Depression: The Nigerian narrative
The World Health Organisation (WHO) in its constitution defined health as follows: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” WHO further defines mental health as a “State of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” From the foregoing, it is obvious that there can be no health without good mental health. The 1999 Nigerian Constitution as amended guarantees the right to health for its citizens. It is noteworthy at this juncture to remind all about the axiom, “Health is wealth.” At no other time in our nation’s history has the call for the diversification of our economy become more strident. Many have advocated for a greater emphasis on human capital development as a way out of the economic recession currently plaguing our beloved country Nigeria.
The theme for the April 7, 2017 World Health Day as espoused by WHO is “Depression: Let’s talk.” According to WHO, the theme for this year’s celebration has been chosen because it provides member nations with a unique opportunity to mobilise action around the phenomenon of depression more so as it can lead to suicide which is at present the second leading cause of death among 15-29-year-olds. A primary aim of the 2017, World Health Day theme is to improve the awareness of the public about the symptoms of depression, its causative factors, preventive strategies, and ways to access evidence based care which will ultimately improve the outcome or prognosis of the illness.
Depression, a form of mental illness, is a clinical condition characterised by “persistent sadness, loss of interest in previously pleasurable activities and low energy level all occurring within 14 days. Other symptoms include: change in appetite, poor sleep, poor attention and concentration and expression of guilt feelings and thoughts of self harm or suicide. It is imperative to mention that factors associated with an increased risk of suicide include: male gender, age less than 40 ears, being single, divorced or widowed. Other factors include the presence of marked hopelessness and the expression of suicidal intent either verbally or in writing. According to WHO depression alone accounts for 10 per cent of years lived with disability globally and as many as 1 in 5 people are affected by depression and anxiety in humanitarian emergencies and ongoing conflict. Recent media reports from several Neuro-Psychiatric hospitals in Nigeria reveal that the incidence of mental illness, depressive disorders inclusive is on the rise.
There is no known single causative factor of depression. Genetic factors have been proposed as a vulnerability factor for developing a depressive illness. There are also biochemical theories that attribute changes in some neurotransmitters in the brain as causative factors of depression. Some psychosocial theories link the development of a depressive illness to the loss of a libidinal object, experience of stressful life events and development of depressive negative cognitions.
A wide variety of biological and psychosocial therapies are available for the treatment of depression. An emerging challenge, however, is the rising costs of medication and cost of accessing treatment in mental health institutions in Nigeria. Payment for such services in Nigeria is still largely by direct out of pocket payment. Another unsavory report is the poor budgetary allocation to mental health care. WHO posits that low income countries like Nigeria invest less than one per cent of their health budget on mental health care. Majority of the institutions that provide professional mental health care services are located in the urban areas and individuals with depressive illness residing in rural areas have to overcome some logistic challenges before they present in such institutions for treatment. Only a few Non-Governmental Organisations (NGOs) exist to crusade for improved care of the mentally ill in Nigeria. Giving effect to the spirit and letter of Primary Health Care that incorporates mental health as its ninth component will improve access to mental health care for all and reduce the stigma associated with the illness. Lagos State and few other states are blazing the trail by making mental health care services available at Primary Health Care centres. Other states should take a cue from them. The 1991 Mental Health policy needs to be reviewed and updated in keeping with contemporary realities. Government needs to exercise the political will to ensure that the Mental Health bill is enacted. WHO avers that Mental Health Legislation serves as a key component of good governance, especially concerning issues related to protection of the human rights of the mentally ill, involuntary admission, professional training for mental health workers and the framework or structure for service delivery.
The media has played a prominent role in respect of disseminating public health education about the early symptoms of depression, its associated stigma and how to access treatment. Ignorance about the etiological basis of depression is responsible for the incarceration of individuals in traditional and spiritual “healing” homes. The latter phenomenon worsens the prognosis of the illness and collectively diminishes humanity.
The Federal Ministry of Health should conceptualise culturally appropriate and evidence based guidelines for identification and management of depressive disorders. Such guidelines should be incorporated into the curriculum for the training of Primary Health Care personnel in Nigeria. As the frontiers and the platforms for discussing this phenomenon in Nigeria expands, multi sectoral and inter agency collaboration will be required such that first responders in emergency and crisis situations will be equipped with the knowledge and skills of early identification of depressive disorders and prompt referral for expert care. The latter recommendation becomes imperative in lieu of the prevailing phenomenon of terrorists’ activities, attacks from herdsmen and its sequelae of numerous internally displaced persons camps in Nigeria.
In conclusion, measures to address the prejudice, discrimination and stigma experienced by those with depressive illness should be developed and implemented. Non-Governmental Organisations, Community Based Organisations and Religious Organisations also have a role to play in expanding the frontiers of our discussion about depressive illness in Nigeria. Indeed the implementation of best global practice in the care of those with depressive illness in Nigeria begins with all.
• Lawani Ambrose, a psychiatrist, wrote from Benin City
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