•Specific pronouncement can only be based on data –Prof Gureje
•’Conditions that predispose to mental health disorders on the increase’
•Hospital records suggest a steady increase, says Dr Umeh

Hardship, exacerbated by fuel subsidy removal, may have brought about negative mental health outcomes in the country even as help is hampered by tight budgets and a lack of skilled staff. In this report, ISIOMA MADIKE, spoke to health experts, who linked the economic hardship to the current mental crisis among Nigerians.

A recent visit to the Federal Neuro-Psychiatric Hospital, Yaba, Lagos, paints an interesting scenario. On the outside, the hospital seems calm. But, on the inside, tensions run high. There is a surge of people waiting to consult with doctors at the outpatient clinic. It was so thick on this day that the crowd spilled into the passage.

In the emergency ward, patients also wait in queue. This reporter was told the scenario is the same almost every day of the week. However a doctor, who does not want his name in print, said there has been an increase of patients in recent times. Though he refused to give reasons why that is so, he stated that the new patients in the hospital present different types of mental illnesses.

While a large number of youths, who are brought to the hospital struggle with substance abuse, the adults are mostly diagnosed with depression. This observation only gives credence to a report from the World Health Organisation (WHO), which stated that one in every four Nigerians suffers from some sort of mental illness.

In Nigeria, only a few federal neuropsychiatric hospitals are functional. Add to this is the dire budget situation, personnel shortfall and health workers that are leaving the country in droves for greener pastures. Some have quit the medical profession altogether.

The projection for better management of mental cases in the country looks as grim for psychiatric care as it does for Nigeria’s healthcare system as a whole.

A man, who spoke to Saturday Telegraph, said he spends over N10,000 to bring his teenage child for treatment at Yaba, daily. Aside from the journey, the endless wait to see a doctor adds to the frustration the family has to endure to see their child get well.

The exhausted-looking father usually takes a full day off work, which also puts his family at financial risk to give his child the psychiatric care that he needs. They make such journeys to Yaba, twice or more every month.

In the over two years since their journey into nowhere, his son’s life is often interrupted by the progression of schizophrenia symptoms. He has experienced homelessness, numerous suicide attempts, inpatient stays and problematic substance use.

As his illness has progressed, so have the voices in his head. These voices have led to violent outbursts with his mother resulting in multiple attacks.

The man, who refused to give his name because of stigma, noted that caring for someone living with a serious mental illness can take a toll. He does not hesitate to say that it has destroyed his family. Friends and family, he said, left, and others in their neighbourhood also treated them like an outcast.

He has learned to build boundaries, including not allowing his sick child to go out unaided. This is one of the hardest decisions he has had to make as a father, but one that has given him time to heal.

However, there are many in this mould in today’s Nigeria, prompting some citizens to say that the current hardship and fuel subsidy removal may have exacerbated the negative mental health outcomes in the country. Some medical experts this reporter spoke to tend to align with this thinking by linking the economic hardship to the current mental crisis among Nigerians.

A Professor of Psychiatric and Director, WHO Collaborating Center, University of Ibadan, Oye Gureje, told Saturday Telegraph that it would not be totally correct to say specifically that there is a surge in mental health issues because “for us to do that, you need to conduct an epidemiological survey, and compare the result with previous rates of mental disorders in the country.

“We can only infer that it is likely that there might be an increase in mental health problems because the conditions that are predisposed to mental health disorders are on the increase. So, on that basis, one can deduce that it is likely that mental health issues are on the rise.

“These issues such as poverty, conditions creating stress, extreme stress, conditions creating fear and anxiety and of course, dislocation, are all prevalent in the country now. With those kinds of conditions, all of those will increase mental health disorders in the community.

“So yes, when these happen, we are likely to be experiencing a rise. But, like I said, a specific pronouncement can only be based on data.”

The professor however, said that anything that is causing increased stress, extreme stress and increased dislocation, social dislocation and emotional turmoil will likely lead to increase in mental health conditions or mental disorders.

He added: “So, the increase in fuel prices, of course, we all know that that is causing a lot of difficulty for people both in terms of being able to afford it and also in terms of being able to procure it. I mean in the last several weeks, we have had difficulties in getting people to get it, even when they have money it may not be easy for them to get.

“And then of course the increase in the price certainly deepened the level of economic distress that people are going through. So, there is no doubt about that. That will be a cause of increasing mental health issues or conditions.

“Of course the other social issues like insecurity, fear and uncertainty that all of those things create, the things that we know from research are precursors for mental disorders. So yes, those are likely to have increased mental health problems in the country.”

Dr Charles Umeh, a Consultant Clinical Psychologist at LUTH and a Senior Lecturer at the Department of Psychiatry, College of Medicine, University of Lagos, agrees when he said that, based on observation as well as what doctors see in the clinic and also based on the kind of consults he gets.

He said: “Yes. And maybe I can say a lot of things could be responsible for the increase. There’s an increased awareness of mental health issues, unlike what it was in the past. That could be another factor. And now people, who had mental illnesses in the past, tend to patronise these faith-based centres and other traditional healers and whatever.

“But now, we’re having a rise in understanding and where to seek help. So, these are some of the issues. Now, let’s go back to the scientific proof.

“Now, if you check WHO, you can see that there has been a steady rise in mental health issues in Nigeria and other parts of the world. If you look at it, you’ll see a major increase since the Twin Tower attack in the U.S. A lot of factors are responsible for that. And here in Nigeria, events are spurring such that so many things are beginning to affect people.

“And I’m almost of the belief that a lot of Nigerians have one mental health issue or another; simply because there is no data to show that, it does not make it a spurious observation.

“There are indices on a daily basis that remind you of that. Also, when we talk about mental health issues, we are not looking at the diagnosis per se. So, if you look at the critical angle, when we say, okay, go to the hospital and check the rates of which people are admitted on mental health issues, you can see that there has been a steady increase.

“Overall, I’m of the opinion that there has been a steady increase in mental health issues in the country.”

Umeh, who doubles as the chairman of Nigeria Association of Clinical Psychologists, Lagos State chapter, said the genetic and environmental factors as well as childhood trauma should not be discountenanced regarding what is causing the rise in mental crisis at present.

“When you merge all these things, then you begin to understand why we could be saying that. Now, when you talk about environmental factors, you are looking at circumstances of living, in which an individual is a major player. And that is where the genetic comes in. Some people have more resilient tendencies than others.

“That means the genetic predisposition is high. And that is exactly where we talk about the diathesis stress model. What is it saying? It says some people might have the genetic predisposition to come down with mental illness. But if the environment and circumstances of their living are right, they might not come down. That means there is a little bit of control from those things coming out.

“Conversely, there are people with that genetic predisposition that any little stress triggers mental health issues. Can you see the point? Now, when you talk about economic hardship that means it’s affecting individuals differently. And what that means, whether they’re going to come down with mental health issues, is their ability to cope or the level of resilience they have built over time.

“So, in a society, you have all this evenly distributed. The tendency is that, yes, the economic hardship will pose some mental health challenges to some people. There are times that you see people calling and talking about wanting to commit suicide because of the hopelessness they find themselves due to this economic situation. That is a pointer that the economic hardship is triggering mental health issues to people.

“Another thing I will use to portray this point is this: when you drive on the road and you see the level of frustration people exhibit on the road, even when it is not called for. You can see that they’re trying to vent their anger in situations they can’t control.

“These are issues that can be able to predict or link the hardship with mental health situations. Above all, we are all living witnesses to the high rate of psychotic substance use in society. “Where is it coming from? A lot of people are looking for something that will enliven them, that will make them happy, or that will make them forget their sorrows.

“That worsens their situation because, you know, psychotic substance use can lead to several mental health issues. And on its own, addiction and whatever, is also a problem. So, that is the situation we find ourselves in,” he said.

He added: “When you talk about the youth, now they say they are the Gen Zs, who do things in a particular way. Why is it that they want to do things in a particular way? Let’s start from the school setting, students don’t believe that they can work hard and pass anymore. So, invariably, they look at other things.

“What is the easiest way for me to get over this? And I think that is what a lot of them are doing now. They are looking for the easiest way. Look at the get-rich-quick syndrome we are experiencing now. Because you believe that working hard does not pay. You find an easy way.

“And those easy ways tend to create a lot of problems in your life and the life of others. So, my take is this: most times, with my interaction with a lot of youths who are doing substances, I tend to pin it on parenting. This is so because you see more youths who go into drugs from dysfunctional homes. I have a lot of them as patients.

“And coming from dysfunctional homes presents them with, sometimes, low self-esteem. And once you have low self-esteem, it mediates a lot of mental health issues. Can you see the foundation? Unfortunately, nobody is questioning the kind of parenting we are having these days. And some of these things can predispose these children to having mental health issues growing up.

“This is so because they have not been equipped with the right attributes, with the skills they need to deal with difficult situations. So, whenever they encounter difficult situations, they are there.

“Another one is the state of the nation. Insecurity, abductions and things like that. It’s building on the psyche of these youths and a lot of them are exposed to several traumatic experiences. These traumatic experiences will dovetail into major mental health issues. So, you can see the avalanche of causes that could predispose these youths.”

However, Gureje and Umeh agree that Nigeria as a country doesn’t have enough and adequate medical personnel to handle the current mental crisis confronting the nation. They both said that Nigeria falls short of the WHO recommended quota.

“How many psychiatrists do we have in this country to take care of the whole population? We don’t have up to 8,000 qualified psychiatrists in Nigeria working now. Do you know what that means for a population of over 200 million people?

“I don’t also think we have up to 8,000 clinical psychologists with a PhD. What about psychiatric nurses? So, if we are talking about personnel, we don’t have enough. In the last five, six years, all the interns I have trained have left this country. None of them are in the country anymore. They are looking at us as old men who have no future ambition.

“So, we are the ones who are in this country. The younger ones are no longer trained to stay behind because the condition of service is pretty difficult here. And they are not well remunerated also.

“You can see currently there is no psychology bill in the nation. We just have a mental health bill. That’s why we are having so many people masquerading as psychologists. Some say they are life coaches without adequate qualification. If you have a psychology bill, that will define who a psychologist is, and what they can do.

“Remember, the first point to measure mental health issues that psychiatrists manage is from psychological distress. If you have people at that stage that will nip it in the bud, don’t you think psychiatric issues will be minimised? This is because they would have to take proper care of the patients before their cases deteriorate into psychiatric situations,” Umeh said.