26 January 2013

Nigeria: Country Faces Dearth of Psychiatrists

The lack of human resources in the health sector, especially in psychology and mental health treatment is becoming alarming, even as more Nigerians are showing signs of mental disorder. Available statistics show that the work force is grossly inadequate and needs a serious rescue operation.

Psychiatry, a major section of health, is said to be relegated to the background, not only in the lack of facilities but also in the lack of professionals who should care for patients with mental illness.

On several levels, health experts say, there are talks about malaria, meningitis, HIV/AIDS and efforts to get rid of them, but not so much talk if at all there is any, in the case of mental illness. It is an illness, for many, that comes with shame and stigmatisation. Could one say this has also spread to the availability of professionals in this field?

Beginning with the availability of such professionals in West Africa, Nigeria has the most qualified professionals in the field. But even with the number of psychiatrists in practice, there are only 150 nationwide; less than one per million people in the country, an insider told Weekly Trust, adding that there is also less than one nurse to 25,000 patients.

Recently, the Medical Director of the Federal Neuro-Psychiatric Hospitals in Kaduna Taiwo Lateef Sheikh told members of the Nigeria Medical and Health Workers Union when they visited him that the hospital in Kaduna was meant to serve eight northern states including Abuja.

A 2012 report by the Mental Health Leadership and Advocacy Program (mhLAP), states that the majority of mental health services is provided by 10 regional psychiatric centres and departments. "The private health care sector plays a limited role in provision of mental health services, though many people with mental illness turn to spiritual or traditional healers for help. The specialists such as psychiatric nurses, social workers, occupational therapists and all those who form members of mental health teams are very few in numbers, grossly inadequate."

"Mental health care in developing countries: the example of Nigeria," a 2004 document, quoted by the mhLAP informs that, the availability of mental health resources in most developing countries is poor due to scarcity of resources, competing health problems and the low priority given to mental health issues. "In Nigeria, modern psychiatric care is developing, but as yet most people have no access to it, because they cannot afford the treatment. Moreover, treatment facilities are mainly concentrated in large urban centres."

A 2006 World Health Organisation (WHO) report on Nigeria's mental health system states that child and adolescent psychiatry is an under-developed specialty in Nigeria, relegated by more entrenched cultural systems, such as traditional healers and syncretic churches, to merely an auxiliary role in child mental health care. "Little is, therefore, known about the epidemiology of childhood disorders as encountered in psychiatric settings. Child and adolescent mental health services are available in four psychiatric facilities. However, no facility has in-patient service appropriate for children and adolescents."

According to the report, there are twenty-two beds in mental health facilities for persons with mental disorders in forensic in-patient units and eighty-five in six other residential facilities such as homes for persons with mental retardation, detoxification in-patient facilities, homes for the destitute, etc. In forensic in-patient units no patient spends less than one year.

Recently, the Federal government reviewed the 1999 mental health policy responsible for regulating the practice and management of mental health in Nigeria. The review is expected to enhance the provision of access and appropriate care for people who have mental disorders in Nigeria and also make adequate provisions for its implementation in the national health budget.

Dr. Emeka Nwefoh, Consultant Psychiatrist and Mental Health Advisor for CBM International in Nigeria with ten years experience in the field, told Weekly Trust that "the practice of psychiatry has improved remarkably since 1954 with the arrival of the first Nigerian psychiatrist, Professor Thomas Adeoye Lambo."

Although in Nigeria, the practice has moved from the custodial care to good hospital-based care, Nwefoh said, "this is not where the world is, at present. Most countries now practice community-based mental health while in Nigeria we are still struggling with hospital-based practices."

In evaluating the availability of these professionals in Nigeria, Dr. Nwefoh said professionals are grossly inadequate and can never be adequate even in the next one hundred years. "Another problem is that even the trained professionals are not appropriately placed and many of them emigrate to Europe and America."

He explained that the reason for the low number of psychiatrists is the lack of interest by qualified medical doctors to specialise in the field of Psychiatry. "This is not unconnected with the stigma attached to the disease and the perception of the public about the causation and treatability of the condition. Many of the trained psychiatrists emigrate to Europe and America for better working conditions."

Although there are psychiatric trained nurses in hospitals, many of them are employed as and work as general duty nurses because there are no opportunities for them to practice it Nwefoh said. "The facilities are very few and it is not a priority of the government."

Sighting the challenges of mental health in Nigeria, the psychiatrist said, "Political will to address mental health is low; mental health facilities are centralised in cities and large institutions. This makes it difficult to integrate it into primary health centres. Also, mental health leadership often lacks public health skill and experience.

"To improve on this there has to be strong advocacy skills with the inclusion of persons with mental illness, decentralisation of services, proper integration of mental health into the primary health centers and public health training for mental health leaders," Nwefoh said.

Mr. Pius Akuchi, a psychologist at the Federal Medical Centre, Makurdi told Weekly Trust that most psychologists in Nigerian hospitals are leaving the jobs because of what they term inadequate incentives.

Meaning, what they earn is not commensurate with the efforts, hazards or time they put in the job.

"In Nigerian hospitals, those considered the 'front-line' health workers earn much-more than we do. Though, I don't want to state categorically which group does the most tedious work.

"All I know is that the time we spend with these mentally ill persons, the job hazard on your psyche and even the social implication is not a joke.

The so-called 'front-line health workers; doctors, pharmacists, nurses, etc often feel they do more than we do but in reality it is not. So this frustration has driven a lot of our professional colleagues who have left most Nigerian hospitals. Imagine, we stay with these mentally ill people for hours, days, relate with them amongst other activities but the reward is not just encouraging."

He said most psychologists have been pushed to regular organisations. Most top class organisations are in search of psychologists to work in Personnel/Human Resources Units. They pay much, much better and you have potentials of growing a huge career and even becoming the boss in such organisations. So why stay in the hospital environment where you don't get an encouraging salary package and you relate with mentally ill people. What is the advantage?" He asked.

"Another major factor that discourages people taking this job is the social stigma. We have had experiences where, people just tag you with some sort of names simply because you work in a hospital where you relate with the mentally ill.

For example, if you are doing something with people in a community and suddenly, a mistake takes place or you exhibit some kind of behaviours which ordinarily if somebody exhibits won't be an issue, but because it is you that works or relate with mentally ill people, they would say, 'You have started behaving like your patients' this is a major problem. We are stigmatised. However, our colleagues in organisations are regarded corporate people, highly respected because they advise top executives, the deliver motivational speeches and spur workers to perform amongst others."

He however debunked such beliefs, saying there is nothing like that. This stigma is just the African mentality and imaginations.

"Mental illness is not infectious. It neither comes environmentally or organically (hereditary)"

In fact, in our case as professionals, we always know the boundary line; we try to detach our patients' condition from what we do. In fact it even makes us more careful, so there is nothing like that."

He further said the situation has affected some of his friends in the medical line. Those that are thinking of specialising in the field of psychology have changed their minds presently due to what is happening.

With the positive policy environment and new progressive programmes providing more opportunities now, it is hoped that there will be more reasons to attract professionals into the field, so that they can have rewarding careers caring for one of Nigeria's most vulnerable set of people.

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