Introduction
About three weeks ago, I saw a really good-looking young man. From where I sat in the moving bus, he looked well and happy. He was walking down the road like someone who needed to be somewhere and the briefcase he was carrying looked cool. With just one look at him, you may not tell that there was something off about him. But my curiosity, or is it lust, did not allow me to take off my eyes.
So I looked till I noticed he was talking to an invisible person and laughing. The woman sitting beside me followed my gaze and then exclaimed, “Eya, and the young man fine o. Who do am this thing? A man sitting next to the driver in front quickly interjected: “this one madness fresh; I never see am for this road before”.
You don’t know how deep my heart sank. How could a fine man like this be mentally unstable? What could he have done that backfired? Those are questions I did not ask out loud. What was worse than the questions in my head were the statements made by the passengers. Their words struck me in all the wrong places and it brought to mind different things.
Firstly, their concern for the young man was only a fleeting thought. It was not deeper than the statements they had made. As soon as we drove past, they moved on to other things. Their attitude is very typical; one ever makes an effort to report cases like this.
Secondly, I wondered what provisions they were to help people like him even if people make efforts to take them in.
Thirdly, I cringed at the usual assumption made by most Nigerians that mental illnesses are spiritual and should, therefore, be attended to by spiritual means.
What is a mental illness?
Mental illness, also called mental health disorders, refers to a wide range of mental health conditions – disorders that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors.
Many people have mental health concerns from time to time. But a mental health concern becomes a mental illness when ongoing signs and symptoms cause frequent stress and affect your ability to function.
Mental illness can make you miserable and can cause problems in your daily life, such as at school or work or in relationships. In most cases, symptoms can be managed with a combination of medications and psychotherapy. And in some countries, there are established policies that prevent inefficiencies and cater for cases.
What is mental health policy?
Mental health policy is an official statement by a government or health authority that provides the overall direction for mental health by defining a vision, a set of values, principles, and objectives, and by establishing a broad model for action to achieve that vision.
According to a World Health Organization (WHO) document, mental health policy in context defines the vision for the future of the people’s mental health and specifies the framework that will be put in place to manage and prevent mental and neurological disorders.
When clearly conceptualized, mental health policy can coordinate essential services and activities to ensure that care is delivered to those in need, while at the same time preventing inefficiencies in the health system.
The mental illness burden
The WHO estimates that about twenty percent of Nigerians suffer mental illnesses with mental disorders accounting for 13 percent of the global burden of disease. They have gone ahead to task governments on the need to increase its investment in mental health, pass the Mental Health Bill and have a health policy on mental health. But has Nigeria done this? With so many health burdens, a great percentage being mental, our nation still operates by the ordinance of the pre-colonial years.
It is disturbing that our National Health Insurance Scheme has not made a generous accommodation for the care of the mentally ill. At the state level, one would expect the government to have made some efforts. They have not done fairly well either in developing sound policies for mental health, despite the fact that they deal with the real burden of mental health directly.
It might interest you to know that the WHO endorsed mental health as a universal human right and a fundamental goal for the health care systems of all countries (WHO, 2005). Unfortunately, mental health systems in many low and middle-income countries like Nigeria face challenges in ensuring optimal mental health care services (Saraceno et al., 2007).
Mental health cases in Nigeria
In Nigeria, the issue of mental health has attracted little attention, with mental health victims often stigmatized, scorned and neglected by families in the belief that their problem is beyond remedy.
Many persons with symptoms of mental problems are not diagnosed, and many of those diagnosed often do not get treatment. The patients are often shackled, locked up and beaten. Many families that find their relatives’ mental health issues too difficult or expensive to handle at home simply pass the responsibility to the prisons and torture houses. For some others who are not well-informed. the streets become their dump.
Take the instance of the man spoken about earlier. When his family finally finds him, they will try to fix him using ‘methods’ they can ‘afford’. If his health does not improve, they will throw him out and let him roam the streets. Then his ‘madness’ grows old, as opposed to the ‘fresh madness’ he started with.
Read also: Building a Better Mental Health
Where it might be easy to blame the family, there is only so much they can do. They can not be completely blamed because there are no policies that will birth adequate healthcare systems for people like that. The medical care and treatment for mental illnesses in these parts cost a fortune, and only a few can afford it. Illnesses that can be treated with therapy are often left to deteriorate – our streets are full of them.
The information available to Nigerians on Mental Health
Information on mental health care and service in Nigeria are lacking. It is therefore difficult to identify areas of need, to make informed decisions about policy direction, and to monitor progress. A consequence of this gap in information is the continued neglect of mental health issues and the unmet need for service that exists for mental health problems in various communities.
Our biggest problem is the existing Mental Health Policy document. It was formulated in 1991 and is the first policy addressing mental health issues. Its components include advocacy, promotion, prevention, treatment, and rehabilitation. But since its formulation, no revision has taken place and no formal assessment of how much it has been implemented has been conducted.
How do then are cases treated? What do medical practitioners and caregivers refer to? What provisions are there to request for in attending to cases?
In general terms, several other countries in Africa are better placed in regard to the treatment of mental health. It is no news that many countries in Africa also give better official attention to mental health issues. Nigeria should learn from these countries make their words deeds.
Awareness is not enough
At the moment, no desk exists in the ministries at any level for mental health. At best, officials with other primary duties are the ones who often supervise mental health issues in the ministries. In a country where general health services are not adequately provided for, is it mental health that will now be catered for?
More so, there is no coordinating body to oversee public education and awareness campaigns on mental health and mental disorders. Government agencies, NGOs, professional associations, and international agencies do what they can to promote public education and awareness but it is the impact is slow. Only about 3.3% of the health budget of the central government goes to mental health, with over 90% of this going to mental hospitals.
In addressing the issue
The goal of putting this up is to point the urgent need for an update on the policy that influences the outcome of a lot of mental health cases. Al Jazeera has recently reported that Nigeria is on the brink of a mental health crisis. As a people, one way to ensure that this problem does not escalate is to revisit the policies and update them to meet the dynamic needs of an ever-growing society.
People with mental health disorders are humans with rights like everyone else. Where they can be treated, efforts should be made. And where they can only be managed, that should also be provided for.
