Nigeria tries to cope with growing number of people with mental illnesses

From The Daily Independent in Lagos:

KADUNA, Nigeria — At the General Out-Patients Department (GOPD), Federal Neuro-Psychiatric Hospital, Barnawa, Kaduna, a neurotic patient, in her mid-thirties, sat with her relatives who kept her company. She was nauseating and blowing her nose constantly in a most repulsive manner. She was fidgeting, miserable, trembling and seemed to have lost touch with even the people around her. She exhibited symptoms of depression, tension and loss of confidence. In short, she had turned into a vegetable.

Barely ten minutes later, a psychotic patient named John Madaki, 25, brought in by his aged parents and four hefty young men in a rented vehicle. They reside at Romi Village, a suburb of the Kaduna metropolis. They hail from Nassarawa State.

The patient was disheveled, dirty, wearing bathroom slippers with unkempt hair. He was in a state of hysteria. He happens to be the only son of the family. Other six children are all females. His father, a former textile worker, was downcast and forlorn.

Johnie, as he is fondly called by his friends and Bomboi by his parents, dropped out of secondary school shortly before the Senior Secondary School Certificate (SSCE) five years ago. He told his parents point-blank that he wasn't interested in pursuing education again.

Indeed, few days before he made the outburst he was rushed to the hospital. The parents and neighbours had noticed some strange behaviour, or what medical experts called classical sign of manic-depressive illness. It manifests thus: sudden, unexplained, often profound, changes in mood to either sadness or elation. It was discovered that he was into substance abuse, smoking Indian hemp with his friends at Romi cemetery.

The patient's thoughts were vague, except for his delusional system. He frequently showed blocking, babbling circumlocution, and flight of ideas. Because of the flight of ideas and thought disturbance, there was an apparent memory loss. His emotions were flat or facile until the delusions were elicited, when he became concerned, excited and finally hyperactive. Denying the correctness of his delusions precipitated him into what medical experts called schizophrenic excitement, where he became aggressive, totally irrational and unimaginable.

Besides, history has revealed that he had been on admission at the hospital a couple of years ago for psychotherapy. He spent few months at the Drug Rehabilitation Unit (DATER).

But experts are of the view that maniac-depressive psychosis is a classically a genetic illness, and inheritance follows the dominant single autosomal gene that such patient invariably complains of periods of cyclical mood swings, frequently not knowing to which mood they will awaken.

However, John's father, 60, told Daily Independent that he could not recall vividly any case of maniac-depressive psychosis in his lineage.

"Bomboi was following bad friends. He was at Rimi College, Kaduna, when he dropped out of school, shortly before sitting for the SSCE. We were appalled and dumb-founded. I thought he would maintain my family name, being the only son. Alas, he has become a liability and burden to us. He doesn't talk to us. He wakes up every morning and goes out and will come back dazed. He still smokes Indian hemp. Most of his friends who led him into it are in tertiary institution. Sometimes, I pray he should just die," he lamented.

Another 30-year-old male patient simply called Mohammed was brought into the hospital by his friends. He complained of inability to sleep or to concentrate as a commercial bus driver. He has non-specific worry, general weakness, irritability and vague pains all over his body. He was sad, dejected and worrying. Medical experts describe such case as worrying hypochondriac.

The patient's father had been employed casually throughout his life, a casual labourer. His parents quarrelled frequently. There were ten siblings, seven of whom were divorced and none of them still appeared happily married. Two others have suffered like the patient and without any definite employment or livelihood.

The patient, who had been driver for over ten years, hardly got a stable vehicle to drive. The last commercial bus he handled was about three years ago. The owner received several complaints about his abnormal behaviour. Though he was not involved in any fatal accident, he was deranged. After he was sacked, Mohammed became a derelict, living in mosques in the Kaduna metropolis.

Also, a female patient, about 40 years old, was among numerous new outpatients at the hospital that fateful day. She was depressed, pensive, rambling, agitated and could not be controlled. She could not give her name. Our reporter reliably gathered that she had taken an overdose of barbiturate while her husband ditched her and went to stay with another woman in the Kaduna metropolis. They had been married for over ten years and were blessed with four children, all females.

Her children had returned from school one day to find her unconscious wherein they raised alarm to attract the neighbours. She was rushed to a nearby private hospital and was on admission for a weak before she was discharged. Since then she had been experiencing vague thoughts. But her strong conviction was that she would be able to overcome her ordeal by drinking excessively, sometimes to stupor. Consequently, at times she showed momentary thought-blocking.

According to investigations, her parents died when she was less than three years old. She was brought up in Kaduna by her auntie. She was educated at Kaduna Polytechnic and passed out with Upper Credit. It was there she met her husband and they got married shortly after her youth service. She had been into business and was very successful. But as a result of the depression she has since stopped the business. Consequently, she was withdrawn perplexed and uncommunicative for several weeks before she was brought to the hospital.

According to experts, depression is a miserable illness - when the sadness is profound, the patient cannot see the silver lining and so this illness is one of the worse to bear.

However, logical the patient may appear in his/her thinking and reasoning, he/she is not logical in his/her affection or feeling and that emotion will, in practice, determine his/her action. Furthermore, if the depression has been present for some time, there may be a secondary anaemia due, in part, to self-neglect.

But the irony about the increasing number of psychiatric patient is that majority of them are youths in their prime, who are into drug abuse or drug addiction. Experts have suggested that the risks in drug addiction can be divided into two groups. Firstly are the social-related risks. Social pressure regarding the drug scene results in the addict continuing the drug consumption to get its effects. This obliterates his personal conscience. It also contrasts with alcohol taking where, at a certain stage, the habitual drunkard is shunned by everyone and a good friend will warn of the risks.

Rejection by family and society, who can neither understand nor manage the patient, makes him even more depressed. This is especially more when drugs are not available and there is a withdrawal phase. What's more, there is a tendency to go on to harder drugs or mixed drugs to get the desired effect. Worse still, there is the risk of killing himself/herself by an accidental overdose or committing suicide when profoundly depressed.

The other is the physical factor; in it the drug taker may become infected by abscesses. There is the possibility of release of latent disease; for example, schizophrenia or epilepsy.

The Medical Director (MD), Neuro-Psychiatric Hospital, Barnawa, Kaduna, Dr. Gambari Toyin Suleiman, decries the upsurge in the number of outpatients now on awaiting list in the hospital. According to him, the nation's economic recession coupled with the current global economic meltdown has pushed more and more citizens to the edge of mental breakdown and mental illnesses.

He laments that what is even worrisome is the high percentage of youths as psychiatric patients. The signs of burnout include anger, irritable behaviour, compulsive habits, rash decisions, disillusionment, and depression. In his words, "I must admit that there has been an unprecedented upsurge in the number of outpatients in the hospital.

"Our investigations have revealed that this is caused by the dislocation of the country in terms of financial and social factors. And then increasingly we see younger people with substance abuse, drug abuse, who are increasingly coming to the hospital. By and large, I think there has been some increase in the number of outpatients, now on the waiting list for admission."

However, the medical expert lamented that lack of funds and inadequate medical personnel had been the major constraints of the 150-bed hospital, which caters for the seven states in the North West Zone, and even the neighbouring states in the North Central Zone. In fact, the disheartening aspect of the problem is lack of proper equipment to cope with the ugly development.

On the increasing rate of youths becoming psychiatric patients, Suleiman counselled parents and guardians not to hesitate in taking their children and wards to psychiatric hospital for counselling should they notice strange or funny behaviour in them.

His words, "If you discover that your wards are doing one or two things and you want to seek advice, in terms of counselling, that is not treatment. So you can come here for a number of reasons, not necessarily because of madness. We have created an emergency unit where we admit patients for just about three days to tie over patients, not really too afflicted. So, after three days, they are stable. We send them home to continue their medication and continue to see us in outpatients unit."

He also encourages people to ensure that they know their true mental status, just like the HIV/AIDS status. The medical expert then classified two major forms of mental illness: psychotic disorders and neurotic disorders.

"Psychotic disorders are what we call major forms of psychiatric disorders; neuroses are minor psychiatric disorders," he explained.

Indeed, Kaduna metropolis is not spared the blight of the upsurge of mental illnesses. At the major streets, roundabouts and on River Kaduna Bridge, more and more lunatics are seen. But the appropriate authorities are shying away from their responsibility of taking care of the insane.

Incidentally, mental health is not even part of the Health Care Programmes of the Federal, States and Local Governments. The Federal Ministry of Health, the State Ministries for Health as well as the Departments of Health in the local governments do not have a clear-cut mental health policy. Though the successive administrations have pledged to formulate a mental health policy for the country, such promise has never been matched with action. Hence, the mental health has been relegated to the background, even as there has been an upsurge in the mental illnesses.