How ignorance, stigmatisation add to burden of mental disorder in Nigeria

In Nigeria, mental health issues are seen as a spiritual issue, which makes it difficult for victims to get help. Grace Abejide reports that government and individuals need to rise up to the challenge before more people fall victims.

 

FOR 22-year-old Freya (surname withheld), depression and anxiety have been constant companions for as long as she can remember; it began when she entered Senior Secondary School where she had no friends, plans or motivation to undertake any task. Her lacklustre attitude was noticed by all including her parents who tried to understand what was happening as she was emotionally numb to the feelings of others and was constantly mean and inconsiderate. People felt she was a sadist and ignored her till it progressed to the point of self-harm.

Freya will repeatedly punch herself in the face so that people will see the bruises and ask her about it but nobody ever did because she had alienated everyone with her terrible attitude. She craved attention, yet, she was suspicious of everyone and she started avoiding people and public places even where she could get help because her previous attitude has made people not to take her serious especially since she was known to cry for no apparent reason.

She was tagged a ‘drama queen’ and many do not actually believe she had serious issues that bordered on her mental well being. This is the situation many people have found themselves, yet, society finds it difficult to understand that they cannot control what they are going through.

 

Mental health and mental disorder

The attitude of the society to people having issues that border on mental health is however not ideal because no one is immune. According to a Consultant Psychiatrist and Senior Lecturer at the University of Ibadan, Jibril Abdulmalik, “Mental health is everyone’s business. We all have times when we feel down, stressed or frightened. Most of the time, those feelings last for a short while and then disappear. But sometimes, they may develop into a more serious problem, and this could happen to anyone of us. It is also important to note that our mental health is never a straight line neither is it constant. It fluctuates all the time, partly as a result of external events and circumstances around us. Otherwise, we would be robots without feelings.

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“Everyone is different. Our abilities, temperament, attitude and personalities may be strengths for us in some circumstances; and at other times, they can make us vulnerable. Our resilience also differs from person to person. You may bounce back from a setback, while someone else may feel weighed down by it for a long time and may become overwhelmed by it all.

“Everyone may suffer from mental health problems from time to time – episodes when you are unhappy/miserable/unable to concentrate at work, within family relationships or unable to enjoy social relationships e.t.c. However, this does not mean that we all automatically have mental disorders on account of these problems.

In reality, our thoughts, feelings, emotions and behaviour are simply a function of certain chemicals in our brains. Thus, when we feel happy or sad; when we think about a problem and are able to arrive at a solution or make up our minds about what to do; when we want to remember something and we think hard and suddenly remember it – we are simply using our brains and certain chemicals are working hard to allow us to perform these functions.

However, abnormal changes can occur in the level of these brain chemicals, which then affects our thinking processes, our feelings of happiness or sadness (emotions), our memory, judgment and behaviour. Mental disorder is a psychological or behavioural disorder that is usually identified through an impairment of the person’s cognitive, emotional and mental capacity. Mental disorders occur along a spectrum, ranging from mild conditions such as anxiety; to moderate conditions such as depression; to severe conditions such as psychosis,” he said.

Mental health experts claim that the most common mental disorders are depression and anxiety disorders, which cause significant emotional distress to affected persons, even while not being obvious to most people that anything is the matter with them. They say that it is a misconception to think that mental disorder means madness and m disorder, if left untreated, can disrupt an individual’s ability to live independently and develop his/her potential.

 

Factors

There are diverse factors that cause mental disorder but there are two broad categories; biological and psychological. Biological includes family history and gender risks while psychological include childhood experiences, physical, sexual or emotional abuse, use and abuse of substance as well as anger management issues.

Speaking on his experience with mental health issues which developed as a result of abuse, Nicholas Adeshola, told Nigerian Tribune that he grew up with daily abuse; both verbal and physical, adding that his dad was a constant abuser that he was always afraid of going home. “One day, while I was in Senior Secondary School, I fought with a cousin while on a visit to their home and my father brought me home and beat me up till I begged for death. After he left, I went to buy sniper, wrote a note telling everyone I loved them and then I drank the sniper.

“Luckily for me, my mum came back, raised alarm and I was rushed to the hospital, the first clinic rejected me but at the second one, the sniper was flushed out and I was later discharged without any guidance, counselling or follow up,” he said.

Dr Osagie Ehanire, Health Minister

Corroborating this, Diane Shatto, a mental health social worker, said in her years of experience as a social worker, anything can trigger a person’s brain and throw off their sense of self, adding that, “socialisation is one of the causes of mental disorders; we gain our self-concept by the feedback we get from others. This starts from childhood, as babies all the way to when we become adults. Some people are lucky and have favourable feedbacks from people, feedbacks that help them to grow a strong self-concept which helps them to accept their weaknesses and develop strength at the core of their being.

“Some people get negative feedback, they get manhandled as children, they get punished for every little thing, and they are avoided and ignored by other children. This happens to all children, as they all tend to go through situations like this at different points of their lives, but, some have adults who teach them how to handle their emotions and others don’t. However, there are some children who grow up in strong positive environments that still happen to develop mental disorders.

 

Misconceptions

It has been said that the attitude to mental disorder in Nigeria is causing more harm as a result of poor knowledge and the widespread belief that mental disorders are caused by supernatural forces like witchcraft, sorcery or even as a punishment from God for wrongdoing. Culturally, Nigerians believe that supernatural forces are behind illnesses and mental disorder is not an exception. It is seen as a self-inflicted punishment or reward for evil which is usually deserved.

This belief cuts across to the extent that some health workers also hold the belief that supernatural causes are responsible for mental disorder and the belief in supernatural causes projects people with mental disorders as dangerous and distasteful. Misconceptions are usually as a result of poor understanding of the nature of mental illness; this is not helped by the secrecy, shame and embarrassment that often accompany mental disorders.

 

Government’s role

It is believed that the government is not doing enough at all. According to Dr Abdulmalik, “I have to say that Government is not doing so much with respect to reducing the stigma of mental illness, promoting awareness and reducing stigma. More often than not, mental disorder is not accorded any priority consideration at all in terms of health planning and policy development. A notable exception at the state level is Lagos State which is becoming proactive in terms of having a state mental health policy and mental health law etc”

Awareness and advocacy to reduce stigma and discrimination have been largely due to efforts of non-governmental organizations. The government is just beginning to recognise that mental health deserves more attention, especially because the definition of health by the World Health Organisation (WHO) that says health is a state of complete physical, mental and social wellbeing and not just the absence of disease or infirmity.

The Federal Ministry of Health’s “National Policy for Mental Health Service Delivery,” Nigeria’s first health policy was formulated in 1991 with components like advocacy, promotion, prevention, treatment and rehabilitation. In 2003, a bill for the establishment of the Mental Health Act was introduced by Sen. Ibiabuye Martyns-Yellowe and Sen. Dalhatu Tafida but was later withdrawn in April 2009 after which it was re-introduced in 2013.

The aim of the bill is to protect the rights of people with mental disorders, ensure equal access to treatment and care, discourage stigma and discrimination and set standards for psychiatric practice in Nigeria and it makes provisions for access to mental healthcare and services, voluntary and involuntary treatment but till now, it is yet to be passed into law.

And because there is no standard policy protecting people with mental disorders, spiritual and traditional healers are having a field day; they make so much money from the family of victims while exposing victims to dehumanizing treatment and assault on the ground that that is the way to push the evil out of them.

A World Health Organisation (WHO) study titled prevalence, severity, and unmet need for treatment of mental disorders as part of the organizations world mental health surveys were carried out in five of Nigeria’s six geopolitical zones in 2002 and the report published in 2004 revealed that one in eight Nigerians has had a mental disorder in their lifetime. The most common were depression and anxiety disorders with Nigeria having the highest rate of depression in Africa

WHO’s 2015 data shows that Nigeria’s age-based suicide death rate was 17.3 suicides per 100,000 people, putting the nation at 15th position on the world suicide rate statistics, it also indicated that those with severe forms of anxiety and depression and substance abuse rarely get any treatment for their conditions in Nigeria. According to Prof Oye Gureje, Director of the WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences, Drug and Alcohol Abuse at the University of Ibadan, there is the probability of a higher number getting treatment from traditional and faith-based healers and this treatment are most often very inhumane and inappropriate.

Findings by WHO-aims report on the mental health system in Nigeria states that about 20 million Nigerians suffer from mental illness and a good number of them go without professional assistance. Indeed, the Permanent Secretary, Ministry of Health, Abdulaziz Abdullahi, had at a mental health action committee and stakeholders workshop in 2018, revealed that three in every ten Nigerians suffer from one form of mental disorder or the other, adding that the level of attention given to mental disorders in Nigeria is inadequate while awareness is extremely low.

Also corroborating this, Evelyn Ngige, Director of Public Health in the Federal Ministry of Health, confirmed the sad level of mental disorder awareness adding that it could get worse given the current economic situations of the country. “The attention of the government at all levels is needed to actively work on bringing more awareness to mental health, its importance and the need for constant check-up for people of all ages and also in the aspect of funding, supporting NGOs that focus on mental health and training focused on the right approach to people with mental disorders,” he said.

 

Recommendations

Dr Abdulmalik recommends that “in addition to improved attention to mental health by the Government, there is the need for concerted efforts at awareness creation and education for our citizens. The recent police discoveries of places where Nigerians were being chained and maltreated because they have mental disorders only reinforces the big problem of societal ignorance we have on our hands.

The government needs to be more emphatic about controlling the growing menace of drug abuse in our society. Increasing rates of drug abuse will lead to increased insecurity and spiking crime rates which bodes ill for us all. There should be improved access to mental health services via the integration of mental health into primary care. Mental health is already the ninth pillar of primary care but most primary care staffs do not feel confident enough to address it,” he said.

There is also a call for the government to speedily pay attention and ensure the passage of the Mental Health Bill that will ensure that mental health services offer quality care that promotes and protects the rights and dignity of affected persons and is in tandem with global best practices.

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