Poverty is major determinant of mental health issues in Nigeria

WORRIED by the rise in suicide and insecurity issues in Nigeria in recent times, the Association of Psychiatrists in Nigeria, APN, has raised the alarm of an imminent explosion of depression and other mental health conditions in the country.

The President of the APN, Prof Taiwo Obindo, told Good Health Weekly that the country was sitting on a keg of gunpowder, no thanks to the harsh economic crisis.

Obindo, who said that urgent steps should be employed to tackle mental health-related issues, tasked the federal and state governments as well as employers of labour to guarantee the well-being of Nigerians to ameliorate the negative effects of the harsh economy on people’s mental health.

Excerpts:

Mental health

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We know that health is a state of well-being, and it encompasses physical, mental and social well-being, some people will even add spiritual well-being. Mental well-being stands in the middle and is the fulcrum upon which both social and physical health are placed and the three interact.

Physical health, when it’s not well, can impact mental health, and then both can also impact social well-being and then social well-being impacts both physical and mental health, and that’s why we talk about social determinants of health and social determinants of mental health. So, talking about the state of mental health in the country, we need to put things in proper perspective.

Mental health wins in 2023

Looking at the preceding year, 2023, it is obvious that attention is being given to mental health in the country. We started with the ascent that the President gave the Mental Health Bill, and this was almost immediately gazetted.

So, for that alone, coming from over 50 years of working under the Lunacy Act, one can say we have made a great jump. Amongst the comity of nations, we are no longer looked down upon. Having gazetted it, it means that it must be enforced. So, the content of the Act needs to be fully implemented.

What needs to be done in 2024

So looking at the state of things, we believe that things will get better in 2024. One of the major key points in the Mental Health Act is the establishment of the Department of Mental Health in the Federal Ministry of Health.

This needs to be done, even though we can say a big thank you to the mental health programme under the Public Health Department of the Ministry. But mental health is bigger than that; the rate and the state of things will encourage setting up a department in the Federal Ministry of Health.

Also, the Mental Health Fund which is one of the components of the Mental Health Act needs to be established to further boost the little that comes in from budgetary allocation. This is because the sources of funds for the Mental Health Fund will include not only just the budgetary allocation, but also corporate organisations plough into the Mental Health Fund. Individuals, philanthropists, social organisations and all can also plough in and take care of the mental health services in the country.

We can also take care of the vulnerable in communities across the country, those who we see on the road and are unable to afford care because of the astronomical increase in the cost of care. Particularly, drugs presently.

One of the thrusts of the Mental Health Act is the human rights posture of Nigerians and those who have mental health conditions, thereby removing or limiting discrimination and stigma against those who have mental health conditions.

We also need to have a situation where we have this Mental Health Act domesticated in the states of the Federation.

As we speak, Ekiti and Lagos states, possibly, Oyo state, I don’t think they have passed it in their state yet, but it has gone far.

This needs to be domesticated in all the states of the Federation. We are, in fact, so optimistic that the Coordinating Minister for Health and Social Welfare will do a good job. He has started it with the mental health policy that was passed towards the end of last year -Mental Health Policy for 2023. The last one was in 2013 and then, they gathered dust on the shelf because they weren’t well implemented.

They also were able to approve the strategic framework for decriminalisation of suicide in the country. These are momentous events in the annals of mental health in the country. We’re also able to have a roundtable for mental health. We had the Minister and other ministers. I think three ministers were available at the event. So we are hoping that this year we will have a better outlook on mental health issues.

Why increase in mental conditions in 2024

If you recollect the Medical Director of Federal Neuropsychiatry Hospital Yaba gave an interview towards the end of last year to say that admissions into the hospital had increased by almost 50 per cent. That is a reflection of the situation in the country.

More and more people are developing mental health conditions following issues of economic insecurity among others in the country. These are predisposing Nigerians to developing mental health conditions.

And of course, we also notice that there has been an increase in the incidence of suicide and suicide attempts in the country. And this is a consequence of what is happening in the country. We talk about the social determinants of mental health. Poverty is a major one and the number of Nigerians who are living below the poverty level has increased in the last four years.

The devaluation of the Naira policy also with the removal of subsidies on fuel, has aggravated the situation and made things even worse. Many are now unemployed, and many businesses have folded up. Those few who are even employed are underemployed if you look at the graduates or the percentage of graduates in the country who have been fully employed.

If you also look at the inflation rate in the country it has gone up. We have so many graduates driving Uber around. There are so many graduates doing all these services around. You don’t know that these are not what they are meant to do. Also, businesses folded up those who are even into the business are not making earnings and they are retrenching workers. So we need to do more.

The higher these are the more challenges that people will and the issues of security, kidnapping, banditry, armed robberies, one chance and all of that in the country are also creating a situation in the country where people are living under distress and distress will push them to develop a mental health condition and quite a number have been pushed into having a mental health condition already.

Mental health in the workplace

We also would need to stem the trend of people leaving the country, where mental health practitioners and other health experts generally are living. We need to stem that tide and how do we do this? We need to improve the welfare of those who are working. We need to employ more and create more positions for people to be employed. We need to make the environment where they work also much better than what it used to be. The government has a lot of work to do to make things better.

People are already facing mental health disorders, with significant challenges in Nigeria, if we do not intervene early enough, we can likely describe ourselves to be sitting on a keg of gunpowder. If something is not done urgently, we will have ourselves overwhelmed with the situation.

We are aware that quite several mental health practitioners, like other health practitioners, are leaving the country in droves because of the economic and security situation and even the remuneration that they are receiving. If that trend is not stemmed, we are sitting on a keg of gunpowder. The few of us that are left around, are already being overstretched. If nothing is done soon enough, we hope those old ones will not leave or break down.

Access to medicines

The issue of access to medicine is also a major one. The cost of drugs is going up, and we need to look at what, where, and how. We will need to intervene and bring the cost down. Most, if not all of the medications used in psychiatry are largely imported, and they are denominated in dollars.

The cost has become astronomical, and people who have mental health challenges are finding it difficult to access the medication. Going off the drugs without supervision will lead to recurrence of all the symptoms, and then people are more likely to relapse.

Integration of mental health

In this new year, integration of mental health into primary health care as said in the Mental Health Act, and of course also in the Mental Health Policy for 2023, should actually be done. The 2013 one said the same thing, but nothing was done. We need to have integration.

We need to have the integration fully done so that people will not need to travel or move so many kilometres before accessing mental health care. We need also to encourage members of the profession to continue to give adequate service to people with mental health conditions. So, doing all these will help in advancing mental health care in this new year.

We thank the Honorable Minister, Coordinating Minister for Health, for what he has done thus far. But there’s room for improvement, and we believe that that will be done as soon as possible.

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