Opportunities for Improving Mental Health Delivery in Nigeria

In June 2014, I returned home to Nigeria for my first real visit in 10 years. This visit was distinctly different from my previous ultra-brief visits in that I was well established in my career and have a green card – in itself a small, but extremely significant difference. My objectives were twofold – my primary goal was to reconnect with family, old friends and training institutions – the elements interwoven in the fabric of my upbringing, and secondly, but just as importantly, to look for opportunities to contribute my expertise towards the improvement of mental health in Nigeria. It was also significant in being my 10-year-old daughter’s first trip to the land of her parents’ birth.

Having read the reports published by Patel et al in the Lancet series on global mental health in 2008, I was acutely aware of the shortage of mental health professionals in the developing world, including Nigeria. As with many contemporaries, I was, and remain keenly interested in serving as a resource to making available what I had learned. Rather than engage in quantitative research, I decided to get a street-level sense of what was both needed and feasible.In order to do this, I conducted several informal surveys using a qualitative interview style.

So, in addition to touring Lagos and Ibadan, visiting the artists’ market, art galleries, and the beach in Lekki, I took the time to meet with individuals that could give me a sense of what the gaps were and how those gaps could be filled. I met with highly successful old friends and classmates in private practice, corporations and teaching hospitals. I watched television and listened to radio talk shows. I visited schools. I met with ministers and leaders of non-profit agencies, people with their finger on the pulse of the culture and current trends. I visited my alma mater’s teaching hospital and talked to mid-level and senior faculty. I talked to cab – drivers. I asked questions and listened to what was said and unsaid.

Shortly after my return, I attended the 2014 ANPA conference, the theme of which was Mental Health in Nigeria. Distilling the impressions from my recent trip and listening to the high-quality presentations and lively discussion, I was left with a sense of both the dire need and the rich resources available to Nigeria to meet them.

The sum total of my impressions is this: Nigeria remains the dynamic, fast-paced, aggressively developing country and society of my recollections. The opportunities in the health care industry are unparalleled and the needs great. In the mental health arena, the opportunities are even greater, with the persistence of stigma around mental health disorders and underdeveloped services. Unrecognized and untreated mental illness remains rife and substance abuse is a growing problem in Nigeria.

It has been said that there are many more  trained Nigerian psychiatrists practicing outside of the country than are within the country. This brain-trust is a gold mine of knowledge and skills that remains largely untapped. Those that do live and practice in the country, though highly skilled, motivated and knowledgeable, are hampered by stigma, lack of resources, and the absence of the political will to drive the necessary system-wide changes that make effective care available and accessible.

Some of the opportunities in the mental health arena include:
1. De-stigmatizing and de-mystifying mental illness and substance abuse. Stigma is the main barrier to individuals with mental health disorders getting the help they need in any society, including Nigeria.
2. Capacity building through infrastructure and workforce development.
3. Developing a legal framework in which the rights of the mentally ill as well as those of the society are protected and adequate provision for effective care is prioritized.
4. Developing a payment structure for mental health treatment. At the least, national and state health insurance programs should cover basic primary care, mental health and maternal and child health care.
5. Research on the epidemiology of common mental health disorders and effective local/indigenous treatments.
6. Translational research on customizing/modifying existing evidence based treatments such as cognitive behavioral therapy; Screening, Brief Intervention and Referral to Treatment (SBIRT); motivational interviewing, and interpersonal therapy for use with the indigenous Nigerian population.
7. Primary Prevention of Mental Health and Substance Use disorders.

In conclusion, my recent visit to Nigeria has left me with a vision both of what is needed and what is possible. Given the political atmosphere in Nigeria and the chronic dearth of leadership in developing the public health sector, it is likely that change will have to come from public-private partnerships and collaboration in the private sector. A strategic approach to addressing the overall health care of the Nigerian populace, inclusive of mental health care, remains essential in ensuring that Nigeria fulfills its potential.