The president, Association of Psychiatrists in Nigeria (APN), Professor James Obindo, in this interview with SADE OGUNTOLA x-rays challenges to maintaining good mental health among Nigerians and what needs to be done

..........The law governing mental health in this country is still largely the Lunacy Act promulgated in 1907, which looks at mental illness as an aberration and a disturbance even to the society, and therefore those who have mental illnesses are meant to be kept away or locked up in an asylum, without care, without plans for them. The mental health policy that was first passed in 1991 and revised in 2013 is just gathering dust on the shelf and is not implemented thus far. Thus, we can see the neglect and lack of priority for mental health.

How will you rate the mental health of Nigerians and what are the predominant mental health conditions in the different gender and age groups?

I will say this is poor and needs urgent and immediate attention by the government. The World Health Organisation’s findings in 2020 indicated that about 30 percent of Nigerians have one form of mental illness or the other. With the COVID-19 pandemic, the security situation in the country and other social issues such as unemployment, it is believed that this figure may have gone up significantly. So, looking at that, you will say that possibly more than half of Nigerians are labouring under one form of mental illness or the other. Mental illness is not just about people misbehaving or those we see on the road; some have issues with the way they think or perceive things even though they are still able to function. But their level of functioning has been significantly reduced.
Predominantly, we will have anxiety disorders topping the chart, followed closely by depression. There are also suicide and suicidal behaviours. Substance abuse in the country is quite rampant. No gender is spared of mental illnesses, although some forms may be more predominant in a gender. The youths have a high prevalence of substance use disorders and anxiety disorders. Every age group is affected by mental illness right from the cradle, even the elderly.

What are the challenges of mental health in Nigeria?

The challenges of mental health are myriad. Topmost is the law governing mental health practice in our country. If the law governing mental health and mental health practice is reviewed, even as done by the Association of Psychiatrists in Nigeria in conjunction with other stakeholders, we will have a better and more robust way of care for those who have mental illnesses. Presently, we have a mental health bill awaiting assent by the president after a very long due process of its review to ensure that it conforms to what is globally acceptable and after it has passed through the rigorous reviews of the National Assembly.
Secondly, the mental health policy which was revised in 2013 has not been implemented. In that policy, the focus is that mental health should be implemented and integrated into primary health care. Up till now, that is yet to be done. General hospitals, and especially the specialist hospitals, are meant to have psychiatrists in their employment. Currently, quite a number of them do not have psychiatrists in their employment.

What are the early predictive signs of mental illness? What are the socio-cultural beliefs about mental illness in Nigeria?

The early signs of mental illnesses include social withdrawal from people. Any deviation from the usual way an individual will think, talk, perceive situations around and relate to society may be symptoms of mental illness. For instance, because of depression, people tend to withdraw into their shells. When sleep, appetite and the way they relate with others are affected, a suspicion of depression can be magnified. Some people tend to have delusions, a false or a wrong belief, which is not in keeping with individuals’ social, economic, or even educational and religious backgrounds and is difficult to change such person’s mind.
People who have mental illness tend to see things others are not able to see; hear what others are not able to hear and feel what others are not feeling. They tend to lose touch with reality. And this depends on the severity of the illness. Some will be seen talking to themselves and running away, even from the people that they used to love and relate with. So, the symptoms are many and depend on the particular type of illness they may be experiencing.
The impact of our socio-cultural beliefs would manifest even in the people accepting that they are ill in the first place. It impacts their help-seeking behaviour and the outcome of mental illness. Quite a number of our people still believe that mental illnesses are spiritual and that people are afflicted with mental illness because of some past deeds or sins. They therefore will seek traditional treatments or spiritual intervention. Eventually, the presentation in the hospital is later than expected and the outcome of treatment is poorer. Even the treatment given in some places is inhuman because of some social-cultural beliefs about mental health and mental illnesses.

What should be the topmost agenda of the Federal Government to ensure universal mental health coverage for all?

The assent to the Mental Health Bill on the desk of the president and the subsequent full implementation of all that is written in that bill. Secondly, we need to make sure that the integration of mental health into primary healthcare is fully done and fully prosecuted. The allocation to mental health should now be a statutory budget line item, so that it is protected. The exodus of mental health practitioners outside the country needs to be stemmed to make sure that our well-trained hands are retained to cater for the people. It is our rough estimate that three out of every five newly trained psychiatrists find their way out of the country. Lastly, the National Health Insurance Scheme needs to cover more mental health conditions and include in their formulary the newer available medications in the country. This will be the panacea even for universal mental health coverage investment.