It is not until a person runs wild in the street in tattered clothing and disheveled appearance that such a person could be said to be having mental health issues. Yet, mental health issues as a phrase can embody an array of concepts ranging from every day worries and challenges that are common (stress, depression) to more serious forms of mental disorders such as psychotic disorders, personality disorders, Obsessive Compulsive Disorder (OCD) and schizophrenia.
This is the reason why it may be hard to dismiss the statistics of the World Health Organisation (WHO) which estimated that about 20 per cent of Nigerians suffer from mental illnesses. Yet, even with this large number of Nigerians with this problem, the issue of mental health has attracted little attention in the country. Experts believe the neglect of this vital sector needs to change, with more investment in mental health issues.
This has led to the call on government to increase investment in mental health as well as pass the Mental Health Bill like some African countries have done.
When can a person be said to have mental health problems? Dr. Boladale Mapayi, a Senior Lecturer and Consultant Psychiatrist/Clinical Psychologist at the department of Mental Health, Obafemi Awolowo University Teaching Hospital, le-Ife, answered that a person can be said to have mental health issues when there are challenges or stressors that have overwhelmed the individual’s ability to cope or adapt with stressful events in their lives.
“At that point, the individuals may begin to have a myriad of unusual experiences which include symptoms of specific mental disorders. These mental disorders usually affect thinking and behaviour and can lead to a wide variety of abnormal behaviour which will usually show the individual’s inability to function in everyday life. This is easily noticed by neighbours, colleagues and family and forces them to seek help. Unfortunately, the pathway to care for most mentally ill individuals in Nigeria is still winding, through the spiritual and traditional centres even though mental illnesses are medical conditions that are well managed with scientifically grounded therapies.”
Reacting to the factors that might have led to increase in mental health issues among Nigerians, Dr Mapayi said the factors may be in two folds as the increase may not be true since mental health illness has always existed but people have labelled them wrongly due to ignorance. However, she added that the myths and barriers are being broken down as people are now willing to ask for help while those suffering from mental illness are now finding acceptance.
“On the other hand, we all know that in recent times the level of stress in the society has increased. Fuel scarcity, terrorist attacks and frequent kidnappings, internally displaced people in conflict situation, struggling small and middle businesses, underemployment, failing naira to the rest of the global economy, falling oil prices, rapid urbanisation, climate change are but a few of the factors that increase the risk of vulnerable people to mental illnesses”, she said.
In the midst of the demand of daily life necessities which may expose many to mental health illness, Dr. Mapayi said there are preventive measures that can be adopted to avoid mental health issues. The preventive measures she said can focus on reducing risk factors and enhancing protective factors.
“Practical steps towards prevention would include paying attention to the warning signs and talking to a therapist when one feels overwhelmed, getting routine medical care, taking good care of your body and mind, adequate exercise, good diet, enough sleep, a vacation now and again, stress reduction exercises and staying away from drugs and alcohol (sorry too be a spoilsport)”, she added.
Unlike the past when mentally challenged individuals are often shackled and beaten, mental health disorders is no longer a sentence to isolation as medications such as physical methods of treatments and psychotherapy are now available in hospitals with mental health professionals.
Commenting on the methods on treatment, Dr. Mapayi raised optimism on the effectiveness of methods used by trained professionals. “They are very effective and give clients the ability to live a productive life and engage with society effectively. These treatments can be given in most good hospitals that have mental health professionals although the global acceptable standard that we are still aiming to achieve is to be abler to treat these disorders in all primary care centres, we are not there yet”.
Advising Nigerians on how they can maintain good wellbeing, Dr. Mapayi admonished Nigerians to learn to relax by taking a minute or two to stare into space or make out time to do what they enjoy. She however warned that these should not include alcohol, drugs, violence and other maladaptive coping mechanisms.
“Increase your physical activity, take an evening stroll, read for leisure, cultivate friendships, add humour to your life, pick up a hobby, volunteer, treat your body right. Build your self-confidence, pat yourself on the back from time to time, manage your stress or get help, live within your means, accept yourself and your limitations”, she stated.
Another expert on mental health, Mr Femi Agberotimi, Clinical Psychologist, Psychiatry Department, Ladoke Akintola University Teaching Hospital, (LAUTECH), Ogbomoso is of the opinion that it is important to make some clarifications on the term mental health, especially the way it is used in Nigeria and the stigma it attracts.
“Just like human physical health can be described in terms of how various parts of the human body function, mental health can be described as the way human mental faculty (brain) functions which can be measured/understood in terms of how we think, feel, and behave. What I describe as the ABC (Affect, Behaviour, and Cognition) of human being,” he said.
He added that as the human body temperature can be said to be normal at 37C, there are certain parameters which are looked out for to say an individual’s mental health is normal. Such parameters include standard of acceptable behaviour set by a society over a period of time, statistical definition of normality by which normal mental health is regarded as such that is experienced by the majority in a given context.
“When an individual’s mental health does not conform to any particular standard of what is regarded to be normal in a society, such is said to have “issues” – what is regarded in technical term as mental illness or abnormal behaviour. To be put concisely, a person is said to have mental health issue when the way he/she thinks, feels, or behaves is not as expected in a given society and at a given point in time. For instance, a grown up person who wanders the street aimlessly dressed in rags will be regarded to have mental health issue. However, mental health issue varies largely in types and severity and across human developmental stages”, he added.
On the factors that may be responsible for mental health challenges, Mr Agberotimi said it can be summed up into two which are the nature (genetic and hereditary) and nurture (environmental).
However, he was quick to add that in Nigeria, the recent increase in incidence and prevalence of mental health problems may be attributed to environmental factors which include stress and issues that can easily trigger anxiety, mood disorder like depression, sleep disorder like insomnia, somatic disorders and even more complicated mental illness like schizophrenia which is understood as madness.
On ways to prevent medical illness, he admonished Nigerians to go for psychological assessment with qualified psychologists and psychiatrists. “Just like regular medical check-up is important, a lot of mental health issues will be prevented and a lot will be better managed”, he added.
Also speaking on the issue, Dr Leonard Okonkwo, a psychiatrist with the Lagos State University Teaching Hospital (LASUTH), Lagos, noted: “Lifestyle is important, by avoiding triggers of mental illness; there are different factors that lead to mental disorder.
There is an increase as it is, but then one can also say that there has been an increase in awareness, more and more people have been coming out to the hospital as against in the past when the mentally ill were kept at home or taken to the supposed native doctor. More and more people are coming out for treatment so that is why it could also appear like there is an increase in the number of those who are mentally ill in the country.
Advising Nigerians on how they can take care of their mental health, Agberotimi is of the firm belief that there is a need to first seek the right information concerning mental health. “Ignorance is the deadliest disease. Knowledge of one’s mental status and any vulnerability is highly important. Furthermore, because mental illness incapacitates any individual who has it, its cost is huge on the entire society. It is therefore crucial that each person takes his/her mental health serious by refraining from any form of treatment that is not by experts in the field, because any wrong treatment modality can result into a serious and irreversible damage”.
He made an appeal to the various levels of governmental and non-governmental agencies as well as individuals to intensify efforts by embarking on laudable and well-funded projects and programmes to combat the menace of mental illness in the society at large.”