Tackling economic recession-induced mental health disorders

Nigeria is in a recession, the economy going from bad to worse.

Many have lost their jobs and more employers are still downsizing to reduce cost.

Prices of commodities have doubled as the purchasing power has diminished with many finding it harder to meet their financial obligations .

All these come at a cost: a rise in mental health disorders.

In recent times, there have been increases in cases of documented suicides, violent crimes, depression, and alcohol dependency among other vices that go with economic recession.

The Guardian investigation revealed that most Nigerians, rich and poor do not visit hospitals when they or their relatives show any sign of mental illness. They rather take the patient to religious houses or traditional medicine practitioner and only go to hospital when there are complications.

The Guardian also found that there is stigma associated with visiting a psychiatrist or having been treated for mental health issues, which is fuelling the patronage of quacks, religious bodies and traditional medicine practitioners.

A visit to Federal Neuro-Psychiatric Hospital Yaba, Lagos confirmed The Guardian’s findings: Only severe cases are brought to the hospital;and the centre has not recorded any appreciable increase in the number of patients despite the obvious increase in the number of mental health-related conditions in the country.

The WHO has confirmed that economic crisis is expected to produce secondary mental health effects that may increase suicide and alcohol death rates.

To the WHO ,“Mental health is not merely the absence of mental disorders or symptoms but also a resource supporting overall well-being and productivity.”

However, it is not all bad news. A recent global study indicates that people live longer during recessions because it forces people to be frugal, cook at home, and stop driving cars.

A consultant psychiatrist and former Chief Medical Director of Lagos State University Teaching Hospital (LASUTH) Ikeja, Dr. Femi Olugbile, told The Guardian that here is a positive relationship between economic recession and mental health disorders.

Olugbile said this happens through the pathway of increased stress, which is common at times of social upheaval or difficult economic circumstances, such as Nigeria is currently undergoing.

He said the relationship is not necessarily a ‘direct, causal’ one – that is in the sense that economic difficulties are directly leading to an increased incidence of mental illness.

The psychiatrist, however, said through the pathway of increased stress on the individual, there is increase likelihood that more individuals will reach their ‘threshold’ for various illnesses that they may be innately genetically or constitutionally susceptible to (including even physical illness such as hypertension) but which they might not have succumbed to in the absence of a ‘precipitant’ such as the increased stress occasioned by such circumstances.

Olugbile said there is no clear statistics showing an increased trend but plenty of anecdotal and sensational stories, especially pertaining to suicide, example the recent sad story of a banker in Lekki, Lagos.

However, he said, it is true that a properly confirmed upward trend in suicide could act as a ‘litmus test’ of increased mental illness in a society, since there is a clear link between suicide and depression (as well as a number of other mental health conditions).

On the prevalence of mental illness in Nigeria, the psychiatrist said mental illness (like ‘physical illness’) exists in a large number of varieties, each with different characteristics, different treatment modalities, and different implications for the individual, now and in the future.

Olugbile said the lifetime prevalence of Mental Illness that is the number, out of a hundred citizens, that would be expected to have at least one episode of mental illness in their lifetimes is variously quoted from seven per cent to 15 per cent in Nigeria.

On the connection between economic conditions and rise in suicides, the psychiatrist said: “Most of the evidence locally is anecdotal and comes from sensational stories about students, professionals and even rural dwellers being reported in the press.

The assumption of an upward trend is a reasonable one to make, but it needs to be backed up by properly conducted research. One million people die annually all over the world from suicide.

WHO statistics (2012) ranks Nigeria 102 among the list of nations in the incidence of suicide among the population, with an annual figure of 6.5 for every 100,000 in the population, and a strong male preponderance.

Obviously, a lot of work needs to be done to deal with that, as well as heading off any upward trend.”

Another consultant psychiatrist, Lagos University Teaching Hospital (LUTH) and Senior Lecturer, Department of Psychiatry, College of Medicine, University of Lagos (CMUL), Dr. Erinfolami Adebayo Rasheed, told The Guardian: “It is plausible that the actual economic crunch increased the population’s psychological distress. This period correlates with higher prevalence of common mental disorders, substance disorders, and ultimately suicidal behaviour. It is also that in order to cope with psychosocial stress people might turn to substance misuse.”

The psychiatrist said some key factors seem to make people more vulnerable to the effects of the hardship: being unemployed, having a precarious work situation, facing debts and economic strain, and having a pre-existing mental illness.

Erinfolami said economic crunch might also have a severe and long-term impact on mental health in children and young people, especially if they face stress within the family as a result of economic hardship or parental unemployment.

He, however, said there were no statistics or local studies to buttress this point but economic hardship as indicated by income and available funds for medications had been implicated or associated with relapse of existing mental health issues as well as emergence of new illnesses by many local studies.
Solutions , recommendations to the individual, family and government

Erinfolami said even though the economy can shape populations’ mental wellbeing, better mental health can in turn, be a major contributor to economic growth.

The psychiatrist said policies and cost-effective measures might affect the extent of the risk factors faced by populations and the occurrence of mental health disorders during and after an economic hardship.

He said the WHO has argued that the mental health effects of economic crises depend on action in five key areas: active labour market programmes; family support programmes; regulation of the marketing of alcoholic beverages, restrictions on their availability, and taxation; provision of quality and equitable access to primary care for those people at high risk of mental health problems; and debt relief programmes.

“So if all these are in place, we can reduce the effect on economic crunch on mental well being of our people,” Erinfolami said.

Olugbile urged government to do everything possible to create a conducive economic and general living environment for the citizens, including attending to the needs for creation of a sense of ‘community’ in every living area, provision of amenities, and a cushioning of the worst ravages of economic adversity through some form social security.

“In addition, provision of an all-embracing health insurance system that automatically takes care of all citizens, including the vulnerable and unemployed,” he added.

Olugbile urged families to pursue cohesion. “Mutually supportive cohesive family structures are the strongest insurance against severe stress which may precipitate mental illness,” he said.

The psychiatrist urged individual to embrace supportive family and other relationships. He said the most vulnerable people to the ravages of Stress are those who are socially isolated.

He recommended positive involvement with other people, such as voluntary work, philanthropy, regular exercise, religious faith and moderate practice of positive tenets or religion and ethics.

“Moderate social habits including avoidance of excesses such as alcohol use and sexual promiscuity, are also important,” Olugbile advised.