Image Source: The public health advocate
Chijioke Iremeka
It is a known fact that mental health problems are widespread in Nigeria, but rarely receive the attention they deserve.
According to experts, this is due to stigmatisation and the prevalence of religious, cultural and superstition beliefs that prevent those with such challenges from seeking professional help, and would rather run to spiritualists and traditional homes for solutions.
To stop this, mental health experts say there is an urgent need to educate Nigerians on the need for proper treatment of mental health disorders by professionals, not spiritualists that may compound their problems.
Defining mental illness as a behavioural or mental pattern that causes significant distress or impairment of proper functioning, experts said the condition is also characterised by a clinically significant disturbance in an individual’s cognitive and emotional regulation or behaviour.
According to the World Health Organisation, about 7, 079, 815 Nigerians suffered from depression in 2017, a type of mental illness that is characterised by unhappiness, which may balloon into suicidal ideation.
The WHO said the seven million Nigerians represent approximately four per cent of the entire population, thus making Nigeria the most depressed country in Africa in 2017, lamenting that only 3.3% of the health budget of the Nigerian government goes to mental health.
Also, the global health agency noted that 90 per cent of the budget goes to mental health hospitals, while very little is allocated for mental health awareness and services in Nigeria.
It added that the majority of Nigerians see mental health as a spiritual problem, while others, view it as a myth that does not require professional treatment.
Speaking against this background, the former Medical Director, Federal Neuropsychiatric Hospital, Yaba, Lagos, Rahman Lawal, affirmed the fact that many people refuse to visit the hospital to treat mental health-related issues because of the belief that psychiatric illness is a spiritual matter.
According to him, family members would rather take such a person to spiritual healing homes, churches or faith organisations to get cured through spiritual means because many have linked mental illness to spiritual attacks.
Corroborating his view, the President of the Association of Psychiatrists in Nigeria, Dr. Taiwo Obindo, said over 60 million Nigerians are suffering from mental illnesses.
He noted that some factors hindering the management of mental illness in Nigeria include myths and traditional beliefs, inadequate mental health facilities, and a limited number of mental health professionals.
In the same vein, a Professor of Psychology at the Department of Psychology, Adekunle Ajasin University, Akungba-Akoko, Ondo State, Bolanle Ogungbamila, said there is a need to educate the people on the difference between spiritual solutions to mental illnesses and professional solutions.
He said due to one religious or cultural leaning or the other, relatives of the people with mental cases ignorantly worsen their situation by taking them (patients) to churches, mosques and other religious places for treatment, just to return to psychiatrists when their health has deteriorated.
In some cases, he noted that those with mild mental stress, if presented for professional treatment early can get well, while those who shy away from seeing psychologists or psychiatrists, may have their condition deteriorate.
He said, “By doing this, they lose their chances of recovery because time is of great essence in mental health treatment. Instead of seeking professional help, these people with wounded hearts and emotions would seek spiritual solutions to physical issues where the spiritualists would tell them that they are being afflicted by the devil or describe the situation as evil machination.
“We need more awareness to educate the people that there is a need to seek help through the right channel before depression progresses and gets out of hand. The first thing that happens to a depressed person is the tendency to redirect the anger to himself, instead of looking for a solution. This may lead to suicide.”
Also, a Psychiatrist from Federal Neuropsychiatric Hospital, Enugu State, Dr. Monday Ugwu said the work of a psychiatrist is different and well-defined from that of certain religious and traditional leaders and therefore, cannot be professional enough to offer mental health first aid when it matters most to stop a negative progression in a patient’s condition.
He said, “Psychiatrists get medical training that allows them to prescribe medications and perform procedures. They normally treat more complicated mental health conditions than even psychologists. Psychologists mainly provide counselling and nonmedical support as well as provide neuropsychological evaluations
“When you make an appointment with a psychiatrist, they will first ask about your mental and physical symptoms. This may involve a physical examination, laboratory tests, or a psychological evaluation. As part of the process, they will refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to determine what mental illness you may have.
“This manual is published by the American Psychiatric Association and used by mental health professionals for diagnoses and by insurance companies for reimbursement purposes. So when you look at this, it’s not a work that one traditional healer or one pastor can embark on, Though I do not doubt the power of God, it’s not given to men the way they claim and that is my problem. By the time they lose the chance of saving a mentally ill patient; by the time the situation gets out of hand, they will then refer the person to professionals to perform magic.
“I would say that in five cases of people with mental health problems handled by these people, four will lose their sanity completely if not all. And this is what we try to avoid by calling on people to go to professionals for proper evaluation that would keep them in order but their faith and belief system would not allow them to do that until it gets really bad.
“There are many rich men out there, even top politicians, who are mental health patients but you won’t know because they take their medications and go for regular check-ups with their psychiatrists. You can’t take a patient with a ruptured appendix to one faith organisation or traditional healing centre or the other, the patient will die there. Or will you take a woman in labour, with serious complications to such a centre without looking for a surgeon to carry out an operation? She will die there.
“So, let us understand that despite religious or cultural beliefs held, there is a difference between a professional treatment for people with mental health challenges that guarantees a higher recovery rate than what we do at traditional and some faith organisations.”
Speaking further, a mental health specialist and an Employee Assistance Professional, Adelowo Adesina, said there is no problem with going to a Pastor or Imam for mental health treatment as long as they are certified mental health professionals.
Adesina, who is also the Managing Consultant at Stages and Stripes Consultants, said there are some pastors and Imams who do their jobs well and are still certified professionals who can handle the cases of people with mental health challenges.
“In this case, it will be good for them because the people have known these religious leaders for a long time and would feel free to speak out about their problems and challenges to them,” he said.
He noted that those suffering from mental health issues like depression have a certain level of trust in these religious leaders, but warned that it will be a disaster if such leaders do not have the skills required to handle the patients’ mental stress disorder early enough.
He said, “The first concern will be, do they have the required skills to handle the patients, if yes, fine, but if they don’t, and also don’t know when the situation has gone beyond them to make a referral, then, it becomes a disaster.
“Like with every other medical condition, early diagnosis and early treatment will always have better outcomes than later treatment. So, the earlier the better and that is why I said it will be dangerous if the religious leaders that they are taking these patients to don’t have the stills.”
Speaking on the consequence of a break in the treatment of a patient, he said, “Generally, when you take some drugs and stop, and there is a break in the way the medicine was prescribed, it will not yield the desired result and it will lead to the sickness developing resistance to the drug. So break in treatment is not encouraged.”
However, a research titled, ‘Spirituality, religiousness, and mental health: A review of the current scientific evidence,’ authored by Giancarlo Lucchetti and his team at the School of Medicine, Federal University of Juiz de Fora, Brazil, noted that the number of studies assessing spirituality and religiousness in mental health has been increasing, resulting in a large body of evidence suggesting an impact of S/R.
Published in the National Library of Medicine, the authors noted that most of the research focused on depression, suicide, and substance use and several studies, have reported promising results with regard to post-traumatic stress disorder, psychosis, and anxiety.
“Fewer studies have examined the relationship between S/R and obsessive-compulsive disorder or eating disorders. The effects of S/R on mental health are likely to be bidirectional, and the way that S/R beliefs are used when confronting stressors (negative and positive) influences the results of studies now being conducted.
“Furthermore, the mechanisms by which S/R affect mental health remains unclear and further studies examining such pathways are needed, as well as clinical trials examining the impact of S/R interventions on mental health outcomes.
“Thus, there remain many gaps in the literature that need filling in this particular area. Nevertheless, based on the current evidence, there are numerous practical clinical applications that psychiatrists and other mental health professionals should consider implementing in clinical care (particularly, the taking of an S/R history in all patients). This, we believe, will lead to a more holistic and patient-centered form of mental health care.”
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