I want to immediately state that I do not like this topic but it is important that the public, caregivers and other stakeholders are sufficiently informed about the possibility of the mentally ill inflicting harm on themselves, their loved ones, nurses and even doctors caring for them and when left to wander the streets they could become dangerous to the society. This does not imply that we treat them harshly in the guise of preventing possible dangerousness but to take proactive prompt referrals. This responsibility has a very strong professional angle especially in the developed countries where the mental health professionals particularly psychiatrists and psychologists have become caught up in the new ‘culture of blame’. In such climes; any damaging occurrence which is experienced by or caused by someone who is or has been, a patient of the mental health services, is transformed into a preventable tragedy for which professionals are to be held responsible. In such developed societies; discourses around the dangerousness of the mentally ill have been gradually replaced by those of risk assessment and risk management. This change understandably is a product of the progress of knowledge and the improved conceptualization of that knowledge into sound policy frameworks in that environment.
The language of danger transmuted into the language of risk with a more obvious claim to being scientific. Risk embodies the interaction of a range of factors which are not necessarily dangerous in themselves such as age, gender, marital status, ethnically, employment status and the mental disorder itself. Whereas dangerousness is assessable; the risk is calculable. The point to note is that anyone who ventures to care for the mentally ill must be able to assess dangerousness and scientifically calculate risk; however, the issue of risk determination is very crucial in an environment that has a well-articulated mental health care system with all the enabling laws and sufficient personnel.
In Nigeria, we are still struggling to get a mental health bill to talk less about adapting its substance to practice. Beyond the professional responsibility of being proactive in identifying and managing dangerousness; the public also has enormous responsibility especially caregivers for prompt referral to the appropriate hospitals for our collective security.
The public must understand that any behaviour that a relative demonstrates that causes personal distress, profoundly affects significant others and not generally acceptable in that society needs prompt attention. I am aware that a good percentage of our people beclouded by sociocultural and religious values may through denial and rationalizations refuse to take a step for appropriate care. The criteria stated above essentially impairs reality testing in such individuals which renders them potentially dangerous to self, significant others and the society. It is possible such an individual hears voices instructing to kill close relatives or unsuspecting passersby if vagrant.
As much as mental health professionals are developing actuarial scientific and clinical approaches at the prediction of risk; it is not a hundred percent efficient talk less of caregivers who are not professionally trained. I am also worried about the increasing number of quacks taking custody of a large number of our patients in facilities that are not appropriate. I expect a part of our mental health legislation to deal with the standardization of the traditional and spiritual mental health practice and entrench collaboration with the orthodox practitioners who are better trained in managing dangerousness. A good number of our vagrant psychotics who are potentially dangerous are absconders from such facilities. On a face value; once a patient is brought and is calm; he is adjudged harmless and left alone to interact freely until he assaults others. As a result; patients are immobilized with barbaric methods like chains and beatings which may cause physical illness that can kill them. A good number of the patients that die in orthodox mental health wards acquire the risk from those places where they had been brutally handled in an attempt to manage dangerousness in an unprofessional way.
There is increasing media reportage of homicide and suicide in recent times which are traceable to undiagnosed and poorly referred cases. Mental health policy in Nigeria must be strengthened to expand capacity at the community level of trained personnel that could quickly recognize these illnesses, institute some immediate intervention and advise on appropriate referrals. Our alternative medicine practitioners also need to protect themselves and their relations by collaborating with orthodox practitioners who have the requisite training to manage dangerousness empirically. There have been cases of admitted patients killing their native doctors who depend on the use of incantations to curtail dangerousness. Governments at all levels should take the rehabilitation of the vagrant psychotics seriously because they are potentially dangerous to communal existence.
There is increasing media reportage of homicide and suicide in recent times which are traceable to undiagnosed and poorly referred cases. Mental health policy in Nigeria must be strengthened to expand capacity at the community level of trained personnel that could quickly recognize these illnesses, institute some immediate intervention and advise on appropriate referrals. Our alternative medicine practitioners also need to protect themselves and their relations by collaborating with orthodox practitioners who have the requisite training to manage dangerousness empirically. There have been cases of admitted patients killing their native doctors who depend on the use of incantations to curtail dangerousness. Governments at all levels should take the rehabilitation of the vagrant psychotics seriously because they are potentially dangerous to communal existence.
Dr Adeoye Oyewole
adeoyewole2000@yahoo.com
+234 803 490 5808(Whatsapp only)
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