Nigerian Youth Suicides - A Call for Holistic Reforms

Photographer Tsoku Maela, who suffers from manic depression and anxiety, has visually interpreted the different stages of depression in a photo series called “Abstract Peaces”.

In May, Sahara Reporters in an article told the tragic story of a promising 400 level University of Nigeria Nsukka (UNN) student Chukwuemeka Akachi, who had taken his own life after leaving a suicide note on a social media channel. A budding poet, his social media posts appeared to indicate that he had been facing mental health challenges and while grateful for the support of friends, it seemed he was still struggling.

This tragic loss of a student with such great potential reignited public debate about what appears to be a number of recent similar sad incidents involving young Nigerian students.

The fervent conversation around the incidents brought to attention what seemed to be a recurrent feature – the apparent links to the relatively new insecticide in the Nigerian market, Sniper.

According to the World Health Organization (WHO), a substantial proportion of global suicides are estimated to be due to intentional self-poisoning with pesticides. Worldwide, an estimated three million cases of pesticide poisoning occur every year, resulting in an excess of 250,000 deaths. Although a powerful insecticide and pesticide, Sniper is readily accessible in corner shops and supermarkets across Nigeria and is available in many households.

Nigeria’s National Agency for Food and Drug Administration and Control (NAFDAC), a few days ago, announced that they would direct a change in the packaging of Sniper. Christiana Adeyeye, the Director General of NAFDAC, said that Sniper containers “could now be made very difficult to open, or may be turned into a spray rather than the liquid contents it is known for.” The announcement came after considerable commentary about the fact that these students and others seemed to have such easy access to such a powerful poisonous chemical. The question about whether Sniper and other poisonous chemicals should be banned is a growing conversation, and several health professionals and advocates weighed in on the question of whether NAFDAC’s announcement was an effective and sufficient policy response to the issue.

 

Reducing access to pesticides or an outright ban?

Abuja-based Public Health Advocate Dr. Bright Otis said NAFDAC’s announcement to make Sniper more difficult to open “will have very little effect on suicide rates amongst students. A suicidal person will always find ways to attempt it; if it’s not sniper something else will show up that’s cheap and easily accessible.” Dr. Ronald Ikpe, Physician & Public Health Advocate in Lagos, agrees that making the bottle difficult to open is not, for him, a solution. Instead, he suggests, “They should make it difficult to buy. It should not even be sold in everyday shops and pharmacies. It is a pesticide and an organophosphate at that, it should be used for what it was intended for. Only those licensed to use it can have access to it and at designated places.”

A WHO study found that restricting access to the means for suicide is effective in preventing suicide – particularly impulsive suicide. In the light of the discussions around NAFDAC’s responsibility, the Twitter hashtag #NAFDACIsNotBanningSniper began to trend on social media by those who say banning Sniper is not what the Agency should be doing.

Beyond Sniper: The heart of the problem
There is very strong evidence that a ban on pesticides is an effective part of a suicide prevention strategy. After Sri Lanka passed bans on lethal varieties of pesticide, suicides fell by half; similarly restricting access and an eventual ban on a particular pesticide led to a reduction in suicides. Therefore, there is a clear case based on evidence for this to be part of a national approach to suicide prevention.

Yet, the restriction or ban alone is not enough, as hinted at in reports that Akachi had been struggling with mental health challenges, exposing again, the dearth of options for young people in Nigeria who may be dealing with difficult situations in their lives or experiencing challenges to their mental health and wellbeing.

Students are often left to deal with academic pressures alone. Photo credit: Nigeria Health Watch

Dr. Otis pointed out that students are often left to deal with academic pressures alone. “Trigger factors for depression amongst students is usually school or home… for example, a student fails an exam and just can’t handle it; there’s no functional system in place to give psychological support to students that are doing bad academically. They are just left to “deal with it, improve or fail out.” There’s constant pressure to perform or keep performing,” he said.

What if teachers, lecturers and school leadership employed a little bit of empathy when dealing with such students? Imagine a system where behavioral therapists and motivational speakers had regular sessions with students in small groups. The morale booster alone will go far. Imagine a regular dose of targeted motivation and cognitive behavioral therapy… just imagine the effect on students. The only permanent solution to suicide rates is not banning dangerous substances but initiating targeted intentional mental health programs in schools, workplaces, social groups.”

Dr Oritseweyinmi Erikowa-Orighoye, who practices in the United Kingdom, agrees that accessible mental health services and support in educational institutions are critical. “It could be a one-stop place, a wellbeing cafe or support groups,” she said, adding that ensuring more people train to be mental health workers to reduce the burden on psychiatrists, addressing the barriers that prevent psychotherapists and psychologists from practicing efficiently in Nigeria, and parental and community level mental health education are viable options.

The above suggestion by Dr. Ikpeme Neto, founder WellaHealth, that the mental health advocacy organisation Mentally Aware Nigeria Initiative’s (MANI) number be put on the bottle of Sniper so that potential suicide victims have a way to reach out, resonated with Dr. Ikpe.

I think MANI’s number on the bottle is a good move. Can we have more suicide prevention hotlines and places to seek help? Then I would like them to ramp up activities around mental health in Nigeria as a whole. MANI is doing great, but they need their activities to be scaled up to schools, offices, homes. We should train more mental health professionals to help with counseling and therapy,” he said.

For Lagos based Mental Health Advocate Rasheedat Olarinoye, opening up the conversation about suicide early to increase knowledge and awareness is critical, and she feels the success of the malaria prevention strategy should be emulated. “A lot of time, the pesticide comes in at the last stage,” she said. “What we should be focusing on is finding solutions from the early stages to prevent the cases from getting to that stage. For example, with malaria, mosquito nets and education of how to not breed mosquitoes were pushed out more.So, the focus was more on ‘Don’t get malaria!’ And then when people do, there was more awareness on how to treat it – go to the hospital, get on antibiotics. I think if we used a similar approach to suicide, it will help. We need to normalize these conversations.”

The case for a ban is strengthened by this article co-authored by a leading expert in mental health epidemiology, Professor David Gunnell of Bristol University which pointed out that  “a large proportion of these pesticide self-poisonings (in developing countries) are acts of self-harm with low suicidal intent. But because of their high toxicity (some products have a case fatality of over 50%), many suicide attempts using pesticides are fatal. In contrast, in the West, where medicines are frequently taken in overdoses, the risk of dying is much lower.” The article also highlights a point that has not featured much in the debate in Nigeria –  the potential conflict of interests of pesticide manufacturers who have a vested interest in ensuring a ban is not put in place. Given previous examples where the tobacco industry and the pharmaceutical industry quietly funded organizations and individuals that appeared to be ordinary, independent not-for-profits, to advance their commercial interests, it should be a possibility that the Nigerian media and public should remain vigilant on. Contributors to the debate should be transparent about any funding they have received from organisations and should be challenged on this.

 

Key risk factors for suicide aligned with relevant interventions – WHO (2014).

MANI Lead Victor Ugo tweeted aptly that suicide is not always a result of mental health issues, and that the risk factors for suicide prevention go beyond tackling isolated mental health issues, but requires a comprehensive suicide prevention strategy at the national level, one that requires an important interplay between the individual, relationships, the community, society, and the health system.

The debates about whether NAFDAC should ban Sniper or not have also revealed a need for expanding the understanding of the importance of evidence-based policy in Nigeria. In formulating policies, as far as possible, it should be based on the best available evidence. If something has been shown over and over again, in research and practice, in other countries, would it not be a good starting point, while trying to address other wider issues?

As the conversation on how best to address the loss to Nigeria of these young lives, our country’s future talent, it is important that we take into account elements that have worked while looking at the gaps in mental health support and other wider factors that should be core parts of a national suicide prevention strategy.

We should also be having broader conversations about why our society is struggling to create an enabling environment for individuals to thrive. We should put into action initiatives that ensure that we all can receive care, both from professionals but also from programmes like Mental Health First Aid which helps highlight some of the simple things that we as non-professionals can do for each other, to provide social, emotional, and psychological support when we have trouble thriving – as we all do from time to time – and need that care the most.

Is it important for Nigeria to have a suicide prevention strategy? What are the things that, in your experience can prevent our young people from achieving mental and emotional wellbeing? Do you know any individuals or organizations doing good work in this area? How can we help our young people achieve fuller, richer, happier lives? We would love to hear from you- share with us in the comments below.

If you are in need of mental health support, please contact Mentally Aware Nigeria Initiative on 0809111MANI

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