In November, 2018, the Federal Ministry of Health posited that 60 million Nigerians suffer from one mental illness or the other. This rather shocking revelation made the rounds in media and got many reactions from mental health practitioners and Nigerians. As usual, the story fizzled out. Everything went back to the abysmal normality of stagnation. Nothing concrete was done to solve the problem at hand.
2023, the new year met with bubbliness, is already here and these 60 million Nigerians have no succour to their mental health issues. In 2019, we lost two brilliant youths; Chukwuemeka Akachi and Michael Arowosaiye to suicide. Both deaths shook the social media space, but the outcry was as expected, ephemeral. Last year alone, we witnessed the death of Adetutu Adedokun and Laolu Martins, a minority stakeholder in the popular Lagos eatery, Bukka Hut, among others who shrunk at the hands of suicide. The Oyo State police recorded at least 10 suicide cases in the state between June and September 2022. These are just the numbers we know, the stories we hear, and unfortunately there are many more undocumented and unreported cases of suicide in Nigeria owing to a number of distasteful factors.
The problem we are faced with can be solved only if we are proactive enough to nip it in the bud. We don’t have to wait for the United Nations (UN) or World Health Organization (WHO) to churn out more statistics before we rouse ourselves. Hence, there is a need to focus on changing the mental health narrative in the country by deploying a number of strategies across board.
First off, functional and dedicated helplines serve as a key tool in tackling mental health. There are mental health hotlines globally but not many across Africa. Less than 10 countries on the continent have mental health hotlines, excluding Algeria, Kenya, Mauritius, and South Africa. In Nigeria, although the Federal government has the 112 toll-free emergency number for fielding and dispatching distress calls, it doesn’t have a dedicated emergency number for suicide prevention and mental health issues. On the other hand, African countries like South Africa and Mauritius have dedicated Suicide Crisis Lines.
However, Lagos state seems to be doing more when it comes to helplines. In 2021, LASG launched “The Lagos Lifeline,” a tele-Mental Health service that provides Lagos residents with access to psychosocial support, counselling and psychotherapy services free of charge through a dedicated line. The initiative has helped the Lagos State government have a hands-on approach to the mental health challenges of Lagosians. If other state governments could be as progressive in their approach, we might begin to see lasting changes.
Mental Health hotlines will serve as the first point of contact in averting crises on time. Nigerians can easily access 24/7 hotlines respective to each state with well-trained call centre agents who have sharp discernment and refer them to the proper offices for further consultation. For consultations to be effective, building mental health facilities should be a priority. This will require collaboration and funding, but the value of a Nigerian’s life supersedes these requirements.
Indeed, we cannot speak of consultations, treatment and management of mental health illnesses without sufficient psychiatrists and other mental health workers. There’s a shortage of psychiatrists globally; countries like South Africa, Indonesia and America are suffering from shortage. Sandwiched between Cote d’Ivoire and Togo, is Ghana, a country that has only 39 psychiatrists (0.13 per 100 000 people) for the entire population of whom an estimated 2.3 million people have mental health conditions and need care, according to the World Health Organization. The case is terribly the same in Zimbabwe and Uganda.
The Association of Psychiatrists in Nigeria (APN), last year, lamented the dearth of professional psychiatrists in the country and the huge shortage gap. The group made it known that only 250 qualified psychiatrists are working in a country of about 200 million people whereas the standard practice is for one psychiatric doctor to take care of 10,000 patients. This is even lower compared with South Africa’s 700 psychiatrists servicing a population of 60 million people. The management of mental illness in Nigeria has been going downhill for decades now. The development has made accessibility and deliverability of psychiatric care relatively difficult.
Every Nigerian knows why this is happening. The government cannot feign ignorance on the causes too. They need to create better working conditions, higher remuneration to match or balance the economic reality, a secured environment, job satisfaction and incentives and more working facilities. The government must block the brain drain and create more incentives for young people to study psychiatry and psychology. A huge percentage of Nigerian youths aren’t willing to study psychiatry or psychology in tertiary institutions. This is a sharp contrast to America where the number of students majoring in psychology has grown tremendously in recent decades. Many young Nigerians currently studying psychology found the course thrust upon them as an alternative. This not only underscores the dispassionate towards the course itself, but also the amount of graduates who do not practise. Hence, the education sector and the government must work together to make both courses enticing to youths. Whether we like it or not, we need more mental health practitioners to close the gap widening yearly in the country.
If people do not have knowledge of a thing, they cannot understand it, and there is bandage in lack thereof. Mental health education cannot be ruled out of a functioning, expansive and proactive mental health system in any country. Mental Health education must be incorporated into Nigeria’s academic curriculum for all three levels of education like many educators and scholars have advocated for. In 2018, New York made mental health education mandatory in kindergarten through 12th grade, and Virginia made it a requirement in 9th and 10th grades. In Europe, the UK government announced the introduction of a new compulsory subject – Relationships, Health and Sex Education, or RSHE in 2019 as part of the national curriculum to focus on mental health and wellbeing. The subject is split into two sections: physical health and mental wellbeing and relationships.
There’s a reason that mental health education is required in schools and that’s not far-fetched. It’s not even rocket science. Half of all mental illnesses begin by the age of 14, according to the World Health Organization. However, most cases are largely undetected and untreated in time or at all. Early intervention and treatment can help mitigate the impact of mental illness on the lives of young people. Teaching children about the importance of having a robust mental fortitude promotes a healthy transition from adolescence to adulthood. This education will help them easily understand the state of their mental health and encourage them to seek out counsel if and when there is a need to.
It’s important that schools should have functional Guidance and Counselling departments whose herculean task is not only to encourage students’ academic, social development, but also their emotional and personal development. Their mental wellbeing is as important as their social and career wellbeing. The individual reflects back into society. If we neglect the individual, we are neglecting society and that’s quite disastrous. To ensure effectiveness, schools should employ a special set of observing eyes that will also train teachers and lecturers on behavioural and attitudinal signs they should look out for. Also, as part of the curriculum, having a qualified psychologist in school as a counsellor helps the students to open up as teachers and lecturers might not have the time required to spend with troubled students. In the UK, they’ve got Education Mental Health Practitioners (EMHP) who work across education and healthcare to provide mental health support for children and young people in schools and colleges.
Anyone can see that G&C in Nigeria has deteriorated so much that schools don’t pay attention to it anymore. Since the proliferation of private schools in the country, many newly opened schools do not have a G&C department. Private schools are popping up in every small space, brandishing the words “international” and “montessori” as some sort of badge. Hundreds of “private” schools across the country have not been duly accredited and possess the licence to operate. This is an issue that can only be discussed on another day. Government owned schools aren’t left out of this rot. They rank high on the table of having a non-functional G&C department.
Nevertheless, schools can incorporate Positive Behaviour Interventions and Supports (PBIS) in their teaching framework. Using PBIS, schools can provide universal mental health strategies as part of the first point of support through teaching behavioural expectations for routines at school (e.g., arrival, dismissal, lunchroom, and classroom) and designing ways to provide recognition for positive student behaviours (e.g., verbal statements, student awards to celebrate positive behaviour). Another great approach schools can use to build a good climate for their children’s mental health to thrive is Neuro-Linguistic programming (NLP). NLP is a set of principles and techniques aimed at enhancing self-awareness, increasing confidence, building communication skills, and motivating positive social actions. Developed in the 1970s by John Grinder and Richard Bandler, NLP can be used to understand a child’s thinking, behaviours, emotional states, and aspirations. This psychological approach has been used in various settings, including psychotherapy, medicine, and personal development.
Moreover, schools cannot leave parents out of a holistic approach to mental health. Parents must be brought on board to avoid a delay in diagnosis and care whenever necessary. A child’s time is often spent between home and school, and many aspects of a child’s psychology are formed at home. Parents should be well-informed on what mental health is with more focus on destigmatising what mental health is. Destigmatisation is important because we live in a highly condemning and myopic society. Also, cultural and religious stereotypes have made a damaging impact on the recovery process of people with mental health issues and how mental health is viewed. Parents can be sent newsletters on the subject as most of them are ignorant of mental health issues and assessment reports concerning their child’s mental health status monthly or quarterly. If the parents aren’t particularly literate, schools can partner with mental health organisations and visit these parents with a view to educate them. Yes, it is a painstaking and time-consuming endeavour, but it must be done.
At this point, there is nothing else the present government can do as it is merely anticipating a bowing out come May 29, 2023. The most laudable win for the mental health sector is the signing into law of the Mental Health Bill harmonised by both Houses of Assembly in 2021 by President Muhammadu Buhari. The long awaited signing by Buhari ensures that the law will replace the Lunacy Act of 1958 widely condemned by mental health experts as “archaic and inhuman.”
Some provisions of the National Mental Health Bill include creating a Department of Mental Health Services in the Federal Ministry of Health and a Mental Health Fund. The Mental Health Fund will be funded with contributions, grants and official allocations, with the objective of providing financial resources for the implementation of the provisions of the law. The law also made provision for the establishment of human rights protections for those with mental health conditions, such as banning discrimination in housing, employment, medical, and other social services. Among other things, the law ensures that mental health services are available at primary, secondary and tertiary health institutions across the country which allows for localised access and management.
Implementing the law to the letter for the benefits of Nigerians is one thing we grapple with often in this political climate. We can only appeal to the incoming government to fully implement this new law, and partner with relevant stakeholders to map out measures for the mental health of Nigerians. State governments must also take charge now and work hand-in-hand with organisations and societal units such as the family, religious bodies, etc to create a safe mental space for everyone, or run the risk of housing mentally volatile citizens who will become ticking time bombs. Good mental well-being builds citizens with well-functioning social, emotional, behavioural, cognitive, and communication skills.