By Toyin Falola
Driving between Ibadan and Lagos, you will find many men and women roaming the streets, some scavenging for food on refuse dumps. If they wander to markets, they drive them away with sticks, sometimes stoning them. I saw them under bridges in Abeokuta. They are all over the motor parks. A decent society does not treat any of its segments in a manner like this. Too depressing. Turning points do occur in life, and a normal person today can become depressed.
The mindset produces stereotypes that eventually lead to maltreatment, as in the case of stoning to chase away. One example: A Yoruba adage would state, “Were du’n wo loja sugbon kose bi lomo,” meaning it could be fun watching an episode of a mentally sick person, but it is despicable to have one as a child. Madness becomes a drama to entertain the sane!
Among the pool of devastating problems evident in Nigerian society, mental health has become one of the most neglected. The number of the mentally ill—a pool of conditions—is on the rise. The scene of a “mad man or woman” walking freely in society has become common and colloquial that it has been made fun of. Seeing a woman or man walk beside the roadside or dance through the market with some assumed euphoria of communing with spirits seems to be entertaining to the on-lookers. Such a person could be and stay in that area for years, constantly displaying without family, friends, or the government coming to their aid. So, the constant sights and lack of attention given to these people made their sickness a normal phenomenon everyone is probably pleased to see but detest to have as a relative.
While Nigerians understand mental health challenges, both as a sickness and some free public entertainment, the sickness attains deeper constructions. Spiritual attributions to acts of lunacy or episodes have been a disparaging phenomenon, even across Africa. Body parts of a mentally deranged, hair, clothes, and private parts have been seen as viable spiritual instruments for rituals. It goes on to ritual sex and sex predation that have endangered female persons suffering from mental challenges. They have become spiritual conduits that interact with other spiritual plains. They are seen as anjonu, spiritual beings, talking and interacting with other anjonu that cannot be seen. So, they become receptors of sacrificial and spiritual materials. In this light, the number of ritual killings of those suffering from mental challenges has proliferated. Thousands are being killed and mutilated every year across the continent without drawing the necessary attention.
While we ignore the veracity and the seriousness of the issue, Nigerian society tends not to consider the fact that mental illness transcends the highly degenerated cases that are displayed across the road but also some instances that might have been the root causes of many societal issues. Anxiety disorder, depression, PTSD, dissociation and dissociative disorder, OCD, eating disorder, and many others are some of the silent mental conditions to which attention is not given. Many Nigerians are facing depression and stress and lash out at society with overbearing and dangerous consequences without much attention being given to them. The World Health Organization posited that about 20% of Nigerians suffer from one form of mental illness or the other, and some other statistics put it at 25 to 30%. Such is a high number of affected individuals and the lack of attention that the sickness suffers from.
The above posits that about 3 out of every Nigerian suffers from one form of mental challenge or the other, and looking at the possibility of a high rate of undetected challenges among people, the number may be more. It means there is a high chance that in a household of 10 people, there would be a probability of 2 persons with the problem, and in a household of 5, there is a probability of 1 person facing mental challenges. Many of them are kept from public notice or wrongly discreetly diagnosed to be spiritually attacked. These issues become uncontrolled, and at an instance of escape, they become public nuisance and government affairs that the government never attended to.
While these mental health challenges are still stuffed down the throats of society, it seems that you and I have not learned to be conscious of the various means of manifestation. Mental health care still ignorantly seems to be some abstract and lofty affair that money and time are being wasted upon. The concepts of mental health and sanity do not strike individuals as health issues worthy enough to attract attention. The era of social media platforms and daily “cruises” has gradually been ripping society of any modicum of regard, reasonableness, and conscience that one would just make statements that would negatively and mentally change lives forever. The world has seen different celebrities lose their balance and careers crumbling because of comments that toy with the mental sanity of individuals. Parents, teachers, religious leaders, and other individuals make demeaning and dehumanizing statements that will cause a dent in the personality of an individual forever. But because the damage is not a physical wound that could be given first aid attention, they are left unattended, and the slightest complaints are dismissed as mere exaggerations.
From the above, it is obvious that those roaming the streets and roads are not just the “mad people,” but some of the persons who dress in suits and with beautiful appearance may as well be challenged as others but could have been able to put theirs under control. Unfortunately, the future of mental health in Nigeria is bleak. The fact that the figure of the sick roaming unattended to around the streets is increasing is evidence that the few that could be managed may be hopeless shortly. Suicide cases and other unconventional social reactions have been at an alarming rate recently.
The crux of the problem, this time, is not even the government, although they take a significant share of the blame; it bounces back to the people who either lack knowledge, are ignorant or decisively choose not to be conscious of the social consequences of their actions. The maltreatment of children by family and relatives in the misconstrued attempts to discipline the child; the violence that they are made to see while growing up; graphic movies and movies that require parental guidance but are shown to the children notwithstanding; untreated and un-debriefed traumas, constant psychological challenges; hypnotizations of people based on their wants and religions; failures and inability to handle consequence; and other scientific explanation for mental disorder are taken so lightly by individuals. People have failed to realize that mental health is not just a personal issue but that we owe society and every individual not to do things that may put them in danger.
Society, not recognizing the extent of these challenges, has made mental health cases increase drastically in Nigeria. People are often ignorant of the medical angle and explanation of mental health problems. They seek unproven alternatives to the issues. Sometimes, the decisions are based on an attempt to avoid stigmatization of the sick. This rationale is quite reasonable, looking at the fact that the social positioning of the Nigerian society refuses to be conscious of the phenomenon. The stigma extends to the family members as well as becomes a point of reference in the future. This explains why the words “Aro” or “Yaba Left” are colloquially used to insult people. “Aro” is the location of the Federal Neuro-Psychiatric Hospital, Aro, Abeokuta, and “Yaba Left” colloquially describes the Federal Neuro-Psychiatric Hospital, Yaba. Once you are metaphorically insulted to be from there or escaped from there, it means you are described to be deeply mad or mentally derailed. Hence, people avoid seeing their wards there.
Where one could muster the courage to brave the social stigmatization, the problem remains the expensive mental health care. With a poverty rate of 4 in 10 people being extremely poor in Nigeria, only very few people can afford mental health care services and treatments; hence, the alternatives are inefficient treatments that further degenerate the sickness. In some cases, the sessions and therapy could cost about 30,000 to 50,000 naira per session, and one may not be able to anticipate the number of sessions needed. The other drugs, treatments, and surgeries are also quite out of reach of the average Nigerian.
In another vein, the government has refused to adequately fund the mental healthcare sector of the Nigerian healthcare services. An estimate by the World Health Organization posits the Nigerian government does not give more than 3 per cent of the general budget on health to mental health care. Hence, the facilities and treatments are rare and available to only about 10 per cent of the total number of affected individuals. Doctors and nurses taking care of mental illness are badly remunerated.
There are not enough psychiatric or mental health experts in Nigeria. The country has only eight Federal psychiatric hospitals, eight professional schools for psychiatric nursing, and just twelve medical schools that are competent in mental health care. More so, many of the facilities, both public, private, and state, are largely seen in the southern part of the country and centred in the urban centres.
As a result of these shortcomings, there are just 0.4 beds available for every 100,000 people in Nigeria. There are also just 0.09 professional psychiatrists, 0.02 psychologists, and 4 psychiatric nurses available to 100,000 persons in the country. There is also a lack of trained mental health nurses and social workers, which makes it difficult to provide comprehensive care.
A viral video of a nurse chasing down a mentally ill patient who had escaped a mental institution is an index to the inadequacy of medical hands because how was such a patient able to escape a facility? This caricature speaks to the soul of mental health practices in Nigeria; as such, a determined nurse came off as a mental person in the chase of her patient. The few mental health professionals that do exist in Nigeria often face burnout due to the high demand for their services and the limited resources available to them. So, after overcoming the shame and stigma and being able to afford some treatments, good medical attentions are not guaranteed because of the lack of attention given to the sector by the government.
The government has largely left the responsibility of combatting mental health in Nigeria to the hands of private individuals and Non-Governmental Organizations, which are not enough to cater to the mental health needs of the nation. One cannot overstretch the need for the government to give adequate attention to these sectors to appreciate and complement the efforts of the private and NGOs that have made attempts in the past.
It is also apparent that there is a need for constant reorientation of the Nigerian physical and virtual spaces if the proliferation of mental health challenges must stop. Society must see every individual as much human as they are and also recognize that everyone is an agent of mental health awareness. Injuries caused to the physical bodies are seen and mostly appreciated, but the concealment of this type of sickness does not make it less important. Research has shown that mental health challenges could amount to an increase in social vices in society. Hence, to protect oneself or society, one must be conscious of the mental health of oneself and others.
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