–Ibrahim Suleiman Ph.D
The World Health Organization has set aside 10 October of each year as World Mental Health Day. It serves as an opportunity to raise awareness of and mobilize support for different mental health concerns. Mental health has not received as much attention as physical health has. That is why the theme of this year’s World Mental Health Day was “Make mental health and well-being for all a global priority”.
Your mental health is as equally important as your physical health. Mental health problems must not be stigmatized nor cared less for. People experience mental challenges triggered by their jobs, friends, families, communities, and sometimes themselves. Rather than discussing these challenges at their early stage, most people prefer to remain in solitude. A decision that further worsens someone’s mental health situation. World mental day provides a chance to discuss mental health issues and promote the need for people to seek help when they are struggling with mental issues.
The COVID-19 pandemic has exerted a significant impact on our mental health. Global statistics have shown that in 2019 (before the COVID-19 pandemic), about 13% of the world’s population was living with a diagnosed mental disorder. A significant rise in the prevalence of mental disorders (especially depression and anxiety) was recorded during the first year of the pandemic. It was estimated that both anxiety and depressive disorders rose to about 28% global prevalence in early 2021.
Nigeria just like most other low-income countries is facing a short supply of funds, skills, services, and treatments for mental health conditions. The growing social and economic inequalities, protracted conflicts, public and environmental health emergencies (such as the recent flooding in various parts of the country), insecurity, and stigmatization have contributed to the rise in cases of mental health disorders recorded in Nigeria.
Stigma and discrimination continue to be a barrier to accessing help. Despite the observed rise in hospital cases, a significant ratio of mental health illnesses is underdiagnosed. According to a report by the West African Academy of Public Health, only about 15% of patients with severe mental illnesses in Nigeria are receiving healthcare assistance. In addition to discrimination, it was also identified that most of Nigeria’s population has misconceived understanding of the causes of mental disorders. This article will focus on sensitizing the public to the causes of various mental health disorders.
Mental health challenges have a wide range of causes. It is also important to note that different people may react differently to the same trigger. Similarly, these personal variations in mental health responses to certain situations must not stir the feeling of superiority or inferiority over others. Identifying the cause of a mental challenge is important in designing successful treatment plans. However, sometimes we may not know the exact cause of someone’s mental health problem, in such cases society, family, and other healthcare personnel are expected to treat the situation as they will for conditions with well-identified causes.
Common examples of causes of mental health challenges include trauma (physical or emotional), child abuse (including bullying and neglect), stress (especially chronic and severe), social isolation, bereavement, discrimination (racism, tribalism, religious intolerance), poverty, loss of job (or losing material wealth), drug abuse, alcohol misuse, insomnia, genetics, and domestic violence among others.
Physical trauma such as traumatic head injury (or neurological conditions such as epilepsy) and stressful/emotional experiences like neglect, military combat flashbacks, observing violence being perpetrated against parents, and divorce (or separation) could result in trauma and stressor-related mental disorders such as acute stress disorder (ASD), post-traumatic stress disorder (PTSD) and depression.
Unlike acute stress disorder which lasts for a short while, PTSD is characterized by persistent frightening thoughts, memories, and flashbacks of past traumatic events. While trying to adjust to past traumatic events, some people develop unhealthy behaviors such as becoming repeat offenders and violating the rights of others. In some cases, especially among children, they may respond to past experiences by becoming insensitive to situations that they are ordinarily expected to be sensitive to. These responses are other forms of mental health disorders arising from trauma and stress causes.
Childhood traumatic experiences could lead to the birth of an alternate self in you, a mental health condition that is known as multiple personality disorder (dissociative identity disorder), which is characterized by the presence of two or more personality states. Sometimes traumatic experiences may result in emotional instability. Everything hurts more than it seems for everyone else, and any ‘thick skin’ you’re supposed to have isn’t there. This mental health state is termed borderline personality disorder.
Trauma, physical illness (especially chronic illnesses and those that could lead to head injuries), bereavement, severe lack of sleep, and drug abuse could result in misconstrued perception or interpretation of reality. Such a person is described to have lost touch with reality. They see, feel, hear and believe things that most people do not. This type of mental health disorder is described as psychosis. Severe depression, schizophrenia, and bipolar disorder are different forms of psychosis. A psychotic person may feel excited, hyperactive, very confident, threatened, and persecuted. Sometimes the feeling of being very special like the thoughts of receiving divine inspiration.
Research suggests that some mental health problems may run in families. For example, if you have a parent with schizophrenia, you are more likely to develop schizophrenia yourself. But no one knows if this is because of our genes or because of other factors, such as the environment we grow up in, or the ways of thinking, coping, and behaving that we may learn from our parents. Although the development of some mental health problems may be influenced by our genes, studies are yet to validate any specific gene that definitely causes mental health problems.
It is important to note that being psychotic does not mean being dangerous. The stigmatization of mentally ill people is very well documented in Nigeria and around the world. This behavior negatively affects the patient’s quality of life as well as creates a barrier to accessing mental health care. Although World Mental Health Day has helped to create improved public sensitization and reorientation on mental health, more need to be done on the part of Nigeria’s legislation, medical/health training, and primary healthcare practice.
The current legislation on mental health had its roots in a lunacy ordinance enacted in 1916 and amended to the lunacy act in 1958. The law is not in consonance with current reality. It gave magistrates and medical practitioners the right to detain people that exhibit mental illness. There is need for a legislation that would dramatically improve access to mental health care. About 80% of people with mental health challenges cannot access care in Nigeria. With the current ravaging economic hardship, social disparity, neglect, and authoritarianism, it is pivotal to enact an all-encompassing mental health law that promotes the rights of the patients to access healthcare services, confidentiality, improved funding for mental health care and a law that protect the social integrity of both the patient and the caregiver.
Subjects that teach strategies for the social promotion of mental health need to be mainstreamed into our school curriculum. There is a need for the integration of mental health clinics into our primary healthcare services. The country needs more psychiatrists, psychiatric nurses, clinical psychologists, and other mental health professionals to help curb the over 20% prevailing mental health conditions in the country. With over 200 million populations, Nigeria has only about 300 psychiatrists, most of whom are leaving in the big cities. This further exacerbates mental health conditions in small cities, towns, and villages.
While the healthcare personnel put in their best to help those diagnosed with mental illnesses, you should know that most mental health problems in Nigeria are underdiagnosed. It is therefore our responsibility as friends, family, and community to assist the vulnerable ones among us. According to the writer, orator, and researcher Professor Brené Brown “Vulnerability sounds like truth and feels like courage. Truth and courage aren’t always comfortable, but they’re never weakness.” We must end the cascade of stigmatization, be bold to seek help, and make mental health and well-being a priority in our societies.