Nigeria is the most populous country in the African Continent and still stands out as one of the 15 largest nations of the world. The country has an estimated population of over 120 million people belonging to various ethnic groups with distinct socio-cultural backgrounds.
Like in most other parts of the world, mental and behavioural pathologies, especially the enduring mental disorders (schizophrenia’s) have been known to constitute an enormous health burden of Nigeria.
The United Nations Commission on Human Rights made it clear that medical treatment should be a basic right for those suffering from mental disorders. Furthermore, in providing treatment and in protecting sufferers and others from potential danger, their respective basic rights must also be guaranteed. Legal safeguards should also be an essential (Desjarrlais et al, 1995).
Unfortunately, the misery and emotional turmoil caused by these problems are not often perceived as threatening enough, except by those who directly feel them. This is because they are not usually the primary cause of the demise of patients. Nevertheless, the fact still remains that mental and behavioural disabilities are significant antecedents of human suffering and loss of the resources of Nigeria.
Prior to the year 1900, those afflicted by mental illness were either exclusively sheltered, punished or exorcised by traditional healers. The Yoruba of Western Nigeria, had a preference for traditional than for orthodox medical treatment of the mental ill. A plant termed rauwolffia Vomitoria which has a high content of reserpine and other alkaloids and known to be psychotropically very potent was used extensively by the Yoruba traditional healers (Mankanjuola et al, 1987).
With time, the impact of clergymen began to be felt. Most of the missionaries were actively engaged in preparing the growth of spiritual healing sects. Most of them claimed to have cures for mental disorders and pastoral counselling was also practised. In the northern parts of the country, the Muslims undertook to remodel some of the asylum, which were under the management of the native authority (Boroffka et al, 1975).
Not long afterwards, the need for the establishment of orthodox mental health institutions became desirable. In 1907, the first two lunatic asylums were established. One was located at Yaba in Lagos (the capital of Nigeria, while the other was based at Calabar, a town in the south eastern part of Nigeria). In 1944, a secure unit for the control of patients’ movement was established at Lantoro (a village in Abeokuta). A few years later, the Aro Neuropsychiatric Hospital was established in Abeokuta.
The Nigerian Government, recognising the need to develop further, mental health facilities, encouraged enthusiastic foreign psychiatrists, to undertake tours of Mental Health Institutions in the country. These itineries highlighted findings, which were tapped for the improvement of the existing centres and for the treatment of mental health disorders.
The first of such was undertaken in 1927, and few other similar trips were undertaken thereafter. Dr. J.C. Carothers, who is credited for having written the first comprehensive monograph on psychiatry in Africa, visited 25 places in Nigeria and an additional 3 locations in the Cameroon in 1956. Fourteen years later, Boroffka and his entourage undertook another survey of the psychiatric institutions in the country. This initiative revealed that about 20 facilities were visited, while 13 centres were not. In some of the institutions visited, there were no psychiatrists available to supervise the care of the mentally ill. In 1964, Professor Thomas Adeoye Lambo established the first University based department of psychiatry at the University College Hospital, Nigeria. Ten years later Moser visited nine African countries under the auspieces of the World Health Organisation (WHO). Nigeria was one of the countries that played host to that visit (Binitie, 1975).
Nigeria currently has less than 15 hospitals, and 12 psychiatric units in University Teaching Hospitals; 8 psychiatric units in State General Hospitals; 5 units in Armed Forces Hospitals; 7 private hospitals with special interest in the care of those with mental and behavioural disorders some asylum located in prisons. Despite the distribution of these facilities, over 70% of the rural dwellers are not favoured.
In Nigeria, it is estimated that about 1 million people are presumed to be afflicted by severe mental and neurological disorder, while about 10-18% could be victims of milder disorders. About 20-40% of the patients attending General Outpatients facilities are afflicted by mental health problems. Of all the psychiatric disorders in Nigeria, the enduring mental health disorders (schizophrenia) morbidity amongst the elderly was 45.3% with depression being the most prevalent disorder.
Alcohol and substance abuse disabilities appear to be on the increase. In a study of the records in four psychiatric hospitals in Nigeria, alcohol was identified as significant precipitant of organic psychosis. As a result of the increase in alcohol consumption Nigeria has witnessed the highest automobile accident rate in the world (Obot et al, 1989; Cherpital, 1995; Cook, 1990; Rosovsky and Lopez 1986; Gureje and Olley, 1992) see Desijarlais et al, 1995).
Between 20% and 50% of male admissions to psychiatric facilities in Nigeria are victims of psychosis associated with substance abuse and it is strongly held that toxic psychosis due to cannabis ingestion accounts for more admissions to psychiatric words than is the case with schizophrenia (xxxxxx, 1980) see (xxxx et al, 1982). Chemical Abuse was found to be significantly associated with psychiatric morbidity amongst the juvenile delinquents seen at a Remand Home in South Western Nigeria (Ononye et al, 1994).
The National Mental Health Policy is an essential and an integral component of the Primary Health Care (PHC). Apart from the policy being socio-culturally oriented, it focuses on the attainment of a level of health by all citizens that will permit them to lead socio-economically productive lives at the highest level by the year 200 and beyond. The most important principle of the PHC is community participation (Creese et al, 1990.
The implementation of the objectives of this policy will remain a fantasy unless the country’s gloomy economic state improves. The number of the mentally ill in the community has increased, but the resources and facilities at our disposal to contain them are not enough.
The Nigerian economy has been suppressed by political instability. With a Gross National Product (GMP) of some $38 billion, the size of the economic is small. With a population over 120 million, the per capita income is about $310. The country’s economy still faces an uneasy struggle.
The poor economic situation notwithstanding, the enduring mental disorders, like schizophrenia still attract prohibitive direct, indirect and intangible costs. The cost of anti psychotic medications was 52.8% of the mean total cost of the illness. This is in contrast to only 2-5% of costs in European and American reports. The cost of the illness is very frustrating for families with slender resources. In the United Kingdom, the cost of in-patient care is more than 5% of the total NHS in-patient expenditure. Price is therefore an important factor to be taken into consideration, when prescribing drugs in present times (Knapp….)
Nigeria has less than 100 psychiatrists (Federal Ministry of Health, 1991). The ratio of psychiatrists to the population in the United States of America is nearly 170 times higher than that in Nigeria. The nation would require over 400 psychiatrists and a corresponding increase in the number of other categories of mental health personnel in other to improve the staff strength. Despite economic limitations; encouraging progress has continued to be made in the clinical areas. A review of the 3 year clinical performances (1993 – 1995), of a Teaching Hospital in South-Western Nigeria, showed that all the 12 departments of that institution, it was only the orthopaedic department with the fifth largest number of bed allocation 53 (9.6%), that had a percentage occupancy of 81% and 68% in 1993, 1994 respectively.
The Mental Health department, with the seventh largest number of bed allocation 24 (4.3%), within the same period, had percentage occupancy of 75% respectively. In 1995, the mental health unit had the highest percentage occupancy of 79%, while the department of orthopaedics, had 77%. Despite the limited psychiatric in-patients facility, there is still a high turn over rate in admissions with priority being given to out-patients demands. It is unlikely that the trend would be different in other mental health institutions. From this data, it is obvious that the demand for mental health services is very high. Presently 3000 beds available for mental health admission in Nigeria, with a ratio of 1 bed to 33,000 persons in the population.
In this paper, an attempt has been made to evaluate the growth and the impact of mental health practice in the context of a depressed economy. The distributions of the mental health facilities in the country were commented on, vis-ï¿½-vis the scope of the psychological problems. It is believed that a sound socio-economic base will undoubtedly improve and proliferate the existing mental health practices and care facilities in Nigeria.