Concerns over hurdles to mental healthcare in Nigeria

Despite the growing rate of mental illness in Nigeria, access to care remains very limited, findings have revealed

Investigations revealed that the high cost of care, inadequate facilities, personnel and the non-implementation of the Mental Health Act two years after it was passed, among others, are some of the challenges hampering access to mental healthcare in the country.

As Nigeria joins the rest of the world to mark this year’s World Mental Health Day, experts have called on government and all stakeholders to increase efforts towards addressing the challenges. The theme of this year’s commemoration is ‘Mental Health at Work’.

According to the World Health Organisation (WHO), mental health is a state of mental well-being that enables people to cope with the stresses of life, realise their abilities, learn well and work well, and contribute to their communities.

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The president of the Association of Psychiatrists in Nigeria (APN), Prof.  Taiwo James Obindo, said one in four Nigerians suffers from mental illness.

He said this translates to over 60 million Nigerians suffering from one of the various mental illnesses.

Quoting the last mental health survey done in 2006 which he said also aligned with the estimates by the WHO, he said between 2006 and now, the so many socio-economic issues, security issues, loss of employment and livelihoods, that are also precursors to poverty, have put a lot of Nigerians under the radar. 

He said the mental health gaps have also widened the difference between those who have the illness and those who are able to access appropriate care.

He said, “So we have had increase in the number of people who have mental illnesses, and increase in relapses among those who have had the illness because they find it difficult to access care and to even be able to afford their drugs. The cost of drugs has gone up significantly, and other gaps. Therefore, we can project that surely the burden will have increased.”

Prof, Obindo said about 85 per cent of Nigerians have no access to mental health care. “So only about 15 per cent of Nigerians are able to access appropriate care,” he added.

Reasons for poor access to mental health care

Prof. Obindo said the fact that mental health facilities are mainly located in city centres continues to limit access to care.

He said other reasons include the lack of awareness of the causes and the best way to access care for mental health conditions.

He further explained that less people are able to access care because of the cost of care that has gone up and some cultural and religious beliefs that becloud them.

He said the non-implementation of the Mental Health Act is also a major challenge.

“There are so many things in the act that will improve the wellbeing of those who have mental health conditions and help us manage patients better. By December, it will be two years since the act was signed. January next year it will be two years after gazetting of the bill of the act. Since then, we have not had even one step fully implemented.

“Yes, the Federal Ministry of Health has started by having a stakeholders’ meeting to look at the road map, even that has not been finalized and has not been launched. So presently, we are where we were. The Lunacy Act, or the Criminal Code, is still in existence, working with the act.”

He said another challenge is the inadequate number of mental health experts in the country which is also fuelled by the ‘japa’ syndrome.

“Presently, we have probably less than 200 psychiatrists in the country of 240 million Nigerians. That translates to having one psychiatrist to over a million of the population, whereas the recommendation by WHO is one to 10,000. In some advanced climes, they even have one to 8,000 or 6,000.

“There was a report by the College of Medicine, University of Ibadan, that out of about 150 graduates, only one person indicated interest in staying behind after graduation. It has also been documented that out of five recently qualified fellows, two or three will leave within a year of completing their programmes.

“So that is where we are. We have more psychiatrists, Nigeria trained psychiatrists outside the country than we have in the country present.”

The founder of Mandate Health Empowerment Initiative and Convener of the Association of Mental Health Reform Organisations in Africa Network, Ameh Zion Abba, said a critical look at the growing population of Nigeria and the availability of mental health professionals in the country showed there is a huge gap in terms of access to quality care.

He said the major challenge to mental health care in the country is the lack of full operationalisation, adoption and implementation of the Mental Health Act, adding that the cost of care, and few treatment facilities, also posed a great challenge to assessing quality mental health care.

Way out

Prof. Obindo called for increased awareness, increased budgetary allocation to health and mental health sectors, reduction in emigration of mental health workers and implementation of the Mental Health Act that will also lead to establishment of the Department of Mental Health in the Federal Ministry of Health.

He said, “There seems to be some level of awareness, but we are not where we are supposed to be. We need to increase awareness. We need to sensitise people the more and then pay more advocacy visits to those who are concerned, the major stakeholders.

“We need to improve the allocation, budgetary allocation to health and, by extension, mental health.

“We need to implement the Mental Health Act to make sure that we have a department. The Act talked about setting up a Department of Mental Health in the Federal Ministry of Health, and that department will now set up assessment committee, set up the monitoring committee, and then we’ll be able to look at people who are quacks working in the mental health landscape.

“We need to reduce the emigration of mental health practitioners; psychiatrists, the clinical psychologists, and social workers among others.”

A mental health advocate, Ameh Zion Abba, explained that there are five key areas that the Mental Health Act will address if fully implemented.

“The first is providing leadership, unifying the leadership role and care and services for the Nigerians.

“Secondly, providing legal framework that will predicate all of the engagements for the good people of Nigeria. Thirdly, it will protect the human rights of Nigerians, especially as it relates to their mental wellbeing. Again, in this act, you will find that there’s also the provision of the protection of persons that come down with mental health conditions.

“So, there are quite a number of very, very key elements that this act is supposed to be providing for us. We see that one of the major challenges for us is the operationalisation of this good and well-meaning piece of legislation.

“We want to see political will. We want to see involvement from all stakeholders, including the international development partners operating in Nigeria. We want to see their involvement in ensuring that this Act does not gather dust on the shelves. So, we want to see how everyone will be involved in ensuring that there is full operationalisation of this act at all levels, including state and LGA levels.”

He added that this will also mean full integration of mental health services at the primary healthcare centres and investment in mental health in the country.

“There is close to zero investment for mental health in Nigeria. The only thing we are seeing is little implementation by some international development partners.  We want a coordinated investment into mental health.”

He also called for the activation of the mental health fund adding, “We want to see clearly what exactly is being done as being guided by the act, especially in the expenditure of this fund.”

While calling for appropriate coverage for mental health in the National Health Insurance Authority (NHIA), he said there is need for investment in mental health personnel, including appropriate remuneration for them, adding that it will help tackle brain drain among them.

“So we want to also see investment in terms of capacity building, training, support and also remuneration. They should enjoy what they are doing, especially with the growing socio-economic problems and cost of living in the country.”

The Coordinating Minister of Health and Social Welfare, Professor Muhammad Ali Pate, said the federal government was working towards improving the mental health and well-being of Nigerians.

Speaking at forum on Suicide Prevention, he said government was working towards decriminalizing suicide and prioritizing other policies and programmes towards improving mental health in the country.