that at least, about 90 per cent of people with clear-cut mental health syndromes do not even get any treatment at all in Nigeria. That is an atrocious figure and everybody knows the issue. The specialists, such as psychiatrist nurses, social welfare officers, occupational therapists and all those who form members of the mental health team, are very few in numbers, grossly inadequate. Numbers of hospital units available for the treatment of mental disorders is also very low. But these are not the only problems, even if the numbers were massively increased, most of those numbers would still reside in urban areas. So, there is still a disconnection between the locations of patients who have mental problems and the location of the services for the treatment of mental disorders.
What we are trying to do, which is the right way to tackle the problem, is to take mental health care services to the grassroots."
"Mental healthcare is supposed to be one of the elements of primary healthcare in Nigeria but that is only seen on papers. Most of the people at the level of the primary health care do not know much about mental health, do not have interest in it and do not have facilities, including simple drugs for treating mental illness. We believe that if we reverse all these three things, giving them knowledge, facilities and supervision, mental healthcare would reach its optimal goal. Right now, there are more people outside the net than inside the net. The problem is not all about non-availability of specialists but the way, services are organized currently do not make for appropriate coverage. Of course, when people do not have access to the so-called mental healthcare services, what are they supposed to do? They patronize people closer to them the traditional healers.
What Lagos State has done is that, it has set up a body, to coordinate the traditional healthcare and also to help standardize it, so that they would be doing some kind of certification, inspecting what people are doing, checking both their environments and the details of their practice," he said.
On the improvement of the treatment of mental illness in Nigeria, Dr. Olugbile said that part of the efforts being made by the association of Psychiatrists in Nigeria is doing vigorous advocacy, some conceptual thinking to help influence policy in order to take mental health care to the grassroots and also to involve the General Practitioners in the care of the mentally-ill.
According to the consultant psychiatrist, "In the United Kingdom and other nations of the world, mentally-ill people are actually not treated by mental health specialists but by General health Practitioners. Most illnesses are of such an order that they can actually be substantially treated and relieved by lower level of care, non specialized care, such as what is available in primary health care centres and in general practices.
"We are missing that and everybody wants all the mentally-ill people to go to the specialists. First of all, there would never be enough specialists for that. It is not feasible and the location for the specialists would be such that it would cost much inconvenience logistically and financially for everybody to be crowding and it is not necessary. We should encourage those at the rural levels of care to see as many as they can so that specialists would attend to difficult cases. Those are the kinds of re-orientations, paradigm shift, that we are seeking to sell, both to the government and the society at large, working at campaign to distigmatise mental illness. Getting people to understand that there is a wide variety in mental illness with different implications. We are getting people to understand that society has to invest resources in the care of the mentally-ill," he said.
Continuing, Olugbile who is the Chairman of the African International Division of the Royal College of Psychiatrists also avers that lack of proper care of the mentally-ill is costing us as a nation. "Most illnesses that people have are as a result of minor disorders like anxiety and depression when people carry them about, managing their jobs, it reduces their productivity sub-optimally and when we quantify the loss in naira terms, it is the most painful thing, wrong decision making that we suffer as a nation."
The Nigerian government, according to Dr. Olugbile, has to buy into this argument. They have to understand the nature of this problem, the size of it and know that it is cheaper to treat illness than to pay the cost of not treating illness.
"We are already paying the cost of not treating illness in Nigeria. People have sat down and they have reasoned that part of the reason why we are under-performing as a nation is that we have a lot of unrecognized and untreated mental disorders, especially of the so called minor categories., anxiety and depressions. So if it is already costing us, whatever money we spend treating mental disorders, is certainly going to be cheaper than that thing mental illness is costing us, even if the cost is invisible. Though there are already some visible costs (people paying some high medical bills), but the invisible costs are greater. If we have found an objective way of quantifying them, then we would realize that it is cheaper to deploy resources for treating mental illness and to activate the primary health centres. It is not just donating money, but the government must understand this argument."
The Association of Psychiatrists in Nigeria, which is now at the forefront in this advocacy for a re-orientation in mental services, have also called for the creation of the Directorate of Mental Services at the highest level of government to keep mental health at a visible level when decisions are being made. "Currently, virtually all the money expended by the Federal government for mental health is what is being used to run the eight psychiatric hospitals that the Federal government has. That means there is no money for programmes, such as, initiative and public education, to make people start rolling back, the scourge of debilitating mental disorder in our nation. There must be equal attention, even more attention, paid to advocacy and programmes meant to change the pattern and to reverse this statistics, about 90% of people who lack access to mental care. That is real fundmental thinking, the paradigm shift that the government has to make," he said.
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