Mental health is very undermined in Nigeria and sufferers are often ascribed as suffering from a spiritual affliction. The devil is almost always blamed as the cause of mental health problems. You would expect this notion to be propagated by lay (non-medical) people, but surprisingly and unfortunately, some medical professionals give credence to this fallacy.
By the way, the term ‘madness’ is now archaic and obsolete. Among other reasons, it is derogatory and encourages stigmatization. More respectable depictions are mental illness or mental health condition.
It is sad that in 2022, people suffering from curable mental health conditions are allowed to roam the streets, often covered in filth and rummaging through refuse dumps for food. If people with other medical conditions are admitted to hospitals and treated, why not people suffering from schizophrenia or psychosis, which are as medical a condition as any other medical conditions you can think of. Looking scruffy, dishevelled or unkempt are not synonymous with suffering from mental health conditions. You can wear a suit and still suffer from schizophrenia.
The neglect of mental health in Nigeria is systemic and multifaceted. Firstly it is not a government public health priority. Governments do not feel embarrassed having people with mental health problems congregate at important landmarks in their state capitals and making a home for themselves there. Whenever a new government comes into power, the best you can get is an ‘executive order’ or an ‘ultimatum’ to ‘clear’ the state capital of ‘mad people’, like they are refuse. Clear them to where? Shallow solutions for complex problems.
Secondly, mental health is not a health system priority in Nigeria. Of all the medical specialties in Nigeria, it is probably the most underdeveloped. The field of psychiatry is not regarded as important enough by the health system. For starters, there are only 8 federal psychiatric hospitals in the country (Enugu, Kaduna, Calabar, Maiduguri, Sokoto, Yaba, Abeokuta & Benin) with a combined annual budget of roughly 16 billion Naira. The 20 federal medical centers on the other hand, gulp almost 100 billion Naira annually.
To put this in context, Nigeria’s population is over 200 million people. One in every four Nigerians (over 50 million people) is said to suffer from a mental health condition. Nigeria has the highest case load of depression in Africa and ranks 15th in the incidence of suicide worldwide. Yet there are only 8 dedicated federal psychiatric facilities in the country. Less than 10% of people suffering from mental health conditions have access to the care they need in the country.
The mental health workforce shortfall in the country is mind boggling. It is estimated that there are only 250 (give or take) psychiatrists in the country. In Kwara for instance, there were only 12 psychiatrists in the whole state as at 2020, and all of them were based in Ilorin. As at 2016-2017 I knew of only one psychiatrist in Owerri. In Yaba, Nigeria’s busiest psychiatric hospital, half of its psychiatric residents resigned in the last 5 years, in search of greener pastures overseas, or to private hospitals. In contrast, psychiatrists are among the most sought after and best paid specialists overseas. Admission into psychiatry residency training positions is very competitive in these countries.
Lastly, the spiritualization of mental health problems doesn’t help matters. Families will rather take their wards with mental health problems to a church than to a hospital. Their pastors encourage them to do so as these people are said to be possessed by the devil. A lady once presented to a private hospital where I worked with severe agitation and aggression. After we managed to tranquilize her, my medical director instructed me to ‘refer’ her to a certain pastor xyz in one church of fire and deliverance ministries. To my utmost shock, he said he had taken a detailed history from the family and that it was clearly a ‘spiritual attack’. No surprise anyway, my MD himself was a pastor.
There is no shame in suffering from mental health conditions. Just as one can be diagnosed with lung cancer, one can also be diagnosed with depression, anxiety, schizophrenia, etc. There should be more government funding and health system prioritization of mental health. Each state should have at least one specialist center. Incentivise psychiatrists and see doctors naturally gravitate to psychiatry residency. Invest in mental health!