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 illnesses during the recent mental
health workshop for clinicians in primary health centres (PHC) in Lagos State.
Excerpts:
Sir, when a case of mental illnesses has been
confirmed what are the steps that should be taken to address it?
If a case of mental illness is confirmed by health
workers, and it is among the common mental disorders – that is mild and
moderate mental disorder; our trained health workers are to either offer
treatment in form of psychological treatment or medications. If those cases
cannot be treated at the Primary Health Care(PHC) Centre, what we are trying to
do is to make sure that they are referred to either the General Hospital or the
Teaching Hospital or Federal Psychiatric Hospital in Yaba.
This is because we discovered from our studies
that between 20 per cent and 40 per cent of patients that 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 at the PHC centre to recognise these common
mental illnesses and offer treatment under their supervision. This way, we are
able to reduce the treatment gap, which is the gap between those who have the
common mental illnesses and severe mental cases, as well as those who are
receiving the treatment. There over 80 per cent of people who have mental health
problem in Nigeria who do not receive treatment.
So, what we are trying to do is to train all
health workers in Lagos State wherever they are. So the idea is if there is a
problem you can go to the PHC centre that is nearest to you, that is the real plan.
You can be referred to the General Hospital or the Teaching Hospital or Federal
Psychiatric Hospital in Yaba, if the PHC centre fails to manage the case.
You mentioned that 80 per cent of people with this
kind of condition do not get treatment. Why?
This depends on three things. One is stigma. We
stigmatise people who are mentally ill. Mental illness is not like hypertension
or diabetes that people are so happy to announce that they have, not many
people would be able to announce that they have a psychological problem,
because we think it’s a very wrong thing around here that is number one.
Then, number two is recognition, people don’t
recognise common health disorder as a real problem, it’s not like headache. So
many just think that person with mental illness is being lazy or that he does
not really want to work; meanwhile the person is actually ill.
And then, of course, the third thing is very
simple – that our health workers too may not be so empowered to pick these
things out. Health workers realise that most of these people with mental
illness report to the hospitals and complain of something else entirely. They
come with complains like: “I have not been able to sleep well; I am having
fever; I am having headache, among others.” They don’t report with complain
like – “I am feeling sad.” So that is the reason they don’t get treatment.
Mental illness is not a physical problem that you
can see or do a simple laboratory test and pick up. So it needs some probing
for you to ascertain that a person is mentally ill, and mental illness is not
something most people are happy to say that they have. Those are the reasons
most people with the illness are not actually identified and treated.
From your medical experience, what are the
challenges that psychiatrists have in managing cases like this?
The first challenge for a psychiatrist should be
the stigma, now I am stigmatized; everybody would say: Oh, they are behaving
like their patients. The mentally ill are treated are treated in similar way.
Most of us behave in a negative way to the mentally ill and expect a positive
reaction from them, which is not true. So if we can behave positively to the
mentally ill, it is likely that the mentally ill will have a positive reaction
to us. But, we behave negatively and we expect a positive reaction, which is
not fair.
So, the main challenge is that people stigmatise
the mentally ill, even the health workers that take care of them.
First, we provoke them to act negatively and when
they do, we say: “Oh, were ni e(mad person). Meanwhile, we forgot that we were
the ones who provoked them. So, these are the challenges. What we need to do is
to make sure that as a population and community, we must develop a positive
orientation towards the mentally ill and treat them right, in order to expect
the right reaction from them.
You rightly mentioned the problem with personnel.
What about the patients themselves and facilities?
The Lagos State government is really trying. Our
plan in Lagos is to make sure that the available doctors and nurses are trained
and well-equipped to take care of the people who are mentally ill, that is why
we organised the recent mental health workshop for clinicians in primary health
centres (PHC). This is to upgrade or enhance the capacity of our doctors, they are
very small in number and nurses need to be able to take care of the common
mental health problem. This is an easy way for us rather than waiting for
government to employ more doctors and more nurses.
Is there any role for the patient, for relations,
for society at large to make things better?
Let people know what is going on, let people
understand that mental illness is not a curse from ‘obatala’ or whatever it is.
That it is something that can happen to anybody just like headache. So those
are the issues. Once people understand what is going on, then it would be very
easy for us.
