‘Many are mad, but only few are roaming’

• The mental health condition of Nigerians against the country’s multifaceted challenges

On the occasion of the World Mental Health Day, KOLA MUHAMMED and FUNMILAYO AREMU investigate the mental health of Nigerians in the face of prevailing socio-economic challenges while seeking experts’ opinions on coping mechanisms.

After interacting with Nigerians from other ethnic groups and all kinds of professions, some people came to a rather humourous conclusion, “many are mad, but only few are roaming.”

It may ordinarily appear to be an offensive statement to assume that a majority of those living in Nigeria are mad with only a few people identified as truly insane. But if you ask Stephen Omoyola, a legal practitioner, what he feels about the claim, he would tell you that he totally agrees.

After witnessing two lawyers exchange blows in court premises over a case and because of a seemingly petty issue in Gombe State on September 23, it becomes understandable why Omoyola agrees that many of his compatriots are indeed mentally challenged.

“It was in a magistrate’s court presided over by a Chief Magistrate. It started out as an argument and we all felt that it should end there, but they started locking each other’s clothes and in no time, the two lawyers started exchanging blows, beating each other up over another person’s matter!

“Truly, only a few [mad people] are roaming.”

It was an experience with a motorcycle rider that made Jeffrey Sampson, a Lagos resident, agree that many Nigerians could be battling underlying mental health issues.

“A bike man carried me one night. On full speed, he began to sing ‘50-50 life na dice’. So, my life na dice shey?” Sampson quizzed.

For Stephanie Adaugo, who also lives in Lagos, encounters with people have taught her that “Nigeria is a place where the end of one person’s madness is the beginning of another person’s.”

Shukurat Abdulhamid corroborates Adaugo by saying: “I meet people almost every day who exhibit crazy behaviours, act irrationally, especially Lagosians, a bunch of crazy people.

“If you want to live in Nigeria, without being bullied by crazy people, you have to learn to switch from a cool cat to a very wild lion. Most people are not mentally stable and it is understandable. All one has to do is match their energy.”

Further interactions with Nigerians by Sunday Tribune revealed a consensus on the majority of Nigerians battling mental health issues, as their actions and reactions to everyday issues suggest that the abnormal has become the normal.

It is the annual celebration of the World Mental Health Day, and with this year’s occasion themed “Mental health in an unequal world”, the socio-political events in the Nigerian scape indicate that the mental health condition of Nigerians may be more serious than it could be possibly imagined.

According to Dr Timothy Adebowale, a former medical director at Neuropsychiatric Hospital, Aro, Abeokuta, one out of four persons in the world, including Nigerians, has one form of mental health problem or the other.

“The global statistics is that one in four persons, that is 25 per cent of the world population, is estimated to have one form of mental health problem or the other, and that applies to Nigeria too.

 

Challenges for an average Nigerian

Being a Nigerian in present times means fighting a lot of wars on several fronts, which inevitably eventually takes a toll on the mental health.

In terms of security, killings, kidnappings and rampage of herdsmen and unknown gunmen continue to dominate headlines. Investigations by Sunday Tribune revealed that about 2,400 were abducted in Nigeria between January and June 2021, with an approximation of 13 persons going missing on a daily basis.

Military personnel have not been left out of the assault on the security architecture of the country, with their bases experiencing  raids and operatives left at the mercy of terror bandits.

For towns and villages that have experienced killings on a massive scale, from Kaduna in the North to Oyo in the South, it would be impossible to expect their mental health to remain normal. Parents who enrolled their children in academic institutions only for terrorists to interrupt their study process would also find it difficult to be mentally stable with every passing day their children spend at the hands of abductors.

 

Inflation

For those who manage to escape the snare of prowling bandits, they land in the net of inflation that has gripped everybody tightly. According to the National Bureau of Statistics, Nigeria’s inflation rate stood at 18.12 per cent as of April 2021 while food inflation rate stood at 22.95 per cent.

Lending opinion on the exorbitant cost of commodities, an economist at SBM Intelligence Risk Consultancy stated that Nigerians would be spending up to 80 per cent of their income on food which would leave little room for other issues like education and health.

“You can bet that today on average people spend more than 60 per cent, maybe around 70 or 80 per cent of their income on food. And when people spend that much amount on food, they cannot do anything else like paying for rent, healthcare, education and the like.”

 

Unemployment

Sunday Tribune’s interaction with the information from the nation’s custodian of data and statistics, National Bureau of Statistics (NBS), showed that one in three able and willing Nigerians had no jobs at the end of the year 2020, with the unemployment rate put at 33.3 per cent.

In other words, roughly 23.2 million people had no jobs at the end of 2020, making Nigeria rank second on the global unemployment index.

With such unprecedented figures, experts believe that increase in poverty and crime rate will be the consequences. Another consequence is mental health instability, especially when a person becomes financially incapable.

 

Mental health pandemic

Passing a general comment, lawyer Stephen Omoyola remarked, “A lot of people are not mentally healthy. The economy and state of the nation which has never been favourable, and the trauma people face on daily basis definitely contributes to this.

“People are down psychologically and they don’t even know it. From health issues, to mental pressure, job hazards and more. It is really sad, pathetic but true. It is an everyday thing. These things align with pressure.

“Even our country leaders exhibit irrational behaviours. Among youths, abnormal things have become normal, while the normal is now abnormal. It is very sad seeing the things people do to survive,” Omoyola added.

 

What mental health is

Providing an expert opinion on what mental health is, Dr Ola Ibigbami, a lecturer at the Department of Mental Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, defined mental health as a condition where a person is able to realise their abilities, cope with stress, be productive and contribute to the community.

“The World Health Organisation defines mental health as “a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.

So, the first level is knowing yourself and your ability, knowing your weaknesses too so that you can know what to avoid, what will upset you and what can destabilise you, that is the first level.

The second level is the ability to cope with challenges of living, the capacity to cope with challenges of living is another level of mental health. Someone without resilience will be easily disturbed and destabilised.

Obviously, that is not a good mental health state. The third level is the ability to work productively and fruitfully. So, for somebody to say he is enjoying mental health, he should have the capacity to work, and what is work? Putting your resources into a productive means.

The fourth level, which is the last level of mental health, is the ability to contribute to changes in your own environment, in your community, in your society.

Putting all that together is like saying mental health is actually like a social capital. Without it, we are bankrupt. It is what makes us to be functional where ever we are placed. Knowing your potentials and abilities, the ability to cope with challenges, being able to put those potentials you have to productive living and then contributing to your society, in the absence of that, we cannot say somebody is enjoying good mental health.

“This implies that optimal wellbeing can only be achieved if all these four components are present in an individual. An average Nigerian can only claim to be mentally healthy if they can realise their abilities and also achieve all the other components adequately.

“In a society bedeviled with unemployment/underemployment, insecurity, uncertainties, disillusionment and other negative circumstances, it is difficult to have people with optimal mental health.

“While we understand that most Nigerians are quite resilient, I see people struggling to eke out a living in the face of adversities. A majority find it difficult to work productively and fruitfully, reach their desired goals and make contributions to their community as much as they would have loved to do,” Ibigbami further stated.

With the challenges plaguing the country showing little signs of abating, Ibigbami believes it is only resilience can check mental health disorders among Nigerians while an overwhelm of adverse conditions would make deterioration inevitable.

“Being mentally healthy is not simply a product of the absence of adversities. Our ability to cope, our resilience – being able to recover after untoward experiences, and the support system that is available for us – can help us mitigate the impact of adverse or traumatic experiences.

“Bearing in mind the prevailing socio-political situations in Nigeria, if Nigerians are able to cope with all these, deploying coping mechanisms, and mobilising the requisite support systems in response to the adverse circumstances, there is a likelihood that our mental health will not deteriorate.

“However, if these adverse conditions fail to stop, or overwhelm all our resources to cope, then the deterioration of the mental health of the citizenry will be inevitable. It is just a matter of time,” Ibigbami disclosed.

Another expert, Dr Timothy Adebowale, corroborated, “environmental factors, apart from other factors like genetics and heredity, are very important in any health condition, The more unstable Nigeria is, the more you unstable the mental health of her citizens will be.”

 

Symptoms of mental health disorder

Sunday Tribune sought the perspective of experts on what symptoms to watch out for in people who may be battling a mental health challenge.

The Chief Executive Officer of Hope Resource Community Care and Rehabilitation Services, Dr Timothy Adebowale, expressed:

“Mental health itself is not the absence of illness. That somebody has no disorder does not mean that he is enjoying good mental health. If we go back to the definition of mental health, it is talking about the totality of an individual, how much we are in touch with ourselves as an individual.

“Talking about manifestation of symptoms, an individual who cannot cope with challenges of life is not enjoying good mental health. Such a person can start to feel sad, frustrated and be unable to sleep.

“While these are the manifestations, the real issue is that the person lacks good mental health – the inability to cope with challenges. Symptoms can be from mild anxiety, feeling sad, low, depressed, frustrated and all these factors.

“The manifestations of fear and anxiety go hand in hand. People are fearful, they become insecure and these are indices of less enjoyment of mental health, because of some of the changes in our environment.

“When people exhibit some of the symptoms I have spoken about, they may not even think they have any mental health problem. It is only when people have severe experiences which begin to disturb their reality.

“This is when people will realise that there is something wrong with such a person. By the time other people begin to notice, it has become serious. When the person or others notice, then they begin to take care of themselves with the use of substances and medications. And that is when we now think there is a problem. But long before that, there had been a problem,” Adebowale added.

Speaking further on symptoms, Dr Ibigbami stated that significant changes in action, mood and thinking are indicators to watch out for in people, irrespective of age.

“The signs of mental disorders cut across all ages. They are characterised by significant changes in behaviour (actions), feelings (mood) and thinking which leads to impairment in functioning of the individual and (or) disruptions in relationships.

“For infants, the inability to form close relationships, manage and express emotions, explore the environment and learn could be a pointer to an underlying mental disorder. For children and adolescents, deficits in overall development, functioning and the inability form age-appropriate relationships could be indicators of mental disorders.

“Adults who have major or severe mental disorders may experience loss of touch with reality, including the perception of things not experienced by others (hallucinations).

“When we suspect that an individual has a mental illness, the best thing to do is to encourage the person to go for an evaluation in the hospital. Early diagnosis and intervention enhance a favourable outcome.

 

Safeguarding mental health against all odds

Suggesting ways by which Nigerians can safeguard their mental health, in spite of the unfavourable odds, Dr Ibigbami advised setting mental health goals and taking conscious steps to meet such goals.

“Probably the most popular phrase in the field of mental health is, “No health without mental health”. Indeed, you cannot be healthy if you are not mentally healthy. It is almost impossible to find any physical illness that doesn’t have a mental health component.

“Therefore, anyone who aspires to lead a healthy life must be mentally aware. The first thing to do is to decide to pursue the attainment of optimal mental health. A lot of people set goals for their businesses, their family, their properties etc. without setting goals about their physical health.

“I will want to look at it [setting goals for one’s mental health] in two broad perspectives: Those who have a pre-existing mental illness and those who don’t have a diagnosed mental illness. The odds are much stacked against those who have a previous mental illness. Improving their mental health is highly dependent on seeking help early and from the right source.

“We know that less than 20 per cent of persons who need mental health care have access to the help that they require in Nigeria. The few available services are unevenly distributed across populations.

“There are states in Nigeria with less than two psychiatrists serving a million people! A lesser number of psychologists are in practice in most parts of the country. Nigerians who are mentally ill deserve to have services that can meet their mental health needs at the primary health care level. It seems like a tall order, but it is realistic.

“The right mental health services include facilities for assessment, treatment and rehabilitation. For those who are without any diagnosis, there is a need to avoid the factors or situations that increase the risk of becoming mentally ill.

“These factors include problems that could harm the developing brain (while the foetus is still in the womb), problems that could affect the health of the mother when she is pregnant, adverse childhood experiences, peer problems and social relationship issues, traumatic experiences and risky health behaviours including the abuse of alcohol and other psychoactive substances.

“We also need to engage in continuous sharing of valid information about mental disorders. There are lots of misinformation that fuel the stigma and discrimination against mental illness and the mentally ill,” Ibigbami further advised.

For Adebowale, a key to improving one’s mental health is having a positive outlook of life.

“First, have a positive outlook of life. No matter the challenges, man is born to cope with them, and truly, we have the resources within us to cope with whatever challenge. Humans are created in such a way that we have the capacity to adapt to situations.

“The realisation of that can also give us the confidence that whatever the situation, we are able to cope. Also, we need interdependence with other people. In the social context of support, nobody can survive challenges alone.

“We need social contact and the support of people. We need to make sure that we have enough social support around us.

“We should also refrain from substance use. You know people sometimes think they want to help themselves, they feel anxious and want to take something to make them feel at ease and that is what leads people to substance use, drugs and whatever. We advise that such are not really the solution.

“Rather, people should seek professional support and even the support of their significant others around them. Improvement in the environment and that comes to the issue of the provision of infrastructures around us, security, improvement in socio-economic status. These are some of the factors that can improve mental health generally,” the neuropsychiatrist further stated.

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