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  • Psychiatrists call for decriminalisation of attempted suicide

    Psychiatrists call for decriminalisation of attempted suicide

    The President of the Association of Psychiatrists in Nigeria (APN), Prof. Taiwo James Obindo, has called for the decriminalisation of attempted suicide in the country.

    He made the call during a session of stakeholders organised by the House of Representatives Committee on Specialty Healthcare on the need to prioritise and implement the Mental Health Act.

    Obindo said the establishment of the National Counselling Centres all over the country in an attempt to address mental health is like putting the cart before the horse because a suicide attempt is still a criminal offence in both the Criminal Act and the Penal Code.

    “Hence the first step would be a move to decriminalize attempted suicide. Criminalising attempted Suicide has proven to be a major barrier to suicide prevention intervention service uptake.

    “The archaic law, inherited from our Colonial masters, in an attempt to stop the act of suicide did not address the thoughts and social determinants of Suicide. Significant evidence showed that 90% of those who take their lives through suicide had a background history of Mental Health Conditions; out of which 80% are attributable to Depression due to various bio-psycho-social etiologies.

    “Why do we, as a Nation, then punish individuals who are ill and need medical attention rather than prosecution? It will shock you to know that Nigeria, the giant of Africa, is lagging behind as quite a number of our neighbouring nations have abrogated that law.

    “Establishing a Counselling centre, without abrogating this archaic law would put, even the counsellors at risk because the law also prescribes penalties for those who are aware of the plan but did not report,” he said

    He called for the implementation of the Mental Health Act, which he said is a product of legislation that went through rigorous due process by the legislature, assented to by the President of the Federal Republic of Nigeria in 2022, and has been gazetted as a law of the Country.

    This, he said would be the address the “many years of neglect of this important aspect of our nationhood.”

    Obindo said a requirement for the effective implementation of the Act is the establishment of a Mental Health Services Department in the Federal Ministry of Health (FMoH).

    “It will shock you to hear that, more than a year later, the department is yet to be established. Most of, if not all, the items in your plan are meant to be supervised by this department in obedience to the rule of law! Hence, the establishment of the department is germane to the success of all your plans,” he said.

    He said the Association of Psychiatrists in Nigeria is an umbrella body of all Nigerian Psychiatrists in the Country and other allied Practitioners.

    He said they have been at the forefront of campaigns and advocacy for global best practices.

    He lauded the Committee for the initiative, saying when well-implemented, would positively impact the hitherto neglected Mental Health, persons affected by Mental Health Conditions, and Mental Health Practitioners.

    The House of Representatives Committee on Special Healthcare Chairman, Dr Alex Egbona, has called for stakeholders’ partnership in addressing mental health challenges and other related health cases.

    The lawmaker said the committee was created to provide the requisite legislative frameworks for improved healthcare delivery in Nigeria.

    Read Also: Nigeria has 400 psychiatrists ‑ Experts

    He said the session is a collaborative initiative of the committee to share its mandate and planned activities with identified relevant institutions and organisations.

    “I, therefore, solicit the support and partnership of all stakeholders, our development partners, international NGOs, and CSOs, you are all urged to take an interest in building the capacity of the committee members and staff to enhance the efficacy of the committee.

    “Consider our five thematic areas of Mental Health, Trauma and Obstetrics Fistula, Oral Health and ENT, Blood Transfusion, Blood and Management, Traditional Complementary and Alternative Medicine and engage the committee for maximum impact,” he said.

  • How to stop brain drain, suicide, others, by psychiatrists

    The Association of Psychiatrists of Nigeria (APN) has held its 49th Annual and Scientific meeting in Lagos, where its members proffered solutions to crises in the sector. OYEYEMI GBENGA-MUSTAPHA reports.

    The mental health sector is in dire straits. With a ratio of one psychiatrist to 3.3 million persons, Nigerians hardly have access to mental health.

    At its 49th Annual  and Scientific Meeting held in Lagos, the Association of Psychiatrists in Nigeria (APN) members brainstormed on how to get solutions to the problem and more.

    With fewer than 200 psychiatrists across the country, and the profession facing a brain drain, the experts agreed the problem was bigger than they thought.

    According to APN President, Dr Taiwo Lateef Sheikh, despite the shortage of psychiatrists, fresh graduates remain unemployed, while others, including psychiatrists in training, leave the country.

    Sheikh said the problems called for concern. “This raises the questions: how will the millions of Nigerians requiring mental receive optimum care? So the theme, ‘Brain drain in mental health’, will help us in examining policies and strategies. And to scale up access to mental health services in Nigeria, including shedding light on various mental health transformations taking place in the country.”

    On why the choice of Lagos for the conference, Sheikh said the state is the best place to discuss germane issues, for it is the first state to work on mental health bill.

    “Lagos has the highest urban population in the country with a population of 25 million, according to  the UN-habitat and International Development Agencies’ estimates. It is also not surprising that it, arguably, has the highest concentration of private and public employed psychiatrists in Nigeria. Many people have achieved their  exit from the country via Lagos.   Sadly, among these are mental health practitioners – specialists and trainees – for greener pastures. This certainly depletes our already inadequate number of psychiatrists,” explained Sheikh.

    “For the same reason,”Sheikh said, “Lagos attracts various kinds of businesses that have produced many success stories. Unfortunately, sometimes such success also creates competition – imagined or real – in the midst of scarce resources and vulnerability to unhealthy lifestyles such as psychoactive substance abuse, highlighted by the menace of prescription drugs abuse.”

    He added that these further increase the risks of emotional problems, leading to manifestation of various mental disorders, especially depression and suicide.

    “We are all witnesses to the rising tide of suicide in the country, and especially in Lagos. I congratulate the state for leading the way to seek protection of the mentally ill and the mental health practitioners through the passage of the Lagos State Mental Health Law.  APN is asking the Federal Government to halt the brain drain in pyschiatry.

    “What is the essence of investing in the training of a person using tax payers money, only for same to be snatched away by another country. All that is required is to give incentives to these experts and they will stay back. No country has enough Psychiatrists, so it does not speak well for us as a country to train, only for them to exit the system or country,” Sheikh added.

    Local Organising Chairman (LOC) and the Coordinator of SURPIN, Lagos University teaching Hospital (LUTH, Dr Raphael E. Ogbolu said the abysmal low ratio of psychiatrists to patients must be addressed.

    Ogbolu said one psychiatrist to about 200million Nigerians was not good. “If we do nothing now, the situation quackery will thrive. If you don’t have qualified personnel to cater for the mental health of a people, a vacuum will be created, and those that do not have business with the subject matter will be parading themselves as psychiatrists. Complications of mental health cases not well handled will lead to increase in suicide rate.

    “Nigeria is the main supplier of mental health practitioners not only in Africa, but other continents. Brain drain cannot be totally stopped, but the government can do something through policies, to retain trained personnel. We are exploring how to retain a bigger chunk of what are trained, to what we are losing.

    “Burn out is equally affecting the practice because the psychiatrists are doing their best within the system, but it is tedious for them to practise with obsolete equipment, and inclement practicing conditions, patients paying out of pockets, and treatment being impeded. For instance, if a person is mentally sick, will output drop, leading to low income. Yet, we expect the same person to deep his hand into his pocket to pay for his mental health treatment. Where is this done?” Ogbolu added.

    Ogbolu said part of the way out is for mental health treatment to be included in the National Health Insurance Scheme (NHIS) via a bill.

    “Mental Health Bill should be passed into law, as it protects the psychiatrists. The person being treated and the costs of treatment taken care of. Look at the criminalisation of attempted suicide.

    “Somebody, who is mentally sick, wants to die, but did not suceed, and the next thing is to take the person in, for 12 months’ imprisonment. That must change. That person needs treatment. SURPIN, for instance, has reached out to many people in 20 locations in Nigeria, despite it’s being situated in Lagos.”

    The guest lecturer, Prof Akin Osibogun, said Nigerians should build recreation centres to curtail the rising rate of suicide.

    “Gone are the days when people find other people to talk with. People talk to gadgets like T.V, handsets and browse endlessly these days. They bottle up so much emotion, and explode. Unfortunately, some comit suicide.

    “Africans have a socio-networking system where one can sit with people over drinks,  or sit on pavements in the evening and watch the world unfolds, and get inspired, or get somebody show interest in him, but that is giving way to the cosmopolitan way now. So, there is a need for socio- re-engineering to ensure the needed support system is there for each and everybody,” Osigogun said.

    Dr Tolu Ajomale of Lagos State Ministry of Health’Mental Health Desk, said Lagos would continue to ensure the mental well-being of Lagosians.

    “We have a desk in the ministry headed by Dr Dolapo Fasawe and we are open to all and sundry 24/7. The state also passed the Mental Health Bill, which will provide leadership, guidance and treatment for the people in the state,” Ajomale added.

     

  • Psychiatrists call attention to child mental wellness

    One in  five young people,  research has  shown, has  mental  health  challenge,  especially depression  and the tendency to commit suicide. And there has been an upsurge in cases of substance use disorders among Nigerian youths.

    The Federal Neuro-Psychiatric Hospital, Yaba, Lagos, Medical Director, Dr Yemi Ogun,  spoke of the trend when the hospital joined the rest of the  world to observe this year’s World Mental Health Day, a day set aside to create awareness on mental health, discrimination and stigmatisation.

    With the theme: “Young people and mental health in a changing world”, Dr Ogun said 20 to 25 young children and adolescents have their first contact with the hospital, and are attended to in the facility weekly, because they are the country’s future.

    According to Dr Ogun, half of all mental illness begins at age 14, adding that most cases go undetected and untreated. “In terms of the burden of the  disease among adolescents, depression is the third leading cause. Suicide is the second leading cause of death among 15 to 29 years of age. Harmful use of alcohol and illicit drugs among adolescents are a major issue, which can lead to risky behaviours  such as unsafe sex or dangerous driving. Eating disorders are also of concern.”

    On the way out, Dr Ogun said much can be done to help build  mental resilience from an early age to help prevent mental distress and illness among adolescents and young adults, and to manage and recover from mental illness.

    “Prevention begins with being aware of and understanding the early warning signs and symptoms of mental illness. Parents and teachers can help build life  skills of children  and adolescents to help them cope with everyday challenges at  home and school. Psychosocial support can be provided in schools and other community settings and  of course, training for health workers to enable them detect and manage mental health disorders can be  put in  place, improved or expanded,” she explained.

    Dr Ogun added that investment by governments and the involvement of the social, health and education  sectors in comprehensive, integrated,  evidence-based programmes for the mental  health of young people, is essential.“This investment should be linked to  programmes  to  raise  awareness among adolescents and young adults of ways to look after their mental health and help peers, parents and teachers know how to support their friends, children and students. This is the focus for this year’s World Mental Health Day.”

    Parents and guardians are also encouraged to ensure that their children are shielded from rape, as rape has a lasting impression on the victim, and worrisome is the fact that such incidences are on the rise.

    According to Consultant Psychiatrist (Special Grade II) at the Child and Adolescent Mental Health Service Center (CAMHSC), Oshodi Annex of the Federal Neuropsychiatric Hospital, Yaba (FNPHY), Dr Grace Ijarogbe, the prevalence of sexual assault are high, and it is a major mental health issue, as about 25 per cent of street hawkers had passed through attempted rape and five per cent of them had been raped in a study in southern Nigeria.

    Dr Ijarogbe said a cross continent surveys carried out in Africa showed that among 12 to19-year-old girls in Burkina Faso (15 per cent), Ghana (30 per cent), Malawi (38 per cent), and Uganda (23 per cent) had been sexually coerced  at sexual debut. “22.2 per cent of female university students in northern Nigeria had experienced sexual violence early in life”.

    “The prevalence of sexual coercion among adolescents was between 15 and 40 per cent in the sub-Saharan Africa. Some studies showed rates of sexual coercion and abuse among female adolescents in north-eastern Nigeria between 11 and 55 per cent. Only 18.1 per cent of rape cases in Nigeria report to the police end,” she added.

    Dr Ijarogbe  said parents and  guardians should double effort to ensure that avenues that make a child vulnerable to  rape are addressed. “Living in  extreme poverty and deprivation; living  in  displaced people’s camps; homelessness; migrating children;  living in war regions; child soldiers; certain cultural norms; religious practices; child labour; children being sent away from home to reside with relatives (fostering) and street begging are some of the factors that make a child vulnerable to rape,” she said.

    According to her, the government has spear-headed the fight by putting in place  Child’s Right Act (CRA).   “Components of the Child’s Right Act act in the best interest of the child; grant the child the needed protection and care; clearly state the rights of the child; spell out the responsibilities of the child and mandate the parents’ role in guiding the child to help him fulfil his role and responsibilities,” she said.

    She said further: “The Act  also  protects the child by stating what activities a child must not be enrolled in. It allows law enforcement agents to take over custody and care of  children deemed to be in need of protection from whoever or whatever. Protect the child from harmful publication and orders care and supervision of the child. It can mandate the use of scientific tests to determine the paternity or maternity of a child.”

    Likewise, the CRA sets up community and voluntary homes. Set up voluntary organisations. It facilitates registration of children’s home, spell out the supervisory function of the minister (inspection, inquiries, financial support); guides the child justice administration; research, planning, policies formulations for the child, and guides the operators of the CRA.

    Dr Ijarogbe said as robust as the CRA  is there are factors militating against  its successful implementation. “The CRA has been weighed down by contentions. Many northern states have not adopted the CRA, as some clauses are viewed to be against socio-cultural and religious norms and traditions, e.g. the stipulation of 18 years as the minimum legal age for marriage.

    “Till date, only 17 out of the 36 states of the country have adopted the CRA into their legislation even though the Federal Government through the Senate has signed the CRA into law. All hope is not lost, as the birth of many Civil Rights Activists, NGOs, international monitoring and report groups,  agencies and law enforcement agents are now increasing to help create awareness, implement and defend these laws,” she said.

    According to Ijarogbe, if child sexual rape is not prevented, there will be so many effects on the child. “Disorganised behavior occurring in the early childhood period, sometimes as early as five-years of age. Fearful and very anxious, loss of confidence/self esteem; feeling of extreme shame; very challenging and distressing to families and the child cannot trust adults and becomes rebellious and disrespectful.

    “It is costly to the society due to investigations that hardly ever reveal the culprit. Interpersonal difficulties; problems with thinking and calculations; severe mental illness –  abnormal behavior; post-traumatic stress disorder (PTSD) – cannot sleep, has nightmares; difficulties with adjusting to changes in the environment and depression problems may go on undetected for years, and can lead to suicide”.

    To  prevent an occurrence  of sexual assault, Dr Ijarogbe suggested making the environments safer for the  female gender; teaching girls simple safety skills like appropriate dressing;  how to walk; non-sexualised  behaviour  training and avoidance of potential assault settings. Others are by addressing cultural values and norms that support and tolerate sexual assault. “This is a long-term  course  that requires sustained leadership effort. Providing adequate facilities e.g.  Well-lit walk ways,  separate boy and girl conveniences and  bedrooms, promotion of gender equality  and alleviation of poverty.

    “The responsibility for the eradication of rape rests with the whole community”, said Dr Ijarogbe, adding, “Give orientation to boys that what is ‘cool’ or  acceptable among young people is having enough respect  for the opposite sex to seek consent before touching them and accepting ‘no’ if that is the response.

    “Parents should have open discussion with their children (both boys and girls) on normal sexual development and sexuality. Caregivers of adolescents should incorporate sexual development and abuse prevention into their routine guidance duties”.

    Everyone  is  encouraged by Dr ijarogbe to develop systems that can eliminate  rape. “Societal systems must become alert to rape issues and institute preventive measures. Young people should not dress provocatively indoors, outdoors  or to school. There must be modification in peculiar social, cultural, and religious beliefs and behaviours in different places as this brings contradictory signals in the contexts of rape and makes enforcement difficult or compromised.

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

  • How to prevent autism in kids, by psychiatrists

    Some consultant psychiatrists have called on stakeholders in the health sector to improve the quality of safe deliveries, pregnancies and immunisation to prevent disorders like autism in children.

    They spoke yesterday in Lagos at a seminar organised by the Federal Neuro-Psychiatric Hospital, Oshodi Annex, in commemoration of the 11th World Autism Awareness Month marked annually in April.

    Its theme was: “Taking Care of the Individual and the Family.“

    According to an online health information, MedlinePlus, Autism Spectrum Disorder (ASD) is a neurological and developmental disorder that begins early in childhood and lasts throughout a person’s life.

    “It affects how a person acts and interacts with others, communicates, and learns. It includes what used to be known as Asperger syndrome and pervasive developmental disorders.

    “It is called a “spectrum” disorder because people with ASD can have a range of symptoms.

    “People with ASD might have problems talking with you, or they might not look you in the eye when you talk to them. They may also have restricted interests and repetitive behaviours.’’

    In her remarks, a consultant psychiatrist, Dr Grace Ijarogbe, said that there was need to improve the quality of safe deliveries, pregnancies and immunisation to prevent disorders like autism in children.

    The Medical Director of the hospital, Dr Oluyemisi Ogun, said children with ASD should be included in the activities of the community.

     

     

  • Don’t discriminate against people with mental illness, say psychiatrists

    Nigerians and reporters have been advised not to discriminate against people suffering from mental illness.

    They spoke at a workshop for reporters and members of the Suicide Research and Prevention Initiative (SURPIN) of Lagos University Teaching Hospital (LUTH), Idi Araba.

    They said the workshop was aimed at reducing the rising rate of suicide across the country.

    The experts, which included Dr Babatunde Fadipe, Dr Bola Ola, Dr Peters Nubi, Dr Raphael E. Ogbolu and Dr Oladipo A. Adepoju, Dr Alero and Miss Titi Tade of LUTH’s Socia Welfare Unit praised LUTH’s SURPIN, saying it is the first of its kind.

    Stigma, the experts said, makes sufferers of mental illness to be maltreated by friends, relatives, neighbours and employers.

    It has aggravated their rejection, loneliness and depression among those with the illness, they said. They also said those with the condition are often denied participation in family life, normal social networks and productive employment.

    According to the psychiatrists, stigma can be defined as a mark of shame, disgrace or disapproval, which results in an individual being shunned or rejected by others.

    The stigma associated with mental illness is strong, but increases more if an individual’s behaviour differs from that of the ‘norm’, they added.

    Stigma, especially the one associated with mental illness, they said, has a negative effect on any mentally ill person’s recovery, ability to access services, the type of treatment and level of support received and acceptance in the community. Rejection of people with mental illness, they said, also affects the family and caretakers of the mentally ill person and leads to isolation and humiliation.

    Major causes of stigma, according to them, are myths, misconceptions and negative stereotypes about mental illness.

    They said the number one factor, which drives suicide or mental illness, is stigma, and that it could be reduced by  talking about mental illness in the community. It could also be reduced by providing accurate information on the causes, prevalence, course and effects of mental illness and countering the negative stereotypes and misconceptions surrounding mental illness.

    Providing support and treatment services, which enable sufferers to participate in community activities and ensuring the existence of a legislation to reduce discrimination in the workplace, access to health and social community services, is another way of reduce the stigma.

    The experts pointed out that mental illness have both economic and diminishing effects on the society. This, according to them, is because it affects the thinking of the individual and diminishes his or her social role and productivity.

    Also, they said mental illnesses could disable one and last for many years, as they take could reduce the emotional and socio-economic capabilities of relatives, who care for sufferers, especially when the health system is unable to offer treatment and support at an early stage.

    The experts listed some of the  costs to include lost production from premature deaths caused by suicide (which most times are under reported, hence, generally equals to and greater than deaths from road accidents); loss of production from people with mental illness, who are unable to work; loss of productivity from family members caring for the mentally-ill person, reduced productivity from people who are ill while at work and cost of accidents by people who are psychologically disturbed, especially dangerous in people like train drivers, airline pilots and factory workers.

    Also, supporting dependants of the mentally ill persons, financial costs for families caring for the mentally-ill persons, unemployment, alienation, and crime in young people whose childhood problems, e.g., depression, behaviour disorder, were not sufficiently well addressed  to benefit from the education available, poor cognitive development in the children of mentally ill parents, and the emotional burden and diminished quality of life for family members.