Experts identify 6 challenges in managing mental disorders

Psychiatrists have identified six major challenges in the management of mental disorders in the country, the News Agency of Nigeria (NAN) reports.

The challenges, according to them, include inadequate funding, dearth of manpower, high cost of treatment, poor facilities, lack of infrastructure and obsolete mental laws.

The medical experts said this while fielding questions from the News Agency of Nigeria (NAN).

Prof. Olayinka Omigbodun, a consultant and Head of Department, Children and Adolescent Psychiatry, University College Hospital (UCH), Ibadan, attributed the challenge to neglect of rising cases of mental disorder in the society by relevant stakeholders.

“The Nigerian government has not put enough emphasis on this area of health challenge which is on the increase daily.

“For instance, out of every 20 admission made daily at the UCH, six or seven are generated from schizophrenia.

“Half of this admission is discharged early after full recovery from treatment, but a lot others remain for longer periods of time in the ward.

“In a population of about 170 million people or thereabout, it is speculated that about 64 million Nigerians suffer from one form of mental disorder or the other deserving attention.

“Government had done much in the area of Primary Health Care and HIV/AIDS, much is yet to be done in the area of psychiatry and mental health and this is a little disheartening.

“In a population of about 170 million people, we only have about 250 psychiatrists. The nurses and social workers are even fewer than the doctors.

“This is because of the stigmatisation of people who are care givers for those with mental disorders. So, most of the patients are managed unprofessionally at home.

“A more serious problem is the way many families hide their wards and children at home because of social stigma and the patients end up being in permanent conditions of unwellness.

“These are probably the cases you see on the streets,’’ said the expert.

She defined mental disorder as a condition that influences the way a person thinks, feels, behaves or relates to others and to his surroundings.

The psychiatrist said although the symptoms of mental illness could range from the mild to severe, a person with an untreated mental illness often is unable to cope with life’s daily routines and demands.

Omigbodun called on government at all levels to commit more funds to the management of mental disorders in the country.

A Social Welfare officer in Oyo State Ministry of Women Affairs told NAN on condition of anonymity that the state government engages in intervention activities for those found on the streets.

“We rescue the subjects off the streets; give them stabilisation intervention depending on the severity of their condition.

“We do not have facilities to take care of them, but we liaise with NGOs that run mental homes.

“After their stabilisation, we get necessary information of their relations and we repatriate them to their various families.

“Evacuation should be carried out simultaneously by respective states so that as a state is evacuating, it is also receiving its share of repatriated subjects who would then be released to their families,’’ he said.

Another psychiatrist at the University of Ibadan, Prof. Oye Guruje, said mental healthcare must be given priority because its burden outweighs that of HIV/AIDS.

“Mental illness is one of the major contributors to disease burden globally; it is the sixth largest burden worldwide and this is much more burdensome than HIV.

“In Nigeria, about one out of seven will have serious mental illnesses, while about one in four has some form of mental disorder and this is a conservative estimate,” he said.

Guruje said accessibility to professionals was imperative as mental illnesses could be treated with the right care.

“Every mental disorder has some form of treatment; whether the person will fully recover depends on the type of illness.

“For example, dementia has no very effective treatment yet while there are effective treatments for depression, including non-medication like psychological treatment,” he said.

Guruje, who is also the Director, World Health Organisation Centre for Research and Training in Mental Health, Substance Abuse and Neuroscience, however, said there were no specific causes of some mental illnesses.

According to him, some might be due to heredity, stress factors and lifestyle.

Guruje said that people should watch out for symptoms like lack of adequate sleep and changes in behavioural pattern as signs of mental stress.

Dr Oyewole Adeoye, the National Coordinator, Mental Health Awareness Foundation of Nigeria, said that mental health policies should recognise and address issues that affect mental health.

He said poor mental health is as a result of human rights abuses, poverty, gender discrimination and unhealthy lifestyles.

“There is a rising incidence of mental health illnesses in Nigeria and the society has not got the full grips of the fact.

“Mental disorder is associated with societal vices, socio-economic pressures, emotional problems and political injustice like terrorism,” he said.

Adeoye said that people with mental health problems should not become outcasts in their society.

“Mental illness is like any other form of disease and victims should be treated with respect and dignity,” he said.

Also responding, Dr Sajo Sunday, a consultant psychiatrist and Chief Medical Director, Neuropsychiatric Specialist Hospital, Akure, attributed mental disorder to biological and environmental causes.
He told NAN that scientific studies had shown that mental disorder was usually the combination of biological and environmental causes, “although most of the disorders were not pinpointed to a particular cause’’.

According to him, the biological causes include genetics which makes human beings products of their parents.

“This explains why offspring usually have some of the traits of their parents, and there is a 45 per cent chance of inheritance of the disorder from parents.

“Some conditions that occur in prenatal and postnatal stages can also cause mental disorder.
“For instance, lack of certain nutrients by a pregnant woman could trigger mental disorder in the baby she is carrying.

“General medical condition such as hypertension, diabetes, stroke and HIV can actually predispose mental disorder.

“That is why we believe that anybody can develop mental illness at any time,” he said.

According to him, anxiety, depression, head injury and others can also affect the brain which might lead to mental disorder.

He listed environmental causes of mental disorder to include life events such as loss, sexual harassment and physical abuse.

Sajo, who said that gender was mostly linked to a particular disorder, pointed out that men were more prone to mental disorder going by statistics of patients treated in the hospital.
The CMD said that men usually abused drugs and dangerous substances the most and that accounted for the high rate of mental disorder among men, “since substance abuse is also a cause of mental disorder”.

He said that disorders caused by depression and anxiety were more common with the female gender “while schizophrenia carried the same percentage for both genders’’.
“The treatment of mental disorder is basically divided into physical and psychological treatment.

“The physical treatment consists of pharmacotherapy which is the use of drugs or it could be the use of machine as a form of therapy.

“There is the electro convulsive machine which uses electro convulsive therapy to induce seizure to cure them.

“We also have a clinical psychologist who counsels the patients, this is called psycho therapy under the psychological treatment,” he said.
However, a source at the Nigeria Drug Law Enforcement Agency, Ondo State Command, said that the command had no rehabilitation programme for victims of mental disorderliness.

The source, who spoke on condition of anonymity, noted that the command usually refer victims of mental problems to psychiatric hospitals for medical care.

According to the source, the command has 10 rehabilitation centres for drug abuse users.

In Abeokuta, Dr Abayomi Olajide, a Consultant Psychiatrist, lamented the lack of proper legislation for the care and management of the mentally challenged.

Olajide of the Neuropsychiatric Hospital Aro, Abeokuta, said that mental disorder remains a menace and the most neglected aspect of medicine in spite of its prevalence of cases.

He noted that the Mental Health Bill in the National Assembly had been not been passed in the last 10 years even though it was categorised as an executive bill.

“As of now, there is no modern legislation backing the operation of mental health services except the obsolete 1914 Lunacy Act.

“The mental health policy domiciled with the Federal Ministry of Health is moribund and hardly do we find mental health desks in any state ministry,” he said.

Olajide added that there is no clear policy direction as to how a sufferer can be treated and no specific budgetary allocation for mental health services.

“There are no social welfare services in most states of the federation and the Federal Government.

“There is no specific budgetary allocation for mental health services except what is given to the psychiatric hospitals for running and personnel costs; and oftentimes for capital projects.

“Because of lack of commitment from government, the traditional healers take advantage of the situation, exploiting patients and relatives physically and sexually abusing patients,” he said.

According to Olajide, the causes of mental disorders include genetic causes, environmental, social, psychological, poverty and substance abuse.

Mr Akinpelu Aina, the Chairman, Ogun Assembly Committee on Health, said that some of the causes of mental disorder had to do with poverty in the country, spiritual attack and disappointment being encountered as a result of joblessness.

He warned that people with mental disorder could perpetrate evil if care was not taken, adding that “they are senseless and could harm anybody at anytime’’.

Aina also said that there should be a law that would protect people suffering from mental disorder.

The Ekiti State Government, however, called on parents and relations of mentally challenged persons in the state to work toward finding permanent solution to it.

The Commissioner for Environment, Chief Bisi Kolawole, also called on religious organisations in the state as well as NGOs to extend their activities to regular counselling of youths against consumption of illicit drugs.

He said findings had shown that drug consumption contribute more than 90 per cent to mental ailments in the state.

Corroborating him, the State Commissioner for Health, Dr Ojo Olurotimi, said though there was no specialised psychiatric hospital in the state, Ekiti State University Teaching Hospital and Federal Medical Hospital, Ido-Ekiti, have departments of psychiatric patients.

He said these were the hospitals where psychiatric patients were given primary treatment.

The commissioner, however, said there were plans to extend this service to all the 18 general hospitals spread across the 16 local government areas in the state.

The Permanent Secretary, State Hospital Management Board, Dr Kolawole Aina, also disclosed that the state government recently approved immediate recruitment of more doctors and nurses to cater for the health needs of residents.

The State Commandant of NDLEA, Mr Suleiman Jadi, said psychiatric patients were often referred to Aro Psychiatric Hospital in Abeokuta, Ogun.

The State Director, National Orientation Agency (NOA), Mr Dayo Famosaya, said his agency would intensify its campaign against illicit drug consumption.

He commended the state government for recently banning public smoking in the state, a move he said would discourage youths from engaging in smoking of Indian Hemp.

NAN reports that lunatics currently roam the streets in the state as there is no law banning them while there are more males than women.

Investigation also revealed that families and relations of affected persons often prefer taking them to traditional homes for treatment.

In Osogbo, stakeholders decried the insensitivity of the state government to mentally challenged persons in the state.

According to them, no single policy statement or initiative had been evolved since the creation of the state to take insane persons off the streets for rehabilitation.

Mrs Folashade Umar, an environmental activist in the state, said successive administrations in the state had not deemed it fit to build any rehabilitation centre for the mentally sick.

“It is a common phenomenon in Osun to see different types of mentally deranged persons roaming about the streets of Osogbo, the state capital.

“It is very unfortunate that a state like Osun did not build a single rehabilitation centre for mentally challenged persons and there is no single effort on the part of government to get them off the streets.

“Even within Osogbo metropolis, there are many lunatics around the popular Ola-Iya junction and many of them are roaming around the metropolis,” Umar said.

Speaking in the same vein, the Executive Director of Green Consciousness Initiative in the state, Mr Goke Ibironke, said government in the state was not doing enough to help lunatics live a decent life.

“Successive governments in Osun, including the present one, have not been favourably disposed to the welfare of lunatics; they have totally neglected them without iota of compassion toward these people.

“Inspite of the laudable achievements of the present administration in the area of environment through O’Clean, Igi-Iye and others, lunatics were left on the streets without care,” he said.

Mrs Abosede Ajadi of the NOA, Osogbo, however, urged Nigerians to avoid stigmatisation of people treated for mental disorders.

Ajadi said that their reintegration into the society should start from their immediate family, friends and neighbours, who will be the first set of people they deal with.

She said NOA, through community campaigns and public enlightenment programmes, reiterated the need for people to show love to one another and people with special needs.

A Consultant Psychiatrist at the University of Ilorin Teaching Hospital (UITH), Dr Abdulganiyu Olarewaju, on his part called on the Medical and Dental Council of Nigeria to regulate the activities of traditional mental homes in the country.

The Consultant told NAN in Ilorin that the practices of these mental healing homes were unethical and should not be encouraged.

According to Dr Olarewaju, many of the traditional healing homes compound the problems of mental patients because of their crude methods.

He said many patients taken to the traditional homes ended up with serious physical disabilities while some were physically and sexually abused.

“Many of the unorthodox practices at the traditional homes are at variance with modern psychiatric practice because they belong in the Stone Age,” he said.

He said many of the concoctions prescribed by the traditional healers contained anti psychotic agents that usually gave the patient side effects.

Olarewaju said the concoction often throws the patient into tremor with muscle rigidity, body stiffness and excessive drooling of saliva.

The consultant, therefore, called for proper training for traditional healers like the traditional birth attendants so that they would have the rudimentary knowledge of psychiatric practice.

This would enable traditional mental health healers know that they can only manage minor mental cases and not major ones.

Olarewaju also said that in an effort to tackle stigmatisation, the association came up with community psychiatric practice where patients would be able to access care close to their homes.

“In community psychiatric practice, we don’t want people to be kept in psychiatric hospital so that the issue of stigmatisation will not be there,’’ he said.

Olarewaju, who identified depression as a major causal factor of mental disorder in Nigeria, added that abuse of substances like cocaine, cannabis, coffee and alcohol could also lead to mental ailments.

He also said some people could mental health problems through inhaling putrid gas from pit latrine and gas from petrol.

Olarewaju said people with severe depression were prone to suicide, adding that four to 10 per cent of patients with schizophrenia were also prone to suicide.

The consultant said the Behavioural Sciences Department in UITH admits patients with mental health challenges, while NDLEA in Ilorin has a rehabilitation centre for substance abuse users.

He said psychiatric doctors and nurses from UITH often visited the NDLEA rehabilitation centre to attend to patients with mental health challenges.

Meanwhile, the Federal Neuro Psychaitric Hospital Barnawa, Kaduna state, said it treated 12,059 mental disorder cases this year.
Mrs Joyce Ovie, a Medical Social Officer in the hospital, told NAN in Kaduna that the care was to help mental patients regain their dignity.

She said the facility cater for 5,567 males, both new and old, and 6,492 females from January to June.

“We are interested in the well being of individuals and we believe that good life is the right of every citizen so we assist them to regain their dignity.

Ovie said the hospital carried out counselling, social group work, community development and repatriate patients so as to build them up and help them become useful.

She said the facility also provides visits which help to elicit useful information to the management team treating the patients.

Ovie also said the social welfare advocate for patients who are financially handicap, adding that there is no budget allocated to take care of the mentally ill in the state.

A clinical psychologist, Mr Micheal Onotu, also in the hospital, attributed high intake of hard as causes of mental health.

Onutu identified biological, social and psychological problems as causes of mental illness.

He said there are causes induced by environment and stress, adding that other minor causes of mental illness are brain damage, epilepsy, accident in the past which affect the brain and some are born with it.

He said there is no immunisation against mental illness and anyone can fall victim of it, advising Nigerians to be conscious of the way they live and what they consumed.

The psychologist said mental illness affects both gender, adding that observation and studies show that prevalence is equal for both gender but for substance abuse it is higher with the male.

He said there are ethical guidelines, but there are no programmes by government for practitioners to go out and pick lunatics on the road.

He said the hospital partnering with state government which provides subsidy for the hospital.

He said there are good facilities in the hospital to cater for the mentally ill persons.

Mr Adamu Adullahi, Manager, Drug Addiction Treatment Centre in the hospital, also said the facility in rehabilitation is having the capacity to handle and manage all patients who are having drug addiction problems.

Besides, he said the facility lacks adequate personnel in handling drug cases or rehabilitation cases.

Adullahi also added that the centre admits patients with personal motivation.

Mr Samuel Azige, the state Commander, NDLEA, said the agency makes referral to mental unit at the ABU teaching hospital or the federal Neuro psychiatric hospital, Barnawa, but do not handle mental cases.

He said the facilities in the NDLEA are not adequately taken care of for mental persons, explaining that is why they collaborate with the hospitals.

He said the NDLEA offers counselling and identified those that dropped out from school, sacked from job and those that have had their family disintegrated due to drug abuse.

Azige said the agency is conducting sensitisation programmes against stigmatisation or rehabilitated persons.

He urged people to relate with relations with mental disorder through support, love and care.

He added that a follow up action is conducted by asking patients to come on a regular interval for interaction or they visit them in their houses to see how they are coping.

He said there are faith based organisations which mostly use religious techniques to counsel some of the clients.

However, Azige said the clients were not too equipped to handle mental cases because only psychiatric hospitals can manage them properly since they have skilled officers