Bello Hussein Adoto
The signing of the Mental Health Bill into law presents a renewed imperative to rewrite the mental health narrative in Nigeria. Here is how Nigeria can do better.
‘All diseases are equal, but some are more equal than others’. Although Nigeria is not George Orwell’s Animal Farm, the country has a glaring disparity in the kinds of diseases it considers a priority, but the recent signing of the Mental Health Bill into law can help us to rewrite the narrative.
At the mention of infectious diseases like HIV, tuberculosis, and malaria, or non-infectious diseases like diabetes, hypertension, and cancer, one could point to tangible, nationwide, and sustained initiatives to promote public health and reduce their impact on individuals and communities. But very few such initiatives are available, if any, for anxiety, depression, or Alzheimer’s disease.
While anxiety and depression do not kill as regularly as untreated malaria, HIV, tuberculosis, and uncontrolled diabetes and hypertension – diseases that received far more attention, these mental illnesses are nonetheless deadly.
Anxiety and depression, for instance, reduce our quality of life and living, undermining our productive capacity, while depression increases a person’s risk of suicide. This reality makes diseases that affect moods and behaviour as relevant as those that affect tissues and organ systems.
Mental health disorders are a huge challenge in Nigeria. A recent report puts the number of people living with one mental illness or the other in the country at 60 million. According to a World Health Organization report, Nigeria has more than seven million people living with depression. This value doubles the number of people living with depression in South Africa and Ghana combined. A similar story plays out in the estimate for people with anxiety in the continent.
Nevertheless, the signing of the Mental Health Bill offers a renewed imperative for stakeholders to harness the several opportunities that could rewrite the narrative of mental health in the country.
The first opportunity is an extensive network of primary, albeit underfunded and underutilized, healthcare centres across the country. Nigeria has more than 33,000 primary health centres with a potential capacity to provide mental health first aid services to Nigerians. The government can expand these facilities to provide mental health care services.
The centres have community health officers (CHOs), community health extension workers (CHEWs), registered nurses, and midwives. Specialists can train these non-specialist healthcare workers to provide basic mental healthcare services nationwide, especially in rural areas, in a task-sharing, task-shifting policy.
Nigeria has applied this policy to provide malaria and family health services, and a 2015 study shows that integrating mental health into primary healthcare in Nigeria could follow a similar model. Such integration will buffer the shortage of mental health specialists in the country and improve care coverage for underserved populations.
Secondly, the digital era is here. Digital channels such as social media, webinars, SMS, and tools such as smartphones and software, provide an exciting, affordable, and sustainable opportunity to reach many people. The government could harness these channels to support non-specialist care delivery, educate the public about the fundamentals of mental health, reduce ignorance about mental health, and eliminate the stigma and dangerous practices associated with mental health disorders in the country.
Beyond helping to raise awareness, the government and other relevant stakeholders should harness digital channels to deliver e-health to people with mental health disorders and bypass the barriers to accessing traditional care. Such digital interventions have been shown to improve mental illnesses among students and could be helpful in care delivery to a larger population.
A third opportunity is the existence of non-governmental organizations, such as the Mentally Aware Nigeria Initiative (MANI) and Asido Foundation, that champion mental health causes in the country.
NGOs are paramount to health promotion because they supplement public efforts to promote health. Some NGOs operate helplines for mental first aid; others, like the Asido foundation, run the Unashamed campaign to increase mental health awareness and reduce stigma in the country. The government can partner with these NGOs to sensitize the public and provide the much-needed care and support that millions of Nigerians need.
Finally, a special insurance package should be instituted for people with mental health disorders, so they can access essential care without worrying about the cost. Awareness about health insurance has increased over the years, and more Nigerians are enrolling in their numbers. The number of enrollees in the Nigerian Health Insurance Scheme [(NHIS), mow National Health Insurance Authority (NHIA)] has nearly doubled between 2007 and 2013. Stakeholders can expand current social health insurance packages for insurance owners to include mental health conditions and give Nigerians a new lease to access proper mental health care whenever needed.
Bello Hussein Adoto, a researcher, writer, and journalist, writes via bellohussein210@gmail.com.