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There is really no doubt that mental health care is crucial for any nation that would prosper and achieve greatness. However, we have assumed that mental health care is readily accessible. One of the most prominent problems is the dearth of competent professionals especially Consultant Psychiatrists who are currently not up to 300 to cater for a population of about 160million people. The doctor-patient ratio is embarrassingly below the WHO requirement and as newer consultants are trained, they are lost to the developed countries. For similar reasons, we do not have enough psychiatric nurses, clinical psychologists and social workers. I am not certain that a particular dedicated program exists for the training of community mental health officers for the primary care.
A good number of studies undertaken to assess this problem have been largely quantitative which only talks of figures rather than contending sociocultural issues that may prevent or otherwise enhance intervention programs. There is a need to undertake relevant qualitative and anthropological studies that will elucidate these issues by influencing policy planning to give birth to modified pathways of care and reorganize our service delivery systems to maximally utilize the available resources.
Most psychiatric patients are treated by non-mental health professionals and only a few; about 1-2 per cent of admitted patients are seen by Psychiatric Consultants. A good number of our Psychiatrists and other relevant health workers are ‘locked up’ in our teaching hospitals while the larger percentage of our patients are seen by incompetent hands at the primary care posts and general hospitals arena. We also have a concentrated number of these relevant health workers in our 'stand-alone' Psychiatric hospitals and Federal Medical Centres across the country. The only modest attempt at channelling these resources to where it is acutely needed is through some community mental health services organized by some of the specialist Psychiatric hospitals and Psychiatric units of the Teaching hospitals.
The clinical paradigm of traditional consultation role where the specialists wait to be asked for their opinion may not be very adequate in our situation; while the sporadic almost philanthropic community health outreaches cannot replace a robust well organized and well-articulated liaison services. This liaison function is more proactive and preventive through the establishment of a consistent relationship with the general medical practice units of Teaching Hospitals, General Hospitals and Primary Health Care posts. This will require additional staff training and ad hoc education of medical colleagues. I have heard of consultation-liaison units in our various Teaching and Neuropsychiatric hospital,; but there is a need for service- grafting with the existing General Hospital system to guarantee the inherent integrative value . The consultation paradigm feeds on the referral system that is ineffective in Africa as it only ensures that mismanaged and chronic cases get to the psychiatrists.
There are several models of consultation-liaison from the developed countries but a Nigerian model has to be invented to handle the challenges of stigma, interruption of the pathways of care by alternative medical practitioners and mismanagement of psychiatric patients by non specialists. It is amazing how contentious the issue of who attends first to any patient with abnormal behavior could be, even in our Teaching Hospitals, which eloquently illustrates that the stigma is both for the patients and the attending health workers. However, some of these our colleagues will visit in the night like ‘Nicodemus visited Jesus’ when they have a relative with mental illness . The much orchestrated millennium development goals cannot be achieved without a robust mental health care program. All stakeholders must be involved in the planning not just some experts who may not be in touch with grass root challenges of mental health care.
It is amazing that the bulk of what exists in Nigeria today as tangible mental health services is in custody of the Federal Government through their hospitals thereby holding more than 90 per cent of competent hands while the psychiatric units of our State University Teaching Hospitals do not have any input into the health care delivery program of their owner states. The irony is that the bulk of psychiatric patients attend health facilities such as the General Hospitals and Primary Health Care posts owned by State Governments usually without mental health program. I am in doubt whether any State Government has up to 4 Consultant Psychiatrists in her employ whether as a full time or on liaison basis. The WHO program of bridging this gap anchored by Professor Oye Gureje can only be of immense benefit if the hosting State governments can seize the opportunity by creating well staffed psychiatric units in selected General Hospitals that will also coordinate the training of community mental health workers to manage the Primary Health Care posts and coordinate the referral system rather than wait for the Federal Government.
Dr Adeoye Oyewole
adeoyewole2000@yahoo.com
+234 803 490 5808 (WhatsApp Only)
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