How To Make Mental Healthcare Accessible In Nigeria

This year’s World Mental Health Day commemorated on October 10, comes at a time when life across the world has been affected by the COVID-19 pandemic.

It has come with a great deal of challenges for people of all walks of life, cutting across different careers, from medical practice to teaching as well as people of all ages -students, adults and children-  as fear and anxiety has gripped all.

According to the World Health Organisation (WHO), the pandemic has put those with existing mental health conditions under even more strain and a greater feeling of social isolation.

In conflict regions and places of war such as the North East that has been ravaged by insecurity perpetrated majorly by Boko Haram, one in every five people who have lived through wars and conflicts have mental health issues, WHO revealed.

With this year’s theme, “Mental Health For All”, it is important to consider the fact that healthcare remains inaccessible to a huge population of mental health patients in Nigeria.

According to Mentally Aware Nigeria Initiative, statistics have shown about one in four persons will experience mental health problems in their lifetime. 

With a population of approximately 200 million, it means around 50 million Nigerians battle with some sort of mental illness.

Majority of mentally ill persons are diagnosed with depression, anxiety and substance abuse-related disorders.

There are less than 250 psychiatrists in Nigeria which means there is one psychiatrist to 800,000 people. One factor worsening the situation is the legislation in place where it comes to mental health in the country. 

The Lunacy Act of 1916, amended in 1958, is a colonial law which is still used to govern mental health in Nigeria. Apart from it being very outdated and largely custodial compared to legislation in other African countries, it in no way protects victims of mental illnesses.

It leaves room for unlawful detention of those who fall under the umbrella of lunacy, which can be easily interpreted in different ways and even lead to wrongful detention of those who are mentally healthy. It also encourages stigmatization of the mentally ill.

In August, HumAngle widely reported the cases of victims locked up and abused by their relations in an effort to cure them of ailments, which a psychologist, Dr. Fatima Akilu, blamed on the lack of awareness of mental illnesses.

A recent publication by Human Rights Watch (HRW) also revealed a number of people with mental health disorders chained up in religious institutions under the guise of treatment.

Apart from this, reports of neglect, assault and other types of maltreatment have been widespread, all due to the fact that those who have been misdiagnosed go through even more traumatizing experiences like stigma, abuse and discrimination.

What’s Hindering Accessibility to Mental Health Care In Nigeria?

Dr. Victor Ugo and Mr Ward Ifedayo said there were several factors affecting the delivery of mental healthcare services in the country.

“These factors range from socio-economic, religious to cultural factors. In a number of traditional Nigerian societies, mental health is a practically forbidden topic to discuss, particularly among younger people in the society. This makes this quite difficult for people to speak about how they feel.

“Individuals living with mental illnesses/disorders and their family members are also discriminated against and treated as outcasts.

“A lot of religious bodies and preachers also portray mental illnesses as punishment for sins or wrongdoings by an otherworldly being. This makes it difficult for people within those groups to seek mental healthcare from the right channels.

“Socio-economic factors such as poverty, stigma and lack of infrastructure also limit knowledge and access to mental health services,” Ugo and Ifrdayo said.

How Viable Is Availability Of Mental Health Care For All?

Speaking to HumAngle, Ugo, the founder of Mentally Aware Initiative, and  Ifedayo, the director, said although the COVID-19 pandemic posed a lot of challenges, it also presented an opportunity for the health sector in Nigeria to get it right, particularly with regard to mental health.

“The first step is to first repeal the Lunacy Act of 1958, which is older than independent Nigeria. Then, pass a new mental health law, one that takes into cognisance, rights and autonomy of every person living with mental health conditions as well as a funded mental health policy and plan,” the mental advocates said.

In 2003, the National Assembly considered a bill to replace the Lunacy Act with a new Mental Health Act. It was later withdrawn in 2009, they said.

The advocates noted that attempt to commit suicide was still a criminal offence in Nigeria and called on civil society organisations to develop a national suicide prevention strategy.

They said such strategy should be “one that has a cross-sectoral integration and approach. This of course should happen after we would have done away with the law that  decriminalises suicide.”  

They also advocated investments in intervention programmes for the most vulnerable victims, amongst other things.

“We need to start to think about the return on investment from investing in early intervention as well as prevention and promotional activities targeted at the most vulnerable in the population.

“We need to start to scale the World Health Organisation Mental Health GAP programme which has been piloted in different parts of the country, to develop the capacity of health workers of different cadres to respond to mental health complaints as defined by their capacity,” Ugo and Ifedayo said.

Another aspect that needs to be considered for a possibility of mental health services to be accessible is a global fund for tuberculosis (TB), AIDS and malaria. 

They said Mentally Aware had established that there was a direct relationship between TB and AIDS and mental health.

“We need to most importantly integrate mental health into primary health care; make sure that people coping with mental health conditions have access to national insurance plans,” the mental health advocates said.