Mental Health Day 2020: COVID-19 raises fears of increased disorders

Mental Health Day 2020: COVID-19 raises fears of increased disorders




Issue of mental illness

•WHO Urges Increased Awareness
•Experts Lament Inadequate Facilities, Manpower In Nigeria

As the world marks the Mental Health Day 2020 today, psychiatrists have warned that anxiety over the Coronavirus (COVID-19) pandemic could amplify the risk of substance abuse and suicide, thus worsening mental health issues globally.

The psychiatrists also identified financial hardship as a top risk factor for suicide attempts, noting that 90 per cent of suicide cases result from untreated mental disorders.

A new research published in the journals Psychiatry Research and Behaviour Research and Therapy has also warned that long after a COVID-19 vaccination is developed and the coronavirus death toll is tallied, the impact on mental health will linger, continuing to inflict damage if not addressed.

Unfortunately, Nigeria has only eight neuro-psychiatric hospitals and 150 psychiatrists to cater for the mental health of her 200 population, even latest figure from the World Health Organisation (WHO) showed that about 50 million people were presently mentally ill in the country. The WHO figures also showed that less than 10 per cent of mental health patients in the country have access to care.

According to the WHO, this year’s World Mental Health Day comes at a time when people’s daily lives have changed considerably as a result of the COVID-19 pandemic.

The WHO observed that past months have brought many challenges for many segments of the society. These include healthcare workers, who have been providing care in difficult circumstances, going to work fearful of bringing COVID-19 home with them; students, who are adapting to taking classes from home with little contact with teachers and friends, and anxious about their futures; workers, whose livelihoods are threatened; the vast number of people caught in poverty or in fragile humanitarian settings with extremely limited protection from COVID-19; and people with mental health conditions, many experiencing even greater social isolation than before. The global health body added that these are outside those managing the grief of losing a loved one, sometimes without being able to say goodbye.

It also said the economic consequences of the pandemic were already being felt, as companies let staff go in an effort to save their businesses.

According to the WHO, given past experiences of emergencies, it is expected that the need for mental health and psychosocial support would substantially increase in the coming months and years. It noted that investment in mental health programmes at the national and international levels, which have already suffered from years of chronic underfunding, has become more important than it has ever been.

This, it noted, is why the goal of this year’s World Mental Health Day campaign is to ensure increased investment in mental health.

Director General of WHO, Dr. Tedros Adhanom Ghebreyesus, said: “As we continue to live through a global pandemic, we need movement on mental health, perhaps more than we have ever needed it before.

“We need to move for our own mental health, the mental health of our families, friends and colleagues, and more importantly, so that there is a massive increase in investment for mental health services at national and international levels.”

President of the World Federation for Mental Health, Dr. Ingrid Daniels, said: “Mental health is affected by many factors and circumstances. It touches on everything ̶ poverty, equality and development ̶ which is why we need to ensure greater investment and greater access to mental health for all.”

Speaking in the same vein, a consultant clinical pharmacist/public health specialist, Dr. Kingsley Chiedu Amibor, told The Guardian that inadequate treatment centres due to considerable neglect of mental health issues in the country was one of several challenges militating against the treatment of mentally ill patients in Nigeria.

He said: “There are few federal neuropsychiatric hospitals in Nigeria, about eight or so, treating mentally ill patients with about 150 psychiatrists.”

He added that some other federal tertiary health institutions have psychiatric departments but observed that the number was inadequate.

Amibor also noted that poor funding and staffing constitute hindrances to provision of psychiatric care to mentally ill patients in Nigeria.

“Brain drain among healthcare professionals including medical doctors, nurses and pharmacists tend to worsen the problem. Nigeria, just like most other African countries, has not been able to meet up with the 2001 Abuja Declaration, which asked African countries to set aside 15 per cent of their annual budgets for healthcare in their respective countries,” he said.

The public health specialist also identified stigma around mental health as another major issue.

He explained: “Mental illnesses affect all shades of people and different age groups. Mental health is shrouded in stigma as opposed to physical health and mentally ill patients are often seen or perceived as unpredictable, dangerous, weak and different from others.

“Over time, this negative perception has persisted and has been preventing many mentally sick patients from seeking the much needed treatment for their conditions. Such people over time often begin to believe the deep-rooted, false stereotypes associated with their condition. This has the tendency to decrease their self-esteem and the likelihood of their seeking treatment for their condition. People with mental health disorders are reluctant to seek help because of social stigmas surrounding their condition.”

Amibor also noted that Nigerians have a poor understanding of mental illness, adding that some mentally ill persons might not understand or accept the fact that they are experiencing a health condition that can be treated or is treatable.

“Some often dismiss their depression as feeling down and lazy and anxiety as simply being over worried. In reality, these feelings may actually be cases of clinical conditions,” he noted.

According to him, a study that investigated why people fail to seek treatment for mental illnesses revealed that majority of study participants did not believe they had a problem requiring treatment while some thought they could handle the problem themselves or that their problem would get better on its own.

“There is lack of understanding of symptoms caused by mental health conditions and the benefits that could be provided through treatment. There is poor knowledge of mental disorders and effective treatments despite efforts to promote more accessible services. Even where these services are available, very small proportion of people utilise them,” Amibor said.

On how to improve mental health services in Nigeria, he said there was need to train skilled psychiatrists and other healthcare professionals who are currently in short supply in order to meet up with WHO’s recommendations.

Other measures he listed include complementing the existing mental health services at the federal level, with community based mental health services, as this has the capacity to improve access to care and clinical outcomes for rural dwellers; encouraging interventions to increase service use as an essential component of the health system; integration of traditional healers into the mental health system and improving the quality of care they administer within the population; and need to adhere to medication plans.

“Prescribed medications play a key role in the treatment of mental health disorders. They can reduce symptoms and prevent relapses of psychiatric disorders. Medications can also help patients minimise cravings and maintain abstinence from addictive substances,” he said.

Amibor stated that in order to get the most out of medications, patients would need to take their medications as and when prescribed and understand the potential benefits and costs associated with medication use. He said medication was an important mainstay of treatment for patients with more severe and long-standing mental illness symptoms.

The clinical pharmacist said many patients do not take their medications as prescribed, adding: “There is need to ensure patients adhere to their medication doses in order to achieve the maximum benefits from drug therapy.”

For a consultant psychiatrist and Director, Clinical Services, Federal Neuro-Psychiatric Hospital Yaba, Lagos, Dr. Olugbenga Owoeye, the theme for this year’s World Mental Health Day, ‘Mental Health for All Greater Investment — Greater Access’ resonates the need for improved investment in mental health care.

Owoeye lamented that mental health has not been accorded the right recognition in the country.

According to him, about 20 to 30 per cent of the general populace has one diagnosable mental disorder or the other while only about 20 per cent of mentally ill patients have access to quality mental health services.

The expert also explained that lack of facilities to carter for the patients, shortage of manpower and resources were factors affecting mental health care in the country.

Owoeye, who noted that the WHO has called for greater investment in mental illness, stated further: “For mental health for all to become realistic, we need to invest more so that people can access care. Everyone across the globe should be encouraged to key into this theme. In the area of infrastructure, in Nigeria as of today, we have federal neuro-psychiatric hospital in all the geo-political zones of the country.

“However, the Federal Government alone cannot do it. They have made efforts but what of the states. How many states have a state-owned mental facility? There is need for everyone, the federal, state and local governments to be involved in the creation of mental health facilities in all the 36 states of the federation.”

The consultant psychiatrist also revealed that in the area of infrastructure, mental health was the ninth component of primary healthcare, but stated that it has not been fully integrated into the primary healthcare system since 1992 when the policy was developed.

He continued: “There is a need for us to incorporate mental healthcare into the primary healthcare system. The primary healthcare system should have a facility to care for mentally ill patients. In the area of manpower, there is a five-member team in the mental health profession; we have the psychiatrist, who is the doctor, the psychiatric nurses, the clinical psychologist, psychiatric social workers and the occupational therapist.

“We have roughly 200 psychiatrists in Nigeria to carter for two hundred million people. This is how serious the condition is. So, there is a need for us to train and retrain more doctors in the field so that people can have access to doctors who will care for them.

“The number of other workers is even much smaller. As we produce the psychiatric nurses, they are moving outside the country in droves. The few available have no jobs to do. Nobody is employing them; we are just training them for another country. We need to look at the manpower aspect of mental health; there is need to train and retrain mental health professionals and employ them and keep them in the system.”

Owoeye harped on the need to make resources available so that people could have access to affordable mental health services.

He urged Non-Governmental Organisations (NGOs), federal, states and local governments to join efforts and invest in the mental health profession and infrastructure so that many people could have access to mental health services.

According to him, the Federal Neuro-Psychiatric Hospital Yaba, Lagos, was at the forefront of managing mental ailments and training of postgraduate medical doctors that are psychiatrists.

“We have post-basic psychiatric nursing school to train mental health nurses. We have the federal school of occupational therapy, the only one of its kind in the West African sub-region, situated in this hospital to train occupational therapists. We are at the forefront of training and retraining of manpower in mental health.

“There is other specialised training on drugs that we carry out. It is what we call universal treatment curriculum on drug advisory programme. We run it in this hospital. United Sates and the Columbia government are sponsoring it. We run the programme quarterly and we certify people to help tackle the menace of drug abuse,” he stated.

On accessibility of care amid the pandemic, Owoeye disclosed that the hospital never closed. “Patients were coming in,” he noted. “But we developed standard operating procedure or protocols to ensure social distancing. The hospital made Personal Protective Equipment (PPE) available to ensure the workers were well protected.”

Owoeye said the current pandemic did not affect the price and distribution of drugs for the treatment of mental illness.

On his part, Consultant Psychiatrist, Dr. Kafayah Ogunsola, decried poor awareness about mental health issues such as clinical depression, anxiety disorders and psychoses like schizophrenia in the country. She noted that many people live with them for many years without realising that they are mentally ill and can get treatment for it. The psychiatrist said there was need to kick-off an advocacy drive across the country to draw attention to mental health. “A good place to begin is in schools; perhaps curriculum can be added to address this need,” she said.

Ogunsola, who is the Founder of EmpathySpace.ng, an online mental health advocacy platform, and also the Liaison Director of Suicide Response and Prevention Initiative in Nigeria (SURPIN), stated that because of the stigmatisation and over-spiritualisation of emotional illnesses, even people who have some degree of awareness don’t seek treatment when they present with symptoms for fear of being stigmatised and judged harshly.

The psychiatrist said the spiritualisation of the causes of mental health problems underlies why many people continue to seek help in the wrong places such as herbal homes and religious places, saying some people were shackled in chains in their homes for many years due to their mental health challenges.

Ogunsola said that collaboration between mental health professionals and religious leaders would be beneficial in ensuring that members of the congregation understand first hand the signs and symptoms of these disorders and know that they are treatable.

She said concurred that there was need for the establishment of more psychiatric and psychological facilities all over Nigeria with adequate attention paid to the rural and remote parts of the country.

“As we know now, most people who currently have access to these services live and work in the more urban parts of Nigeria,” Ogunsola said.

The psychiatrist said the brain drain of mental health experts has to stop for Nigerians to enjoy adequate and widespread mental health services. She noted that psychiatrists, psychologists and other allied mental health professionals continue to leave the country in droves, saying the situation has been depleting the human resources available to cater for Nigerians.

“Recent statistics reveal that less than 250 psychiatrists cater for 200 million Nigerians,” she said.

Ogunsola said mental health treatment has to be subsidised and included as part of the National Health Insurance Scheme (NHIS) to ensure affordability by the masses.

“Currently it is accessible to only those who can pay from their pockets. This hinders a majority of people from getting help for their emotional health struggles. What this means is that many more are at risk of taking their lives by suicide. According to research and findings based on clinical experience, about 90 per cent of suicide cases are linked to untreated mental disorders,” she said.



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