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It is no news that mental health challenges and illnesses are on the rise in contemporary times. The socioeconomic and political climate and other biopsychosocial factors have been implicated as factors contributing to the fast-rising burden of mental health. While other parts of the world are catching on to this realization and making an effort to match the demand for mental health care with the supply of caregivers and professionals, Africa and Nigeria in particular still have a long way to go.
According to the World Health Organization 2017 Report, approximately 450 million people grapple with mental illnesses, and an estimated 25% of the world’s population will encounter mental health challenges at some point. Furthermore, mental disorders contribute to approximately 7% of the global health burden, impacting nearly 19% of individuals with disabilities.
Nigeria is grappling with a staggering mental health crisis, as millions of its citizens suffer from various mental disorders. The World Health Organization (WHO) estimates that a whopping 20% of Nigerians (1 in 5 persons), or around 40 million people, are affected by mental illness. Some of Nigeria's most prevalent mental illnesses include depression and anxiety disorders. In 2017, about 7 million Nigerians (3.9% of the population) had depressive disorders, and 4.9 million Nigerians (2.7%) had anxiety disorders. Nigeria ranked 15 in the number of suicides per year On top of this, substance abuse disorders, bipolar disorder, schizophrenia, and personality disorders are common in Nigeria.
Mental health is fundamental to our collective and individual abilities as humans to think, observe societal norms and behave in socially accepted manners, work to earn a living, as well as interact with one another and enjoy life. For this reason, the promotion, protection and restoration of mental health is of a vital concern for individuals, communities and societies throughout the world.
Numerous factors underlie the inadequacy of mental health care services in Nigeria, with one of the most prominent being the shortage of psychiatrists within the country. Astonishingly, despite a population of 200 million people, Nigeria boasts only 250 practicing psychiatrists (Association of Psychiatrists of Nigeria6. This glaring disparity in the Psychiatrist-to-population ratio underscores the marginalization of mental health within the country, a situation exacerbated by the issue of brain drain, which continues to deplete the healthcare workforce in needed to address the mental health challenges in Nigeria.
Many mental health conditions can be effectively treated at relatively low cost, yet health systems remain significantly under-resourced and treatment gaps are wide all over the world. Mental health care is often poor in quality when delivered due to inadequate funding. In this regard, there is need for increased investment in the promotion of mental health especially in LMICs such as Nigeria.
In 2019, WHO launched the WHO Special Initiative for Mental Health (2019-2023): Universal Health Coverage for Mental Health to ensure the closing of the gap in access to mental health services . This heightened awareness has led to widespread initiatives, encompassing awareness campaigns, advocacy rallies, the establishment of nongovernmental organizations, the expansion of hospital facilities, the dedication of passionate professionals and governmental interventions, all aimed at fortifying the support system for mental health and psychiatry. However, while many regions have embraced this progress, certain parts of the world lag, with Nigeria notably standing at the forefront of this challenge.
It should be borne in mind that the human resource for addressing mental health conditions extends beyond psychiatrists alone. A multifaceted approach necessitates the involvement of various healthcare professionals, including social workers, psychologists, community health experts, occupational therapists, mental health pharmacists, counselors and community support workers. The factors influencing mental health are wide-ranging, encompassing familial, social, economic, environmental and more (9) Therefore, effective mental health care and management demand a holistic approach extending beyond the confines of hospital walls. In contemporary Nigeria, addressing mental health challenges requires a collective effort, engaging individuals and platforms at the grassroots level, with interventions spanning sectors such as education, transportation, welfare, housing and beyond.
In Nigeria, fewer than 10 percent of those with mental illness have access to mental healthcare. To a large extent, access to diagnostic, therapeutic and rehabilitative mental health services are limited to urban centers, leaving the rural areas where majority of Nigerians live without the requisite resources for psychiatric care. Many of those living with mental health disorders reside in the rural areas, with no access to quality mental health care; therefore, these people often have no choice that to resort to self-diagnosis and self-medication or alternatively they seek the care of traditional or spiritual healers (10). Moreover, available data shows that about 80% of people in Nigeria with severe mental health needs are unable to obtain care, which is primarily attributable to the country’s stigma and negative social attitudes toward mental health issues as well as a lack of facilities, resources and mental health professionals.
The acute shortage of qualified psychiatrist and allied professionals as well as the absence of skilled mental health care providers at the primary health care level is seen as major obstacle in bridging the access to the already existent mental health service gap in Nigeria; which has been described by Ugochukwu et al.(2020) as “a state of emergency” in mental health service provision.
Demyttenaere et al., (2004), have equally highlighted the role of unique socioeconomic and cultural barriers have played in impeding mental health outcomes in Nigeria and the need to tailor interventions to meet the needs of local communities. The call for the integration of mental health into primary care in Nigeria has been explored to some extent with emphasis on the need to leverage on the primary health care system to deliver mental health services at the community level
This approach is envisaged as a stop-gap measure in addressing the poor utilization of formal mental health services at the grassroots, largely due to the unavailability of the requisite infrastructure, and the human resource shortage at the primary health care level. It will also help improve access to and affordability of mental health services. The thrust in driving grassroots mental healthcare at the grassroots can best be achieved through comprehensive community-based mental health awareness programs should extend beyond medical circles and engage the wider public, particularly the youth. These initiatives, including public seminars, workshops and informational campaigns, can educate citizens about the importance of mental health protection and its promotion.
People with mental health conditions often also experience stigma, discrimination and human rights violations. There is need for the de-stigmatization of mental through the creation of mental health awareness to increase understanding and reduce stigma. There should also be a concerted effort by the government at increasing access to quality mental health care and effective treatments; as well as the conduct of evidence-based research to identify new treatments and improve existing treatments for all mental disorders.
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