TELL Magazine

A combination of lack of access to proper medical care, social stigmatisation and poverty swells the ranks of Nigerians suffering from one form of mental illness or the other

From the way he dashed into the reception of a private psychiatric hospital in the Federal Capital Territory, FCT, Abuja, no one was left in doubt that he was in distress. And truly the man, a serving senator in the country, was going through a very tough time. He insisted on seeing a consultant almost immediately and explanations that he needed to join a queue fell on deaf ears. The senator was inconsolable. “I don’t have time for frivolities, I need to see the doctor, and very urgently!” he insisted.

By the time he finally got audience with the doctor, the senator told the story of his agony. His house had been literally on fire. He recently lost one of his children in a road accident. He had to lock up the remaining three in a room in his house due to what he described as their “abnormal behaviour.” As it turned out, the senator himself appeared to be under severe stress and the consultant had no choice but to immediately place him on a bed rest.

Also going through treatment in the same hospital in Abuja is Sarah (not real name), an eight-year-old daughter of a high society lady who works in the Presidency. As young as she is, doctors who pleaded anonymity both for themselves and the hospital said Sarah’s mental illness is traceable to cocaine to which she must have been exposed, most likely from home. This is further confirmed by the fact that Sarah’s mother sometimes begs nurses at the hospital to administer cocaine to her daughter in order to calm down the 8-year-old’s craving for the banned substance. While still on admission at the hospital, Sarah almost committed suicide by swallowing curtain nails in her room.

Also lucky to be alive after attempting suicide is a high-profile nurse who would not want her name in print. She said while studying in the United Kingdom, UK, she met a prince from Nigeria, who she simply identified as Wale. The duo fell in love, and she was looking forward to a life-long relationship with him. At their convocation ceremony, Wale’s relations were in attendance, and he only introduced her as a friend. Wale later returned to Nigeria while promising to send for her soon. When this was not forthcoming, she decided to pay her lover a surprise visit in Nigeria. What she met left her dumbfounded. To her chagrin, she found that her Prince Charming was married with children and was only taking advantage of her.

Heartbroken, the lady withdrew into her shell. She now sleeps less, eats very little and is not bothered even by her own personal hygiene. At a point, her relations decided to seek help at a private mental health institution after she attempted suicide and was complaining of a loss of self-worth.

Although they are not particularly in a very good shape, the persons earlier mentioned can still count themselves lucky since they could afford access to proper medical care for their state of mental health. There are countless others who daily roam the streets, abandoned by friends and relations and tagged as mad by the society. Although statistics of the number of people with mental illness in Nigeria is hard to come by, Richard Adebayo, a consultant at the Federal Neuropsychiatric Hospital, Yaba, Lagos, said such ailments are common and are no respecter of persons. He added that the World Health Organisation, WHO, estimates that about 20 per cent of Nigerians suffer from mental illness. “It affects black, white, rich, poor and any socio-economic class. Even children with childhood autism are regarded as having mental disorders, as well as those suffering attention deficit hyperactivity disorder, ADHD,” Adebayo revealed. In addition, he said elderly people too could suffer mental disorders like dementia.

And the need for proper diagnosis and treatment for the mentally ill cannot be over-emphasised. For instance, Emmanuel Owoyemi, chief executive officer, Mental Health Foundation, said: “If there are depressed people with some level of insanity at the helms of affairs of a country, it will lead to economic depression because they won’t do the right thing.” He added that “you should understand that it is insanity when a governor embezzles monies meant for roads and hospitals and looks on while people die. It is insanity when lawmakers know that they are been watched on television and they still go ahead to throw chairs and exchange blows in the National Assembly and State Houses of Assemblies.”

Asked what exactly constitutes mental instability, Tayo Daramola, consultant psychiatrist, Asokoro Hospital, FCT, Abuja, at a recent Mental Health and Addictions Summit, held at the Lagos Sheraton Hotel and Towers, Ikeja, organised by Nightingale Foundation in conjunction with TELL Communications Limited, said: “It is a spectrum of behaviours characterised by certain abnormal mental or behavioural patterns. It may manifest as violations of societal norms, including a person becoming a danger to themselves or others, though not all such acts are considered insanity.” Daramola added that when a person stops operating in the realm of reality, then it is obvious the person is mentally ill. He also said when a person starts hallucinating and claiming to be what he or she is not, then there is a problem.

The psychiatrist, though he would prefer to be called a behavioural physician, grouped the causes of mental illness into three categories. “In the past, people had this notion that mental disorder was caused by a demon or through diabolical means, but nowadays we know scientifically that the causes can be biological, psychological and sociological.”

Further breaking it down, Adebayo, in his own submission said mental disorder could be biological, that is, inherited if it runs in the family, just like diabetes and hypertension. “Even right from the time a baby is in the womb, maternal infection, maternal lifestyles like smoking and alcohol intake could affect the unborn baby in the womb and when the baby is delivered eventually, there may be problems such as neonatal jaundice, cord infection and much more, which can affect the brain and when the baby is growing up, one will see the evidence that there is brain damage.”

Explaining how it can be psychological, Adebayo said an individual may be predisposed to developing mental disorder and may be fortunate all his life not to come down with the ailment, but when an occurrence beyond the person’s capability happens, then such a person is pushed off the edge. “Such psychological issues may include growing up in a family that is dysfunctional. If there is no proper bonding, it becomes traumatic to the children at the early stages of their lives. Child abuse such as rape can also affect a child psychologically. It could also be failure in examinations, relationship problems, traumatic experiences like bombing, flooding or any other thing that could have really tasked the victim mentally,” he stressed.

On the other hand, Mbadiwe Onyeama of the Department of Psychological Medicine, University of Nigeria Teaching Hospital, UNTH, and a former consultant at the Federal Neuropsychiatric Hospital, Enugu, said the causes of mental disorder could be organic, functional or genetic. He said in the case of organic, when such a person is examined, one can see the kind of physical problem that is causing the mental illness, such as delirium and dementia. In the case of functional mental disorder, he said there is usually no clear-cut physical derailment either in the brain or any part of the body, but through observation experts can see that the individual is mentally unstable.

While identifying the class of people who are mostly prone to mental disorder, Onyeama said occurrences of some form of mental illness are higher among the low-income earners. He was quick to point out too that some forms of mental illness, such as bipolar disorder, an extreme form of depression characterised by mood swings, is higher among the rich, especially those in the academics who are dubbed to be very intelligent. “But generally, when you come to the psychiatric hospital and you see patients, it is mostly those in the lower class that are visible, because the rich have the money to procure private treatments for themselves instead of coming to the general hospitals,” he said.

Adebayo added that the cost of treatment for mental disorder is oftentimes on the high side and out of reach for the poor who due to their mental state may already be out of job and totally dependent on family members and friends. “Ideally, government is supposed to make treatment free or subsidised to a great extent so that patients will be able to have a kind of succour but in this part of the world, unfortunately, it is not so,” he lamented. This view is supported by Olubukola Hassan, chief executive officer, Nightingale Foundation, who argued that mental health care is supposed to be one of the elements of primary health care in Nigeria. A well-travelled mental health care giver, Hassan said in the Western world mentally ill people are actually not treated by mental health specialists, but by general health practitioners, because in such climes those suffering from mental illnesses are not seen as untouchables or stigmatised.

In a similar vein, Oyedeji Ayorinde, a consultant psychiatrist based in the UK, said that “lack of proper care for the mentally ill is costing us as a nation as most illnesses that people suffer are as a result of minor disorders like anxiety and depression, which reduce their productivity and when we quantify the loss in naira terms, it is the most painful thing.”

Equally of concern to experts is the fact that most mental health care facilities are located in urban areas, whereas most of the people who suffer mental disorders are located in rural areas. Olufemi Olugbile, permanent secretary, Lagos State Ministry of Health, said: “It has been established 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.” He added that “there is a disconnection between the locations of patients and the location of the services for the treatment of mental disorders, and that specialists such as psychiatrists, nurses, social welfare officers, occupational therapists and all those who form members of the mental health team are very few in numbers and grossly inadequate.”

He was not exaggerating. At present, the country could only boast of eight psychiatric hospitals while there are very few private ones for the rich. Those who can’t access either of these two usually end up patronising spiritualists, herbalists and their likes for treatments. For example, Lagos with a population of 18 million people has one federal psychiatric hospital located in Yaba, some few beds at LUTH, LASUTH and Military Hospital, Yaba, making a total of about 550 beds for the Lagos population. These hospitals are located in Yaba, Surulere and Ikeja and it is left to be seen how they would service people living in far-flung places like Ikorodu, Epe, Badagry and those who live on the outskirts of Lagos. Onyeama, on his part, pointed out that in the whole of the South-east, there is only one federally funded psychiatric hospital. “That is bad. Remember we are talking of a population of more that 30 million people. That is not enough at all,” he stressed.

Aside the limited treatment available to mentally challenged persons, what is also of great concern is the perspective on prescription drugs and its abuse by those who buy such drugs across the counter. Adetoyese Mudashiru Oyewumi, a pharmacist at Rite Aid Pharmaceuticals, Atlanta, Georgia, US, who was also a facilitator at the summit, noted that in the US, it is very difficult for an individual to purchase drugs in the pharmacy without a doctor’s prescription. He further said that any drug purchased is registered, and cannot be duplicated elsewhere, or even re-purchased by the patient, until the prescribed dosage of the previous one is completed.

But the reverse is the case in Nigeria. No one monitors how drugs are purchased and used, as well as how they get to those who actually don’t need them. “I marvel at the rate people go to the pharmacy to buy drugs without showing a prescription order from a doctor in Nigeria. No doubt, this will expose people to abuse of such drugs. In the US, this is not permissible,” he reiterated. He also pointed out that illicit drug usage can lead to mental disorder, a notion that was supported by Ngozi Onuorah, a director at the National Agency for Food and Drug Administration and Control, NAFDAC. She called for an extensive campaign to be mounted against the sale of illicit drug, and that those under its influence be provided with adequate care and mentoring.

Indeed, until these areas of gaps are filled, the fate of many who ordinarily could have benefitted from proper care and treatment will continue to hang in the balance while they roam the streets, tagged as mad.