Prof. James Taiwo Obindo is the president of the Association of Psychiatrists in Nigeria (APN). In this interview, he speaks about barriers to accessing mental health services, the need to assent to the mental health bill, and abolish punishment for suicide attempts among others.
What is the prevalence of mental health problems in Nigeria?
It is believed that 20 to 30 percent of Nigerians are laboring under one form of mental health illness or the other. Look at our population of about 200 million that translates to about 60 million Nigerians suffering from mental illness.
The figure may even be higher given the recent events in the country such as insurgency, kidnapping, and attacks here and there.
The socio-economic situation also means that more people are pushed over the edge. Like unemployment ; a graduate receiving N10, 000 or N15, 000 a month is under paid, and people working before and now disengaged, such pressure could push them into mental illness.
Mental health itself is a state of wellbeing in which an individual is able to realize his potential, able to face normal stresses of life and work fruitfully, productively and is able contribute to the community.
Some one who is mentally healthy will be able to do all these, and it is different from those with mental health disorders.
Generally if well -being ranges from here to there. Mental health disorders starts from there. We all oscillate between there and here.
What is the major difference between mental health and mental health disorders?
Mental health disorders have to do with mental disturbance in the person’s thougths, deviations from acceptable emotions and his or her relationships and interactions with people are also affected.
It therefore means somebody who has issues with their thoughts and probably has delusions , false believes about somethings and difficulty to change the persons mind.
It can also include disturbance of perceptions and also what we call hallucinations. The individual may not also be able to control his thoughts, and may have negative thoughts.
Some thought may not be real but the person is finding it difficult to remove it.
For relationships with people there maybe withdrawal, and isolation.
People with the condition have varying diagnosis from anxiety disorder to depression, schizophrenia, and substance abuse to mention a few.
So mental health is that state of wellbeing which we all desire to have.
The mental health bill which has been passed by the two arms of the national assembly for over a year now is still awaiting President Buhari’s assent?
What we operate on presently is the lunacy act which originated from the colonial masters in 1907 and was later reviewed in 1958.
So what we are working with is that archaic law of 1958, and that law largely separates those who are well from those who are not well . Those who are not well are believed to be dangerous to those who are well. Therefore they are kept in an asylum from the so called healthy and normal people. That kind of disposition to those who are mentally ill stigmatizes them and they are not given adequate attention.
So the mental health bill that has been passed in both lower and upper chambers has been harmonized and passed to president Buhari.So we appeal to him to please assent to the bill.
We also appeal to Nigerians to use their influences in whatsoever way for the passage of the bill into law. You may not have mental illness now or your close relative may not have it ,but there are those who do .
Infact there is hardly any family in this country that does not have one person who has been mentally ill. So for the sake of the weak and the vulnerable pass the mental health bill into law.
The bill includes taking care of those who are mentally ill and the practice itself.
Also , the mental health policy which was initially passed in 2001 and reviewed in 2013 is yet to be implemented because one of the trust of that policy is that mental health should be situated right from the primary healthcare level.
As it is now it is only Lagos State that has some form of mental health care at the primary healthcare level.
There is a bill being proposed by a House of Representative member about de-criminalising suicide attempts, What is your take as a psychiatrist?
There is a criminal act of the country which stipulates a year imprisonment as a form of punishment for those who attempt suicide.
The bill that the honorable member, Francis Ejirogene Waive is proposing is wonderful. It has gone through two readings and it is saying that those who attempt suicide should not be punished at all but should be sent for assessment. The one year sentence or the six months community service should be expunged completely.
He is proposing that that aspect of the law that stipulates a year imprisonment should be removed.
The idea is that people who are ill should not be punished for being ill. Those who are labouring under socio-economic problems and don’t seem to have a way forward should not be punished .
Also even Nigerians being evacuated from the Russian-Ukrainian war will need psychological first aid and counselling, and a few may need treatment.
The pressure and challenges the returnees have gone through put them at risk of anxiety disorders and more serious mental health problems.
So they will need at least psychological first aid . The Association of Psychiatrists in Nigeria (APN) is willing to support government on this, the association works with different stakeholders from government, non -governmental organisations and others .
What are the barriers to receiving mental health care in the country?
Stigma is one of the major barriers to accessing care for example someone who know he will be sent t o prison or community service will not want to access care.
Also the way people look at mental illness , and belief it is something spiritual , inflicted by evil deeds and use of substances could make people shy away from treatment.
Note that it is only a low percentage of mental health disorders that are as a result of substance abuse. And even where substance abuse is the cause of mental illness it should be seen as an illness and the person needs care.
Religious belief is another barrier. People belief they should go for traditional treatment or deliverance at a religious centre. Some come to health facilities initially and then go to traditional healers.
Another one is non-implementation of policies. Like the mental health policy. PHCs should also be a hub of mental health care because they are closer to people at rural areas. The cost of travelling long distance to access care and the cost of treatment make those in rural areas to opt for traditional healers.
So stigma and discrimination affects sufferers and prevents them from getting married, securing jobs , getting political offices and chieftaincy titles among others because of the strong opinion people have about them.
In other climes some serial killers and rapists are treated as mentally ill but here they are all sent straight to prisons. What is your take on this?
That brings me to correctional facilities. In the whole of the country , it is only one correctional centre that has a psychiatrist. Before they have about three , I think one retired.
That is not enough, and it is abhorring and unheard of.
The need for need for psychiatrists, psychologists and psychiatric nurses in the country’s correctional facilities should be emphasized.
What we have presently are psychiatrists in some places volunteering their services, and going to correctional facilities. I have a colleague who even pays for the treatment of the inmates with her own money.
There is a medical review board that each state should set up, that has not been done till now and that board must consist of a psychiatrist who will head the team, psychologists, and psychiatric nurses or other nurses and that has not been set up.
They are meant to review cases of those who are in prison and may need psychiatric assessment and services.
If someone who is alcohol dependent commits a crime and is sent to prison, three days after he has not had alcohol , he will come down with a withdrawal state. And that state could make the person see things .
Some serial killers , rapists have mental illness and the board will review and refer those who need care appropriately.
This enlightenment should go to the police , military, judiciary and correctional facilities that some of these case are mental illnesses.
Do you think we have enough psychiatrists in the country ?
Before now the number was between 250 and 300 psychiatrists in the country but in the last one year, half of that number have emigrated out of the country either to the United Kingdom or Canada.
I was on a zoom call with the president of the Association of Nigerian Psychiatrists in Canada and he said over 150 Nigerian psychiatrists have registered with them. Some have not registered. That number is probably more than what we have in Nigeria.
So the number of psychiatrists, psychiatrist nurses , psychologists , occupational therapists and social workers are very few. You can imagine 0.4 psychiatrist to 100, 000 Nigerians that is about four psychiatrists to a million Nigerians. Even the number of facilities for psychiatric care are also very few. Most General hospitals do not have psychiatrists in their employment.
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