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Dr Biodun Ogungbo, MBBS, FRCS, FRCSEd, MSc

Case 1: There was a day I stopped the car by the roadside. I stopped to dance to a great song on the radio. I was carried away dancing with a fine girl. She was a new friend, and I was giving it my all. She beckoned to me inviting me to kiss her. I leaned forward but got a slap instead. It hurt and suddenly I realised I was trying to steal a kiss. From a Policeman! I did not realise that he and a large crowd had gathered. It seemed I was dancing on my own!

Life in Nigeria is an emotional roller-coaster and many people are barely hanging on. Nothing seems to work in Nigeria or work the way they are meant to work. The abnormal has been normalised in Nigeria such that sane people constantly question their own sanity. The slide from sanity to insanity is smooth and easy.

We are in a dark place in Nigeria! The country appears to be in an abusive relationship with its own people.

How can you keep it together, in the face of poverty, dejection, rejection and a hoard of bad news cascading down our heads daily? Many people are at boiling points and quick to anger. It is better to agree and move on rather than argue the finer points of life in Nigeria.

Case 2: He was beaten black and blue, and stabbed in the head. This was a young man of 18. He ran out of the house one day and abused some thugs in the neighbourhood. They set upon him and beat him silly. Of course, they had not realised he was going mad, manic and unable to help himself.

People who have suffered mental stress and breakdowns are poorly diagnosed and poorly managed. The Nigerian public adds fuel to the raging fire inside the head of sufferers. There is little compassion or understanding of what people are going through. The management of mental illness is hellish.

According to Lancet (Global Health) Nigeria currently faces a global human rights emergency in mental health. Underpinned by poor societal attitudes towards mental illness and inadequate resources, facilities, and mental health staff, figures suggest that approximately 80% of individuals with serious mental health needs in Nigeria cannot access care.

80% of people who need a mental reset are unfastened by the society. We do not help tighten the screw. With fewer than 300 psychiatrists for a population of more than 200 million, most of whom are based in urban areas, and in view of poor knowledge of mental disorders at the primary health-care level, caring for people with mental illness is typically left to family members.

Case 3: Suddenly, she fell silent, then she was running around, shouting and being totally disorderly. It scared the daylights out. It sucked fun out of life and everyone felt it. She was moved to the ‘specialist’ in mental illness. Next time we saw her, she had changed significantly. She had bedbugs in her hair. She had scars all over her body. She was anemic and her eyes were sunken deep in her head. They were staring into nowhere and we knew it then. She was lost to us!

Families mean well but they are not equipped to handle mental illness, and many make terrible mistakes. They send mental health sufferers out of the home. They throw them out due to stigma and society pressure.

Stigma and misunderstanding about mental health conditions, including the misperception that they are caused by evil spirits or supernatural forces, often prompt relatives to take their loved ones to religious or traditional healing places.

They place them in these care facilities in order to have peace at home. Many are managed by sociopaths and charlatans due to the extreme shortage of trained mental health care practitioners. We are losing potentially viable and good men and women daily.

A paucity of community-based and primary health-care services means that access to care is restricted to the most severe cases, usually in the form of psychiatric inpatient care or makeshift institutions.

The result is a chronically and dangerously under-resourced mental health system catering to the needs of an estimated one in eight Nigerian people who suffer from mental illness, poor awareness of the causes of mental health, widespread stigma and discrimination, poorly equipped services, and abuse of people with mental health problems.

Detention, chaining, and violent treatment are pervasive in many settings, including state hospitals, rehabilitation centers, traditional healing centers, and both Christian and Islamic faith-based facilities.

As reported by Human Right watch in 2019, “People with mental health conditions find themselves in chains in various places in Nigeria, subject to years of unimaginable hardship and abuse.”

A nun in charge during a Human Rights Watch visit to a state-owned rehabilitation center in southeastern Nigeria said they chain people to their beds “so they do not run away.” The nun defended chaining a woman who had HIV “to stop her from going around the men.”

Human Rights Watch found another woman at the same institution chained naked to her bed.  People who are chained are forced to live in unsanitary conditions. Many must eat, urinate, defecate, and sleep in the same place, usually within the same space where they are confined.

Case 4: Miss A, a 22-year-old woman who had a mental health crisis following the death of her mother and who had been detained in a church in Abeokuta for five months at the time of a March 2019 interview, said: “When my father brought me, I didn’t know that he would leave me here. I was not happy, but I don’t have a choice.”

A reform of the mental health law that is in keeping with international standards is urgently needed to drive change. People with mental health conditions should be supported and provided with effective services in their communities, not chained, used and abused.

The first thing though is to create better awareness among the population. Mental health is like any other issue and can become a sickness. It needs empathy and treatment as may be necessary. It is not a curse and the sufferers are not possessed.

Case 5: In front of a traditional healer’s home in Abuja, researchers saw several women holding down a 12-year-old girl and making cuts on her back with a blade. They then smeared ground herbs into the cuts. The healer justified it by saying the girl had been stealing from her mother, and they had to let the evil blood come out of her.

They are not agents of the devil. They are simply sick family members who deserve to be treated with love and compassion. Many are a danger to themselves more than to family members or the society at large.

The Nigerian government should ban chaining and urgently investigate chaining in state-owned rehabilitation centers, psychiatric hospitals, and faith-based and traditional healing centers in all 36 states and the Federal Capital Territory.

The government should also prioritize the development of quality, accessible, and affordable community-based mental health services.

Finally, the government should stop abusing its citizens. Provision of jobs, social amenities, security and peace will reduce mental health issues in Nigeria.

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