Demystification of Mental Illness is a Critical Step in Improving Mental Health Delivery in Nigeria

On my most recent trip to Nigeria as  part of a Yale School of Medicine Global Mental Health collaborative program with the Lagos University Teaching Hospital,  our project team visited a suburban pentecostal church on the outskirts of Lagos. This particular church specialized in “prayers and deliverance” for  the “possessed”.

One of the more striking cases was that of a young man in his early twenties who was dumped at the gates of the church premises by his family. Apparently, the young man who was originally from Abia state, had developed a sudden change in behavior.  He thought that the cell phone company MTN was controlling his brain with a S.I.M card. His symptoms did not respond to initial prayers by his family and local pastor in Abia state necessitating transfer to a “specialist church” in Lagos state.

My immediate impression was that of a first episode psychosis.

Nigeria, with an estimated population of 160 million people, has less than 150 practicing psychiatrists. Numbers for other mental health professional are as damning. Yet common mental health disorders like depression, anxiety and schizophrenia are as common in Nigeria as in other countries of the world that have better mental health resources.  A mental health expert in Nigeria was quoted recently as estimating that 64 million people in Nigeria suffer from one form of mental illness or the other.

Thus, there is a huge gap in mental health care in Nigeria and a significant burden of unmet mental health need symbolized by the ubiquitous “crazy man” or “crazy woman” wandering the village market or begging in the streets of busy cities.

The reasons for the dearth of resources for mental health in Nigeria are multifaceted. Most prominent is the absence of political will to develop a mental health service based on a comprehensive legal and policy framework. Career interest in mental health by aspiring undergraduates is minimal and reflects society’s negative attitudes and poor understanding of the bio-psycho-social basis of psychiatric disorders.

One could argue that there are more pressing healthcare issues in Nigeria including malaria, HIV/AIDS, diabetes, renal failure and high maternal mortality. Unfortunately, in health as in other areas of life, everything is connected.

Maternal depression and stress cause long term negative effects on the child’s brain development and has been linked to higher maternal mortality. A person experiencing emotional difficulties is less likely to manage their diabetes or hypertension or HIV. In fact, research shows that outcomes for most medical illnesses including cardiac and surgical outcomes are worse in those with untreated mental illness.

The good news for Nigeria is that the social structures and support systems that have been shown to help people cope better with mental health issues are still quite strong in our society.

The much celebrated extended family system, our community churches (who, in fairness, have been first responders for emotionally distressed people) and well integrated local school systems can form a strong basis for innovative efforts aimed at demystification of mental illness and the integration of basic mental health interventions into routine community activities.

The challenge is to find ways to stimulate interest in, and secure funding for these innovative ideas.