Mental Health Personnel Inadequate In Nigeria – Igwe

| July 24, 2019 | 0 Comments

With an increase in mental illness in the country leading to many unfortunate deaths, well-meaning Nigerians are lamenting the non-availability of facilities and personnel to curb the situation. In this interview with the Medical Director of Federal Neuropsychiatric Hospital in Enugu, Dr. Monday Igwe, he speaks on the rising trend with PATIENCE IVIE IHEJIRIKA

What, in your opinion, is responsible for the rising case of mental illness in the country and how many cases are currently being handled in your hospital?

The burden of mental illness has always been enormous. However, in recent years, the World Health Organisation’s, WHO, collaborative project called the Global Burden of Diseases (GBDs) quantified it. According to the study, neuropsychiatric condition constitutes 14 per cent of the GBDs.

In Nigeria, the Federal Ministry of Health stated that 30 per cent of Nigerians suffer mental illness. Considering the estimated population of 200 million Nigerian, this translates to 60 million persons with mental illness in Nigeria. In other words, Nigeria has more persons with mental illness than the population of every West African Country.

The cause can be better classified as unmodifiable causes (the gene) and modifiable factors (psychosocial factors.)

In the recent time, our country has experienced economic adversities (e.g., recession) and violent crimes (e.g., kidnapping, terrorism and most recently armed banditry). These factors, coupled with diminishing supportive environment engendered by distortion of our traditional extended family network and lack of neighborhood cohesion as a result of westernisation, reduces our resilience and increases our vulnerability to mental illness.


Is there any trend that has been noticed?

From our clinical experience, we have noticed some trends in the area of pattern of presentation or diagnoses: we have seen what could be described as an emerging epidemics of substance related disorders. Although substance use disorders have always been part of our experience, but the ramification of use has increased from usual alcohol and cannabis to opioids and inhalational gases.

We have also noticed that though the traditional path to care in most African society is still maintained i.e., unorthodox to orthodox, increasing number of people now come in contact with orthodox care early enough. This is important because it reduces the duration of untreated illness and improve outcome.


 What is depression? What are the signs? And how can it be managed?

Depression or what we call major depressive disorder is one of the severe mental disorders characterised by three core symptoms of low mood or sad feelings, loss of interest in activities previously enjoyed and getting tired easily. These symptoms and others that will be listed shortly should occur nearly every day for at least 2 weeks. This last sentence is to differentiate it from normal fluctuations in the mood that can occur in normal individuals.

Other symptoms include changes in appetite (low or high), changes in sleep (poor or excessive), changes in weight (loss or gain), difficulty concentrating (what many patients report as memory lapses), feelings of guilt or blaming self unnecessarily and feelings of inferiority.

Also, worthlessness, hopelessness and pessimistic view of self, the future and the society, recurrent thoughts of harming self, suicidal attempts etc., are other symptoms. I suggest that if you feel this way, you should see your doctor preferably a psychiatrist or a family physician for further evaluation and treatment. However, for completeness, treatment is usually a combination of medications and psychological treatment.

The high rate of suicide especially among young people in Nigeria is becoming worrisome, why and how can we address it?

Suicide has always been with us in Nigeria. However, because of the cultural impediments (i.e., being seen as a taboo), it was under-reported. However, with the improvement in communication with social media, suicide cases are now easily shared to vast majority of people. This has implications.

According to WHO, one million suicides occur annually and 90 per cent of them are related to depressive disorder. This means that one suicide death occur every 40 seconds worldwide. The age group at maximal risk is 15-45 years.

Many reasons have been given, including untreated mental illnesses especially depression. Other psychosocial factors e.g., unemployment, natural and man-made disasters, irresponsible media reporting. Other factors include increasing family disharmony, social and economic exclusion etc.


 How can we address it?

It will require a multi-sectorial and multi-disciplinary approach involving various government ministries, agencies and departments especially that of health, labour and employment and other social services. It also requires measures to improve access to mental health services through community mental health services or primary health care. Interventions to improve family relationships and neighborhood cohesion and modification of existing legislation that criminalises attempted suicide. This is necessary to improve access to treatment.


 Are there measures one can take in order to be in good mental health?

Yes! This is what we call positive mental health or positive psychology. In other words, factors that promote joy, happiness, resilience, satisfaction are necessary for good mental health. In fact, WHO described mental health in a positive sense as “a state of well-being in which an individual realises his/her own abilities, copes with the normal stresses of life, works productively and fruitfully and makes a contribution to his/her community.”

Therefore, mental health promotion strategies cuts across the life cycle, from conception to dignified death. It focuses on building resilience and other protective factors and diminishing vulnerability factors.

Things we can do to promote good mental health are many and include good obstetric and early childhood care, increased social connectedness which builds social capital and diminish social isolation and exclusion, reduce violence and discrimination, increased economic participation, good parenting etc.


 Do we have enough psychiatric doctors to cater for the huge number of patients with mental illness? What is the ratio of psychiatrists to patients?

We don’t have enough psychiatric doctors. Not just psychiatrist alone, the mental health personnel in Nigeria is grossly inadequate. I mean clinical psychologist, mental health nurses, occupational therapist, speech therapist and social workers. The WHO recommends one psychiatrist to 10,000 population. As at 2014, in Nigeria we had one psychiatrist to 1.7 million population.

Recently, in an interview published in one of the dailies on May 19, 2019, the president, Association of Psychiatrist in Nigeria (APN) Dr Taiwo Sheikh, stated that there are 250 psychiatrist providing mental healthcare to over 200 million Nigerians currently. In other words, from this figure the ratio should be one psychiatrist to 800,000 population.

However, this figure could be misleading as it was rightly observed by him that three out of five psychiatrists left the country after being certified by the postgraduate medical colleges.

Most psychiatric patients in Nigeria prefer to go to religious or traditional healers for treatment. Are there psychiatric hospitals where such cases can be managed?

Yes! The federal government established now some-stand-alone psychiatric hospitals scattered across the six geopolitical zones. However, there are psychiatric departments in medical schools and teaching hospitals and many other federal medical centers. In the South-east, psychiatric services are available at the Federal Neuropsychiatric Hospital, Enugu, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State University Teaching Hospital, Parklane, Enugu, Alex Ekwueme University Teaching hospital, Abakaliki, Ebonyi State, Federal Medical Centre, Umuahia, Abia State, Neuropsychiatric Hospital, Nwafia, Anambra State, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, OdimegwuOjukwu University Teaching Hospital, Amakwu, Anambra State, Federal Medical Centre, Owerri, Imo State University Teaching Hospital, Orlu, Imo State etc.


How do you intend to tackle the crisis in your hospital?

We have already settled down to work. Presently, there is no crisis. I was warmly welcomed and I can say that this hospital has great men and women who are ready to work provided there is peaceful environment. I would provide an open leadership. I am a leader and not a boss. I will carry everyone along and no one will be denied his or her right. We will work as a team and I’ll be the team leader. Every success or failure will be a collective responsibility. God will be placed first in all decisions and by His grace, my position as medical director will end in praise.


Culled from :Here

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Category: Health