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Why Mental Health Problems Are Rising – Dr Akhator-Eneka

Dr. Nwife Akhator-Eneka, the Consultant Psychiatrist, Synapse Services, Abuja, explains why mental disorders deserve more attention than they’re getting in Nigeria.

Dr. Nwife Akhator-Eneka/Photo Credits Dr. Nwife Akhator-Eneka
Dr. Nwife Akhator-Eneka/Photo Credits Dr. Nwife Akhator-Eneka

The world celebrated the Mental Health Day on October 10, why didn't we hear so much about it?

The World Mental Health Day is observed on the 10th October every year, with the main objective of raising awareness about mental health issues and encouraging efforts in support of better mental health.

It was first celebrated in 1992 and has a different theme every year. Mental health professionals strive to create awareness about mental health and its challenges on these days. However, one major problem facing such efforts in Nigeria is the disproportionate number of trained psychiatrists to the population of Nigeria and the expectation that such efforts should be carried out by only the professionals.

We need to understand the need for a collective effort to achieve this aim as it cannot be driven by the mental health professionals alone. Stigma still prevails in our society and people who do not carry the label “mental health professional” are reluctant to speak out in respect of mental health.

However, it is not all doom and gloom because although gradual, few people are coming out of their shells to speak.

Is it true that about 20-30 per cent of Nigerians suffer from one mental health disorder or the other?

 

The WHO reports that one in four people will be affected by mental illness at one point or the other. This figure is universal. We in Nigeria are a subset of the entire world population, the world is a global village, and hence, what obtains in other parts will obtain here in terms of the prevalence of non-communicable diseases.

Our data gathering is poor and hence there is a possibility that this figure will be higher in regions with high rates of poverty and social upheavals such as terrorism, wars etc

That's really troubling. How did we get here?

 

Let me mention, that no mental health challenge should be taken lightly. However, when we speak of mental health disorders, often, the picture that comes to mind is the vagrant man roaming the streets who makes up one per cent of the total number of mentally ill people.

However, I understand that it does not make the situation appear less troubling when we consider the high number of people with depression, anxiety, bipolar affective disorder and others

Further worsened by a rise in stressors brought about by dire economic strains and the increasing level of insecurity in the nation

Dr. Nwife Akhatpr-Eneka
Dr. Nwife Akhatpr-Eneka/credits Dr. Nwife Akhatpr-Eneka

Why then do we have, at best, a fleeting attention given to mental health given the grim statistics?

 

Permit me to further highlight how sad the situation is. The 2006 WHO-AIMS report on mental health system in Nigeria made some revelations. It reported that “there is considerable neglect of mental health issues in the country.

The existing Mental Health Policy document in Nigeria was formulated in 1991 and it was the first policy addressing mental health issues and its components which include advocacy, promotion, prevention, treatment and rehabilitation.

Since its formulation, no revision has taken place and no formal assessment of how much it has been implemented has been conducted.

There is considerable neglect of mental health issues in Nigeria. Stigma, discrimination and misconceptions about mental illness have continued to flourish.

"The WHO reports that one in four people will be affected by mental illness at one point or the other. This figure is universal. We in Nigeria are a subset of the entire world population, the world is a global village, and hence, what obtains in other parts will obtain here in terms of the prevalence of non-communicable diseases. Our data gathering is poor and hence there is a possibility that this figure will be higher in regions with high rates of poverty and social upheavals such as terrorism, wars etc"

Recently, there was this outrage over the number of our young people, especially in Northern Nigeria, addicted to codeine; has there been any significant changes?

After the BBC documentary and the outrage that followed, the Federal Government on May 1 ordered an immediate ban on the issuance of permits for the importation of codeine which is a major step towards addressing the problem.

The concern remains the unregulated production and illicit trade. However, there is now a heightened awareness of the drug addiction scourge hence, people especially schools, employers and caregivers are more alert to its warning signs.

The need for routine and random drug testing in schools and the workplace has also been emphasized.

Tell me, what are the three major reasons people get addicted to drugs?

 

Some people resort to drug use as a mal-adaptive way of coping with day to day stressors. Stress is a key risk factor in addiction initiation, maintenance, relapse, and thus treatment failure. People with poor coping skills turn to drugs.

For adolescents, they are biologically wired to seek new experiences, hence, this desire to seek new experiences puts them at risk. In this age group, peer pressure is also a key factor. Availability is also a factor.

Drugs that are prone to abuse are available in many nooks and crannies which has made people desensitized towards the grave consequences of its use.

What, in your opinion, is the most worrying fact about drug abuse/addiction in Nigeria?

In my opinion, the most worrying fact is the threat it poses to successive generations. Our youth are the leaders of tomorrow and the vehicle through which the growth of the Nation can be realized. They however, are the most deeply involved group in this menace which if not nipped in the bud, threatens the future of the nation.

Do you think there is anything doctors can do to reduce the number of people to get addicted to prescription drugs?

The most common prescription drugs of abuse are the Opioid analgesics which include Pentazocine, Pethidine and Tramadol. For many people, opioid addiction begins with legitimate medical prescriptions.

Referred to as iatrogenic addiction, which means addiction caused by medical treatment following a liberal prescription of medication. Effort to address the crisis must begin with a review of the prescribing patterns of Opioid analgesics.

Physicians also play a critical role in managing these addictions by helping their patients recognize that a problem exists and provide or refer them for appropriate treatment

"The concern remains the unregulated production and illicit trade. However, there is now a heightened awareness of the drug addiction scourge hence, people especially schools, employers and caregivers are more alert to its warning signs. The need for routine and random drug testing in schools and the workplace has also been emphasized."

Do we have the capacity to tackle mental health disorders in Nigeria?

With the available resources, human and material, it would be unrealistic to admit we have the capacity to tackle mental health disorders. Nigeria, home to 200 million people, has a gross short supply of mental health professionals.

The psychiatrist to population ratio is 0.09/100,000 with a continuous mass exodus of the available hands. There are only eight federal psychiatric hospitals in the country most of which are located in urban areas. This is further worsened by financial and cultural barriers.

What can be done?

In terms of service provision, it is imperative we make the most use of available resources. There should be provision of basic diagnosis and simple treatment at the primary health care level and increased integration of mental health care services in private hospitals.

The cultural barriers which include feelings of shame about having a mental illness often engendered by fear of stigmatisation and discrimination can be addressed by working on changing the perception of mental health challenges from the grassroots level

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