Abiodun Adewuya, a Professor of Psychiatrics in Lagos State University Teaching Hospital (LASUTH) and a Psychiatrist, recently spoke with CHIOMA UMEHA on issues of mental health in Lagos State. Excerpts:
A medical doctor recently stated that it is not only the people, who are mentally deranged and roam the streets that are mentally sick. How do you identify those that have mental issues?
Well, mental health problem are diverse in that there are some with mild mental health problems, which is called common mental disorder; there are some moderate ones; there are some severe ones. Yes! The doctor is very correct. It is only those ones that have severe cases that are likely to be seen on the streets. But, what we are trying to do is to make sure that we prevent that from happening. One thing is to treat the people that have already broken down, that have severe mental illness. But, the best way to tackle common mental disorder is by treating the mild and moderate mental disorder. That is why we are training our doctors to be able to recognise mild and moderate mental disorder in their patients that come for malaria or tuberculosis or any other thing, even diabetes etc. This is because we discovered from our studies that between 20 and 40 per cent of patients who attend primary care centre and general hospitals have a form of common mental disorder or the other.
So, what we are trying to do is to build the capacity of our doctors and nurses to recognise these common mental illness and offer treatment under their supervision in such a way that we are able to reduce the treatment gap, which is the gap between those who have the problem and those who are receiving the treatment, because we know that over 80 per cent of people who have mental health problem in Nigeria or in Lagos do not receive treatment.
So, how can we make sure that they get treated? That is by enhancing the capacity of our nurses and doctors to be able to recognise the common mental disorder in the patients, even when the patients are not aware of this. They come to hospital and complain that they have malaria, they have headache, they have this and that, but the problem is that they mostly depend on their anxiety. So we are trying to train our health workers, all of them, health workers, Medical Officer of Health (MOHs), nurses, doctors to recognise this common mental health disorders and then offer treatment when possible and make a referral to the tertiary hospitals where possible, that is what we are doing.
Sir, what are the Standard Cooperative Procedures for professional in psychiatric?
The standard cooperative procedures professional is that we have to distinguish common mental disorder in patients. We are not training psychiatrists; we are training the non-specialist health workers, who are doctors. So what we are trying to do is to set up a kind of procedure for them, that once somebody is brought to the hospital, who is probably very angry, very anxious and things like that, these are the steps in which you are going to take.
What are those common health mental disorders?
The three we are focusing on, which the World Health Organisation(WHO) said that we should focus on are: depression and anxiety that is number one; epilepsy which is called (Girior Warapaaradia) and the big ones we see on the streets, psychosis. These are the three big ones we feel we should focus on. Right now, in Lagos State we are trying to start by looking at depression and anxiety because we cannot teach people how to recognise and treat these three at the same time. So we want to start with depression and anxiety first, then we can add epilepsy, then we can teach people how to recognise psychosis. That is our plan.
Concerning care-givers at home what are the things you see in your relations in your children that make you think they are mentally ill?
Ok, there are nine symptoms of depression, for example, it can start from someone feeling low, unhappy, unusual sadness, crying without being prompted, that is number one. Then, it can actually progress to other things – if someone has loss of interest in whatever was his pleasurable activities, like he loves going to church, he likes going to mosque, playing with his friends and suddenly he is not interested in doing all that again. And then, of course, it can be someone who has no energy at all to do anything; he is always lying there watching TV, and there is part of other things like appetites, he may not be able to eat as he normally eats.
Of course, he can have striking difficulties in such a way that the fellow would find it difficult to sleep and when he sleeps, he wakes up in the middle of the night and may not be able to sleep again, maybe until 5 p.m or around 6 p.m. Even when he wakes up, he feels so non-refreshed like he still wants to sleep. Then if he is a worker, his work schedule will go down, he won’t be able to do what he normally does and everybody would be complaining about him. People around may think that he is being lazy, no, that person may be depressed.
So, we should look out for all these points very carefully. If we noticed that in someone we can just ask the person; why don’t you see them at the nearest primary health care centre? Of course, we have a list of the health care centres in which their health workers have been trained to recognise these common health mental disorders.