Tackling Mental Illness
Martins Ifijeh writes that it's not a good time for psychiatric patients in Nigeria, as the high cost of treatment and lack of proper medical services are hampering timely and adequate treatment needed for management and cure of the illness
When 25 years-old Omono noticed her only brother, Oseodion, who was 15 years-old at the time, behaving strangely, it didn't occur to her that he had developed a kind of psychiatric disorder. It was not until after a month that it dawned on everyone in the house that something terrible was going wrong with the child. "We knew we were in for something bigger than us; it has never happened in the history of my family that anyone ever developed such psychotic disorder.
"Oseodion, who used to be a very quiet and intelligent teenager, suddenly started coming up with harebrained ideas that could really make a stranger run away from him or worse still fight him," Omono explained tearfully.
She said it got to a point he had to be withdrawn from school due to his deteriorating health, adding that Oseodion’s teachers became scared of what he might do to other students, as he was increasingly violent and unpredictable.
While at their home in Idumebo, a small community within Ekpoma in Edo state, Omono said her brother would scatter the house, refuse to bathe for days, fight everyone over nothing, including their father, and at some time, he would stay depressed for several days.
"Obviously, he needed to be taken for treatment, but there was no facility close by for his kind of sickness, apart from pockets of traditional psychiatric homes, where patients are tied to movement restrictors, locally called aban in Ishan dialect; made from heavy logs of wood placed around one or the two legs of the patients, in order for them to be restricted to a particular spot while been treated," she added.
As time passed, it became clear to them that it was the traditional psychiatric home or nothing. So, they took him to one of such traditional homes, as the family could no longer bear the pain and bizarre behaviour that came with the illness.
"We took him to a traditional doctor in Uromi, who told us he could treat him, after telling us to pay the sum of N20, 000 as deposit.
"Raising the money was somewhat a problem since my family is very poor. Edo state government has refused to pay our father his pension arrears and gratuity which has accumulated into several millions of Naira since 2009 when he retired. Yet we struggled it out to get the money with the hope that Oseodionwould be treated and be well again," she lamented.
But Omono, who is now a graduate of Ambrose Alli University, Ekpoma and her family were wrong, Oseodion’s health never improved. His case continued to worsen. His anxiety increased, his depression increased and his suffering increased. The traditional healing home could not cure him.
"I shed tears every night because his sickness shattered everyone in the house, especially our mother who had been hypertensive for years.
"Three months after, we had to discharge him when we didn’t notice an improvement in his health. At this stage, we had spent over N75, 000 on his health," Omono explained.
Again, they had to take him to another traditional herbalist, known to treat mental illnesses in Ukpenu, a rural community also in Ekpoma town. Yet, his condition deteriorated even more. "I watched my only brother suffer from this 'strange' illness that has taken away the joy and laughter of the whole family.
"Against our hope, the traditional clinic in Ukpenu didn't help matters. They chained my brother to a wooden log stationed in a small hall sheltering over 20 'inmates'. The offensive smell from
the hall was terrible; I wondered how Oseodion would be cured there, considering the poor hygiene and stench coming out of there.
"Majority of the patients defecate in the hall, which made me cry any time I go visit my brother. I remember the herbalist always telling me not to worry about the stench from the hall and the chains on his legs, that in no time he'll be fine.
But that never happened. "Months passed and his condition didn't improve. Rather, it became worse. His skin wrinkled with sores all over. I wept as I watched my once-handsome little brother become a shadow of himself. We had no choice but to take him out of the place," she said.
According to her, they didn't leave the 'clinic' without coughing out over N40, 000 within the months he was admitted.
Omono, explained that when they took him home and cleaned him up, they discovered the chains used on him had given him severe sores. "The sores were so big that it became another issue,” Omono stated.
At this point, it dawned on the family that they needed to take him to a proper neuro-psychiatric hospital even though they had taken him round the major traditional mental homes in the town without success; an idea they shelved off earlier, because they learnt the only neuropsychiatric hospital in the whole of Edo State was far more expensive than the traditional mental homes, making it difficult for poor families like theirs to take their sick loved ones there.
"We finally took Oseodion to Federal Neuropsychiatric Hospital, Uselu in Benin, for treatment, but not before selling off some valuables in the house in order to pay for his treatment.
"The place was different from the herbal homes we previously visited. It was neater, bigger and more organised. But we were all spell-bound when the hospital told us we had to pay almost N100,000 for admission and onward treatment,” she narrated.
According to her, this became another burden since they thought the money they brought would be at least enough to take care of his first few months in the hospital. "Realizing that there was no more options available, our mother began to cry and pleaded that they accept the N40, 000 naira we had brought.
"They reluctantly accepted the money and then told us to bring the balance within weeks. That is how Oseodion was admitted in Uselu, while they commenced treatment,” she said.
This latest move raised the family's hope of getting their son cured, but finance remained a major constraint. “Months passed and we noticed some level of improvements in him. But these improvements were coming in 'pockets'. Oseodion would be 'almost well' today and tomorrow he'll be worse off.
“That is how we managed his illness at the hospital until we were all exhausted financially, with no single hope of getting financial help from anyone. My father met a lot of people, but nobody was willing to assist.
“The last straw was when our father made several attempts, using different All Progressive Congress (APC) politicians to persuade the government to consider him and pay his entitlements,” said Omono.
She explained that her father retired from the state's civil service in 2009 and happened to be among those yet to be paid their entitlements.
About 12.5 per cent of Nigerians have one form of psychiatric disorder or another, which is about 21.2 million Nigerians. This is why we need more hands; more psychiatrists, more health workers and more health facilities
After a while they were thrown out of the hospital because they couldn’t meet up with the hospital bill. "The hospital told us they could no longer treat him since we owed so much. We pleaded, but they didn't listen, as the hospital discharged him.
“There was nothing we could do other than to take him home, with the full consciousness that he hasn't been cured of the illness that took away our joy. We had to bring him back home, praying that God will do his miracle and heal him.
"It got to a time he would leave the house and not come back until after two or three days. At a point he stopped coming home. The streets became his new home; toiling every nook and cranny of Ekpoma town during the day and sleeping any where at night.
"And then he 'graduated'. Clothes became his new enemy. I would see my brother walk aimlessly and stark naked on the streets. He couldn't even recognise me anymore. Most times, I avoided seeing him because it could make me depressed for days. I would shed tears and cry myself out because he was my only brother. I couldn't come to terms with the reality on ground," Omone wept.
And then, the unimaginable happened. He was knocked down by a hit-and-run vehicle at the age of 17. Oseodion died instantly, leaving his dream of becoming an engineer unfulfilled.
"His mental illness could have been prevented. He couldn't get proper treatment that would have made us laugh again. That was how he went with his promising dreams and aspirations," she sighed.
The tone at which Omono described her late brother who used to be one of the most brilliant student in his class in EguareSecondary School, Ekpoma, showed how much his death devastated the whole family.
The memory of Oseodion's last moments on earth has haunted the family till date. It is over a year now since he died…but to the family, it looked just like yesterday.
A visit to the mental home in Ukpenu.
This reporter, on arriving the traditional mental home in Ukpenu, saw that there were few patients in the expanded compound, with some tied up in a small hall while others, who were presumed to be getting better were seen strolling or sitting within the compound premises.
One would not know at a first glance that those strolling in the compound are psychiatric patients except on close observation, as their demeanour sometimes gave them away.
“The home is not as popular as it used to be. If you had come here some years ago, you would have found that Baba (as the native doctor is fondly called) was very popular as people all over the country bring their sick ones to this clinic for treatment" revealed Augustine, one of the sons of the owner of the traditional healing home, noting that "People hardly bring their loved ones here these days because baba is not as active as he used to be, his health is failing."
The patients who were in the small hall (the size of the hall could be that of a big sitting room) were all under wooden restrictions and the reek from the hall was bad enough to cause them other illnesses.
Augustine only agreed to take this reporter round the large compound because the reporter claimed he had a sick loved one who needed to be brought in for their care, and as such Augustine was very anxious to explain how things were run in the psychiatric home.
"One thing about cure for mental illness is luck. Not everybody gets cured, but majority go home well. Those who are not well are sometimes asked to go, especially when they have overstayed in this place without improvements," he said.
Augustine does not believe the hall the patients are kept is untidy and could affect their health negatively.
Some of the patients who were under wooden restrictions had urinated on themselves. Another one was seen defecating on a small bowl, which, according to Augustine, would be disposed-off by one of the workers.
Everything is done in the full glare of other patients in the small hall, while inhaling the stench of faeces and urine from fellow 'inmates'.
On how they get people to work there, Augustine said majority of the workers were patients in the mental homes before but got well and couldn’t go back to their houses because they believe they might fall sick again.
At first, this reporter opted to stand on the entrance to the hall while observing the activities going on inside the 'ward'. But since Augustine, whom they know very well was with him, he summoned courage and entered the hall for apt observation.
On a closer look, it was discovered that the wooden restriction (aban) used to immobilize the patients, caused bodily harm to most of the ‘inmates’. With some having major sores on their legs. It was obvious this added to the horrible smell coming out of the ward.
According to Augustine, "The sores will heal once we remove aban from them. And we can't remove it when there is no sign of improvement on their health. With experience, we know a lot of them could run away from here once we remove it from them, so we only remove it when we are doubly sure they won't run away. The aban is also useful to protect the workers who feed and treat them because some of the patients are violent,” he added.
Oseodion is not the only psychiatric patient who has gone through this horrific agony in search for treatment. Millions of Nigerians are grappling with the inability to pay for their loved ones' psychiatric treatments due to increased financial demands by neuropsychiatric hospitals as well as traditional psychiatric homes.
With an estimated population of 170 million people, Nigeria has less than 150 practicing psychiatrists, according to available statistics.
Numbers for other mental health professional are as damning as that of psychiatrist, yet common mental health disorders like depression, anxiety and schizophrenia are as common in Nigeria as in other countries of the world that have better mental health resources.
In a mental health forum organized in Lagos to mark Mental Health Day, the Founder of Mental Health Foundation, Dr. Emmanuel Owoyemi, revealed that about 64 million Nigerians were going through one form of mental illness or the other.
According to him, "There is so much panic at heart, anxiety, high level depression and there is no mental health policy in Nigeria right now; the National Assembly has been delaying in passing the Mental Health Bill,” he said
Tackling high cost of psychiatric treatment
A neuropsychiatric doctor with Federal Neuropsychiatric Hospital, Uselu, who prefers to remain anonymous said, the reason the hospital charges high for admission and treatment of psychiatric patients was because of poor funding in most neuropsychiatric hospitals in the country.
According to him, "the number of psychiatric patients in the country is increasing by the day, but our government has refused to come to term with this. Hence, for the hospital to survive, patients have to pay something substantial, otherwise it would be difficult to treat them.
"When government give priority to psychiatric care in the country, funding will increase, while patients would have to pay little to access medical services,” he said.
He also advised the government, organisations and public spirited individuals to establish psychiatric hospitals in rural areas.
"If you look carefully, you will discover that most neuropsychiatric hospitals in the country are located in the cities. Meanwhile, a lot of our rural dwellers are dealing with this sickness. Hospitals like these should be close to the people. It shouldn't be located only in the cities," he said.
The Doctor believed the reasons for the dearth of resources for mental health in Nigeria were multifaceted, adding that political to develop a mental health service based on a comprehensive legal and policy framework was needed. “Career interest in mental health by aspiring undergraduates is minimal and reflects society’s negative attitudes and poor understanding of the bio-psycho-social basis of psychiatric disorders,” he said.
More neuropsychiatric hospitals are needed in the country
In an interview with THISDAY, the Medical Director, Federal Neuropsychiatric Hospital (FNH),Yaba, Dr. Rahman Lawal explained that state governments must compliment the efforts of the Federal Government in terms of providing enough neuropsychiatric hospitals for the country.
He said the country presently has eight federal neuropsychiatric hospitals, adding that going by the country’s population, it wasup to the state governments to set up neuropsychiatric hospitals in their various states. “I know some of these states have, but they are very few. If every state set up neuropsychiatric hospitals then the burden of patients not able to access treatment promptly will reduce drastically,” he said.
For states that are unable to establish such hospitals, Lawal advocated for establishment of neuropsychiatric departments in their various general hospitals or health centres and then provide specialists to manage the department.
“With the high number of persons in Nigeria who needs psychiatric attention, it is worrisome that we have only few neuropsychiatric hospitals and trained psychiatrists in the country making it difficult to meet the medical needs of the people,” he added.
He believed when neuropsychiatric hospitals are closer to the people, it would in turn aid in the reduction of money expended on treatment.
“About 12.5 per cent of Nigerians have one form of psychiatric disorder or another, which is about 21.2 million Nigerians. This is why we need more hands; more psychiatrists, more health workers and more health facilities, so that we will be able to cope with treatment and management of psychiatric issues in Nigeria,” he noted.
A Nigerian and a Psychiatric Nurse with Healing Wounds Foundation, Georgia, Matilda Oje, said psychotic disorder, often known as psychosis is an abnormal condition of the mind described as involving a 'loss of contact with reality'.
She said persons experiencing psychosis may exhibit some personality changes and thought disorder that may be accompanied by unusual or bizarre behavior, as well as difficulty with social interaction and impairment in carrying out daily life activities.
On the causes, Oje explained that there were primary and secondary psychiatric causes. “The primary psychiatric causes includes schizophrenia, chronic hallucination disorder, bipolar disorder, stress, among other causes.
“The secondary psychiatric causes of psychosis includes the use of psychoactive drugs (whether legal or illegal) - cocaine, cannabis, alcohol, methamphetamine- which has been implicated in causing psychotic states and disorders in users. This may be upon intoxication, for a more prolonged period after use, or upon withdrawal.
She said there was no sure way to prevent mental illness, stating that steps can however be taken to control stress, increase personal resilience and boost low self-esteem, as these in someway suppresses it.
The number of psychiatric patients in the country is increasing by the day, but our government has refused to come to term with this. Hence, for the hospital to survive, patients have to pay something substantial, otherwise it would be difficult to treat them