THE numerous times we have received feedback from readers and other members of the public, have clearly shown that there is a huge gap with information dissemination about mental health services. It is a multi-faceted problem, ranging from ignorance about what signs and symptoms are suggestive of a mental disorder; to lack of information about where to go for help.
We continue to make efforts to promote understanding about the various signs and symptoms of mental disorders in this column because it is our firm belief that the ignorance and shame that is associated with mental illness can only be dispelled with information and positive messages of support and encouragement.
However, in today’s article, our focus will be about how to access care for persons with mental health challenges. Where to go to, how much it costs, what processes are involved e.t.c.
How to access care: In every state of the federation, there is at least one teaching Hospital or a federal Medical centre. These tertiary facilities usually have a Department of Psychiatry/Mental Health or Behavioural Medicine – all of which are different names for the same department.
In addition, there are eight specialist neuropsychiatric Facilities in all the geopolitical regions. So, the following specialist neuropsychiatric hospitals are settings where professional expertise will be readily available: South West: Aro Neuropsychiatric Hospital, Abeokuta and Yaba Psychiatric Hospital, Lagos, South-South: Uselu Psychiatric Hospital, Benin and Neuropsychiatric Hospital, Calabar; South-East: Neuropsychiatric Hospital, Enugu; North-West: Federal Neuropsychiatric Hospital, Barnawa, Kaduna, and Federal Neuropsychiatric Hospital, Kware, Sokoto; North-East: Federal Neuropsychiatric Hospital, Maiduguri.
For most teaching hospitals, you cannot simply walk into a specialist clinic to be seen and to make complaints. You will need to have a referral letter from another doctor directing you to that specialist clinic. This is to ensure that you are properly directed to the appropriate clinic for effective and smooth operations. So you don’t end up going to a cardiology clinic to complain about diabetes when you should be attending endocrine clinic, or presenting to psychiatry clinic for a brain tumor that should be seeing a neurosurgeon.
So, if you are not coming from a doctor with a clear referral to a specific clinic, or if you are unsure where to go, then you may have to firstly present at the General OutPatient Department (GOPD) of the hospital, where you will be sorted out, attended to by doctors and referred to a specialty clinic as may be indicated. It is very important to be patient with the process, as it may be time-consuming.
In addition, some states have specialist neuropsychiatric hospitals, such as in Ondo state, as well as state hospitals that have psychiatric units, such as Ring Road Hospital, Ibadan; and the flagship primary care clinics in Lagos. Thus, it is very unlikely that in any state of Nigeria, there will be no psychiatrist in a tertiary facility to attend to mental health problems.
How much does it cost? The government facilities described above usually will cost below N5,000 to register, open a folder and cover consultation fees to be seen by a specialist, including transport fare and some variations across hospitals, under N10,000 should suffice for a first time visit.
Subsequent visits will cost much less, as the registration and opening a folder are one-off expenses that will not be repeated again. Cost of medications, where indicated, will also typically range from N3,000 to about N10,000 per month.
Thus, while it is not very cheap, it is also not prohibitively expensive either, to seek specialist mental health care in Nigeria. What is unfortunate, however, is that we still operate an Out-Of-Pocket (OOP) payment system, due to the low coverage of our National Health Insurance Scheme (NHIS).
However, private consultations and private facilities maybe more convenient and comfortable but are far more expensive than seeking care in a public facility.
What services are available? In most departments of psychiatry in tertiary facilities as well as the neuropsychiatric hospitals, there is usually a multi-disciplinary team in place, comprising psychiatrists, clinical psychologists, psychiatric nurses, occupational therapists, social workers etc.
Furthermore, the services available are not just for those with serious mental health challenges. Individuals with concerns about aspects of their life, or who simply want to have an assessment and feedback about their emotional well-being are also welcome and will gain from the expert interaction.
These include providing drug abuse prevention counselling for adolescents at risk, or difficult-to-manage children with behavioural disorders etc. Other instances include traumatic experiences such as armed robbery attacks, bereavement, kidnappings, and so on.
Conclusion: Mental health services are available across the country and should be accessible and affordable to most citizens. Please let’s utilise them.