By Edwin Philip and Ernest Ogezi

What if somebody told you that you are insane? Well, not insane, insane but at least not completely sane; and you never even knew about it. 

It is a common to see a shabby looking young man, dressed in a tattered brocade and a face full of untidy hair, getting a hot chase in the neighbourhood. Some ‘professionals’ chase him down, overcome him, and drag him, literally, to a corner store, housing the global headquarters of the spiritual centre, and he is given a beating of his life. The mental home is run by an overbearing individual, himself a candidate for an insane asylum, dressed in tartars and assuming the position of grand supreme leader of the mentally unstable.

What does go on in the make shift insane asylum? You can only imagine. Unqualified, untrained and unmonitored people allowed to run free coordinating people who are unaware of their own presence. It’s the perfect recipe for catastrophe. There are cases of sexual abuse, physical torture, people are practically chained and cuffed, fed like dogs and subjected to subhuman treatment. It is a reality for the mentally ill in Nigeria. You may have also seen a pregnant mad woman. Well, I’m sure you have. And you think she actually consented to sexual intercourse? Think again!

It could be surprising to see family members trying to hide their mentally sick relative from the public or visitors or hinder them from associating with others, like their peers. Food and basic necessities are sent surreptitiously to their ‘shack’ abode in a clandestine location somewhere at the back of the compound; and most times they are chained to a pillar. The family is quietly praying for the day he will peacefully pass away. To them death is better than shame. 

You wake up in the morning, in an urban or suburban community in Nigeria, just to a see new neighbour whose home is the street, roundabout, an uncompleted building or the open market square, irregularly dressed or unclad. Eyewitnesses who could give some account will narrate in low tones that the ‘new neighbour’ was dropped off at night by a vehicle not known in the area, suggesting that it came from a distant place.

The more inquisitive members of the town, usually children, through sheer curiosity will find out that the new member of their town does not speak the common language of the area. He had become an unwanted member of his former community because he had lost touch with reality. Since everybody knows him, and people can connect him with his family, his immediate family members are shamed. So, to the dungeons! He is bundled and driven in the steal of the night because losing him to a distant land is far better than the shame of his mental state.

One in every four Nigerian has mental health issues, forming part of an estimated 50 million people suffering from one sort of mental health issue according to research. There are only eight federal neuropsychiatric hospitals, doted across the six geopolitical zones of Nigeria, giving room for quack psychiatric doctors, nurses or spiritualists to fill in the gap of providing the much-needed medical attention to thousands of psychiatric patients.

Records show that there are less than 150 psychiatrists in the country of over 200 hundred million persons and it is estimated that fewer than 10 percent of mentally ill Nigerians have access to the care they need. The monumental difference between Nigeria’s need for better psychiatric care and the resources available can be typified by the health care gap at Yaba Psychiatric hospital, which had a 2018 budget of 133 million Naira but less than of 10 percent of that amount was released by the Federal Government. As a result of financial deficit and other challenges, Yaba hospital lost 25 – about half, of its resident psychiatrists over the past four years, some left to other countries, some to private hospitals, others simply quit.

Each doctor now tends to 50 to 80 patients per day, including the about 535 who fill the in-patient beds, and the 100 or more emergency cases who are rushed to the hospitals each week. Yaba Psychiatric Clinic once open from 9 am to 1.30 pm, is now open until 5pm, so its doctors can try to catch up their backlogs of patients.

And you know, as they say, there is no smoke without fire, meaning that mental health issues in Nigeria are a child of circumstance, with drug abuse toping the list, possession by ‘evil spirits’ (whatever that means and if you can believe it) and sickness of the mind ranked as second and third respectively. In Nigeria, an estimated 20 to 30 percent of the population is believed to suffer from mental disorders, ranging from: Depression – anxiety disorders such as generalized anxiety disorder, social anxiety disorder, panic disorder and phobia, obsessive-compulsive Disorder (OCD), Bipolar disease, Post-Traumatic Stress Disorder (PTSD) and the likes.

Considering depression as a case in time, amongst the mental health issues in Nigeria, may not hold water in the street, as it is never considered an illness let alone a serious mental issue. Parents, siblings, friends and colleagues will wave off anybody passing through depression and give preference to headache instead, as it tends to have some physical signs of pain. But depression is real. It is not just real; it is deadly and so many people are in that vicious circumstance. Because it is so stealth and unappreciated in Nigeria, depression has killed many, latently.

Nigeria has the highest caseload of depression, it ranks 15th in the world in the frequency of suicide, research shows, the highest caseload may not be unconnected to handling the issue of depression with kid gloves, with current economic realities in the country and lifestyle changes, there is tendencies that the caseloads may remain higher or break the ceiling. A mentally ill person in Nigeria is perceived as a demon-possessed either by a deity or a victim of his or her doing (quest for supernatural power, wealth, fortune and their likes). Even after recovery, they are still seen as insane and their actions and in actions are still seen through the lenses of a sick person, with everybody socially distancing from them.

Family members of a mentally ill person in Nigeria are prejudged as a potential mental health candidate, which of course can set in, due to unfair treatment the society gives to them. Coping mechanism for dealing with mentally ill patients differ from one family to another for variety of persons. In appreciation of what a mentally sick person goes through, it can be likened to one who puts his finger into burning a flame, walking into danger with no caution, not wearing clothes in the peak of an unfriendly weather, eating decayed food littered in and around unpleasant of places, it is hell.

We’ve been told that every human being sinks into some seconds of insanity, just imaging if mentally ill people can also get some sanity in some split seconds every day, what will be people’s reaction to their state of mind at that time? The need to treat them better should be a collective responsibility.

Instead of treating the mentally challenged people as vulnerable and requiring assistance, what do they get? They are sacrificial lambs for ritualistic purposes; they are objects of ridicule, mentally ill women are seen to be pregnant obviously impregnated by a sane man, who through the advice of a spiritualist, has had carnal knowledge of a woman who does not have the state of mind to grant him consent. A mad person for lack of what to eat or in raw hunger, picks a mango or a loaf of bread from a road side vendor is given a beating of his life and is left with injuries that may not be treated by anybody. 

Due to some superstitious beliefs about mental health issues, family members of the mentally sick patronise traditional native healers, who, due to lack of formal education and standardisation of their treatments, may unknowingly be prolonging the illness rather than addressing and treating them of their sickness. The traditional healers are essentially the mental health system in Nigeria, the federal government has drafted a mental health policy, yet its actual implementation into the health infrastructure and society is still in the tunnel.

The limited health legislation or policy implementation seems to favour those who can access the urban areas and the facilities health services. However, much can be done to remove the barriers that prevent the integration of traditional healers into the mental health system and improve the quality of care they administer within the population. Doctors’ exodus amidst rising numbers of mental health issues in Nigeria spells doom on the country’s health care system. It is worthy of note that nine out of every ten doctors in Nigeria are seeking to leave the country. If an average of 12 doctors leave Nigeria to seek employment in the UK every week, where they can earn twice as they do at home, better welfare packages and good work environment, Nigeria will only be a training ground for the healthcare systems of the UK, Canada, Germany and others. It is common to see a shabby-looking young man, dressed in a tattered brocade and a face full of untidy hair, getting a hot chase in the neighbourhood. Some ‘professionals’ chase him down, overcome him, and drag him, literally, to a corner store, housing the global headquarters of the spiritual centre, and he is given a beating of his life. The mental home is run by an overbearing individual, himself a candidate for an insane asylum, dressed in tartars and assuming the position of the grand supreme leader of the mentally unstable.

What does go on in the makeshift insane asylum? You can only imagine. Unqualified, untrained and unmonitored people are allowed to run free coordinating people who are unaware of their presence. It’s the perfect recipe for catastrophe. There are cases of sexual abuse, physical torture, people are practically chained and cuffed, fed like dogs and subjected to subhuman treatment. It is a reality for the mentally ill in Nigeria. You may have also seen a pregnant mad woman. Well, I’m sure you have. And you think she consented to sexual intercourse? Think again!

It could be surprising to see family members trying to hide their mentally sick relatives from the public or visitors or hinder them from associating with others, like their peers. Food and necessities are sent surreptitiously to their ‘shack’ abode in a clandestine location somewhere at the back of the compound, and most times they are chained to a pillar. The family is quietly praying for the day he will peacefully pass away. To them, death is better than shame. 

You wake up in the morning, in an urban or suburban community in Nigeria, just to a see new neighbour whose home is the street, roundabout, an uncompleted building or the open market square, irregularly dressed or unclad. An eyewitness who could give some account will narrate in low tones that the ‘new neighbour’ was dropped off at night by a vehicle not known in the area, suggesting that it came from a distant place.

The more inquisitive members of the town, usually children, through sheer curiosity will find out that the new member of their town does not speak the common language of the area. He had become an unwanted member of his former community because he had lost touch with reality. Since everybody knows him, and people can connect him with his family, his immediate family members are shamed. So, to the dungeons! He is bundled and driven in the steal of the night because losing him to a distant land is far better than the shame of his mental state.

One in every four Nigerians has mental health issues, forming part of an estimated 50 million people suffering from one sort of mental health issue according to research. There are only eight federal neuropsychiatric hospitals, dotted across the six geopolitical zones of Nigeria, giving room for quack psychiatric doctors, nurses or spiritualists to fill in the gap of providing the much-needed medical attention to thousands of psychiatric patients.

Records show that there are less than 150 psychiatrists in the country of over 200 hundred million persons and it is estimated that fewer than 10 per cent of mentally ill Nigerians have access to the care they need. The monumental difference between Nigeria’s need for better psychiatric care and the resources available can be typified by the health care gap at Yaba Psychiatric hospital, which had a 2018 budget of 133 million Naira but less than 10 per cent of that amount was released by the Federal Government. As a result of financial deficit and other challenges, Yaba hospital lost 25 – about half, of its resident psychiatrists over the past four years, some left to other countries, some to private hospitals, others simply quit.

Each doctor now tends to 50 to 80 patients per day, including the about 535 who fill the in-patient beds, and the 100 or more emergency cases who are rushed to the hospitals each week. Yaba Psychiatric Clinic once open from 9 am to 1.30 pm, is now open until 5 pm, so its doctors can try to catch up on their backlogs of patients.

And you know, as they say, there is no smoke without fire, meaning that mental health issues in Nigeria are a child of circumstance, with drug abuse topping the list, possession by ‘evil spirits’ (whatever that means and if you can believe it) and sickness of the mind ranked as second and third respectively. In Nigeria, an estimated 20 to 30 per cent of the population is believed to suffer from mental disorders, ranging from: Depression – anxiety disorders such as generalized anxiety disorder, social anxiety disorder, panic disorder and phobia, obsessive-compulsive disorder (OCD), Bipolar disease, Post-Traumatic Stress Disorder (PTSD) and the likes.

Considering depression as a case in time, amongst the mental health issues in Nigeria, may not hold water in the street, as it is never considered an illness let alone a serious mental issue. Parents, siblings, friends and colleagues will wave off anybody passing through depression and give preference to headache instead, as it tends to have some physical signs of pain. But depression is real. It is not just real; it is deadly and so many people are in that vicious circumstance. Because it is so stealth and unappreciated in Nigeria, depression has killed many, latently.

Nigeria has the highest caseload of depression, it ranks 15th in the world in the frequency of suicide, research shows, the highest caseload may not be unconnected to handling the issue of depression with kid gloves, with current economic realities in the country and lifestyle changes, there are tendencies that the caseloads may remain higher or break the ceiling. A mentally ill person in Nigeria is perceived as a demon-possessed either by a deity or a victim of his or her doing (quest for supernatural power, wealth, fortune and their likes). Even after recovery, they are still seen as insane and their actions and inactions are still seen through the lenses of a sick person, with everybody socially distancing from them.

Family members of a mentally ill person in Nigeria are prejudged as potential mental health candidates, which of course can set in, due to unfair treatment the society gives to them. The coping mechanism for dealing with mentally ill patients differ from one family to another for a variety of persons. In appreciation of what a mentally sick person goes through, it can be likened to one who puts his finger into burning a flame, walking into danger with no caution, not wearing clothes in the peak of unfriendly weather, eating decayed food littered in and around unpleasant of places, it is hell.

We’ve been told that every human being sinks into some seconds of insanity, just imaging if mentally ill people can also get some sanity in some split seconds every day, what will be people’s reaction to their state of mind at that time? The need to treat them better should be a collective responsibility.

Instead of treating the mentally challenged people as vulnerable and requiring assistance, what do they get? They are sacrificial lambs for ritualistic purposes; they are objects of ridicule, mentally ill women are seen to be pregnant impregnated by a sane man, who through the advice of a spiritualist, has had carnal knowledge of a woman who does not have the state of mind to grant him consent. A mad person for lack of what to eat or in raw hunger picks a mango or a loaf of bread from a roadside vendor is given a beating of his life and is left with injuries that may not be treated by anybody. 

Due to some superstitious beliefs about mental health issues, family members of the mentally sick patronise traditional native healers, who, due to lack of formal education and standardisation of their treatments, may unknowingly be prolonging the illness rather than addressing and treating them of their sickness. The traditional healers are essentially the mental health system in Nigeria, the federal government has drafted a mental health policy, yet its actual implementation into the health infrastructure and society is still in the tunnel.

The limited health legislation or policy implementation seems to favour those who can access the urban areas and the facilities health services. However, much can be done to remove the barriers that prevent the integration of traditional healers into the mental health system and improve the quality of care they administer within the population. Doctors’ exodus amidst rising numbers of mental health issues in Nigeria spells doom on the country’s health care system. It is worthy of note that nine out of every ten doctors in Nigeria are seeking to leave the country. If an average of 12 doctors leave Nigeria to seek employment in the UK every week, where they can earn twice as they do at home, better welfare packages and a good work environment, Nigeria will only be a training ground for the healthcare systems of the UK, Canada, Germany and others.