Mental disease is not a curse

By Adeze Ojukwu

Mental disease is generally viewed as a curse. But it is not. This unsubstantiated assumption, is a fallacy borne out of sheer myth and mischief.

Despite, decades of media advocacy and enlightenment initiatives, these erroneous notions have refused to wane.

Medical practitioners and health advocates have tried to counter this jaundiced belief, with scientific evidence.

Furthermore, many patients have been successfully treated and rehabilitated across every land.

Obviously, these misconceptions are driven by ignorance and superstition, as well as government apathy to the welfare of its disadvantaged citizens.

Expectedly, these negative opinions are quite prevalent, across several Nigerian communities and other traditional societies.

As a result people, suffering from psychiatric illnesses resort to self-help, unorthodox therapists, who lack the prerequisite training and skills to cure such maladies.

Sometimes the patients are abandoned by their families and caregivers, due to lack of free medical facilities, especially in rural areas.

With the shame and stigma associated with these disorders, many sufferers live precariously, due to exclusion, threats and discriminatory practices against them.

Females are even, more disproportionately affected, as some of them are sexually abused or murdered for, alleged ritual purposes.

Determinants of these ailments are not limited to personality traits and capacity to manage one’s emotions, behaviours and social interactions.

Brain damage, trauma, substance abuse, poor nutrition, heredity, birth defects, exposure to toxins such as lead can trigger the illness.

Other contributors are stress, ‘perinatal infections as well as social, cultural, economic, political and environmental factors including family settings, national policies, social protection, standards of living, working conditions, and community support.’

Poverty, stigma and sexual abuse are also linked to psychotic incidences, defined as ‘maladaptations related to mood, behaviour, cognition, and perceptions.’

The spectrum ranges from anxiety, panic attacks, schizophrenia, autism and bipolar to depression, Post Traumatic Stress Disorder (PTSD), psychosis and Attention Deficit Hyperactivity Disorder (ADHD).

With advanced medical interventions, several counselling techniques and prescription medications are readily available, particularly in western countries.

Many reputable centers, such as, John Hopkins Bloomberg School of Public Health provide ‘comprehensive mental and behavioral guidance and treatment using evidence-based assessment, consultation and intervention.’

This is certainly not the case in this part of the world, where these unfortunate individuals are left to parade in rags and sometimes in chains, bereft of all human dignity and sanity.

It is not only pathetic and inhuman, but a keen testament to this society and its leadership.

Indeed this specialty is indisputably, one of the most neglected areas of medicine.

According to World Health Organization(WHO) about one billion people are living with a mental disorder, even as three million persons, reportedly ‘die every year from the harmful use of alcohol. One person dies every 40 seconds by suicide.’

This is clearly evident in Nigeria, witnessing escalation of such cases, from  surveys and clinical records.

The pathetic conditions of deranged citizens, parading the streets and rummaging through refuse dumps, says a lot about the nation’s leadership and health system.

It is therefore, heartening that this year’s World Mental Health Day(WMHD) has challenged governments to invest more in treatment and management of maniacal ailments.

The lead health institution, along with United for Global Mental Health(UGMH) and World Federation for Mental Health(WFMH), have called for a massive scale-up of investments in neuro-cum-psychological services.

This is predicated on the sore fact that ‘relatively few people around the world have access to quality mental health services.’

‘In low- and middle-income countries, more than 75 percent of people with mental, neurological and substance use disorders receive no treatment for their condition at all.’

‘Furthermore, stigma, discrimination, punitive legislation and human rights abuses are still widespread.’

The real tragedy is this: ‘The limited access to quality, affordable mental health care in the world before the pandemic, and particularly in humanitarian emergencies and conflict settings, has further diminished due to COVID-19 as the pandemic has disrupted health services around the world.’

The team attributed primary causes to infection and the risk of infection in long-stay facilities such as care homes and psychiatric institutions.

Others include barriers to meeting people face-to-face, mental health staff being infected with the virus, and the closing of mental health facilities to convert them into care facilities for people with COVID-19.

To stem this bizarre tide, the coalition, last month, kicked off a major campaign tagged, ‘Let’s Invest,’ as well as other sensitization messages to in line with the treatise, marked annually on October 10.

The commemoration ‘provides an opportunity for all stakeholders to talk about their work and what more needs to be done to make mental health care a reality for people worldwide.’

Last year’s edition was on ‘Focus on Suicide Prevention,’ because ‘every 40 seconds, someone loses their life to suicide.’

It became absolutely necessary to amplify awareness about the scale of this abnormality and the imperatives for everyone to help prevent it.

Unfortunately, COVID-19 has worsened this terrible syndrome.

Director General of WHO, Dr. Tedros Ghebreyesus said these complexities have ‘underscored the need for the world to redress the historic neglect of mental health.’

Yet, relatively few people around the world have access to quality and prompt medical services.

‘In low- and middle-income countries, more than 75 percent of people with mental, neurological and substance use disorders receive no treatment for their condition at all. Furthermore, stigma, discrimination, punitive legislation and human rights abuses are still widespread.’

The limited access to vital and affordable care in the world before the pandemic, particularly in humanitarian emergencies and conflict settings, has been further diminished due to COVID-19 and its multifarious disruptions of health services around the world.

Therefore the current focus is particularly pertinent, given the widespread devastation of lives and businesses, across all continents.

The apex health agency provides a vivid picture of this tsunami-styled crises.

‘The past months have brought many challenges for health-care workers, providing care in difficult circumstances, going to work fearful of bringing COVID-19 home with them as well as students, adapting to taking classes from home, with little contact with teachers and friends and anxious about their futures.’

This trepidation is also same ‘for workers whose livelihoods are threatened and the vast number of people caught in poverty or in fragile humanitarian settings with extremely limited protection from COVID-19.’

Certainly, ‘persons with mental health conditions are experiencing even greater social isolation than before. And this is to say nothing of managing the grief of losing a loved one, sometimes without being able to say goodbye.’

‘The economic consequences of this highly infectious zoonotic infection are already being felt, as companies let staff go in an effort to save their businesses, or indeed shut down completely.’

‘Given past experiences of emergencies, it is expected that the need for mental health and psychosocial support will substantially increase in the coming months and years.’

‘Investment in mental health programmes at the national and international levels, which have already suffered from years of chronic underfunding, is now more important than it has ever been.’

As stressed by Dr. Ghebreyesus ‘we are already seeing the consequences of the COVID-19 pandemic on people’s mental well-being, and this is just the beginning.’

‘Unless we make serious commitments to scale up investment in mental health right now, the health, social and economic consequences will be far-reaching,’ he warned.

The regulatory body has consistently, mounted advisories on best practices for hospital personnel, frontline workers, managers of facilities and people of all ages, whose lives have changed considerably as a result of the pandemic.’

Indeed some countries are deploying innovative ways to provide crucial facilities and strategies to strengthen psychosocial support.

However the response is terribly deficient, with funding as a major problem.

According to WHO Chief Executive, even before the current outbreak, chronic under-investment has often undermined standard treatment protocols.

Therefore ‘the vast majority of mental health needs remain unaddressed. He further lamented that ‘countries spend on average only two percent of their health budgets on mental health. Despite some increases in recent years, international development assistance for mental health has never exceeded one percent of all development assistance for health.’

‘This is despite the fact that for every one dollar invested in scaled-up treatment for common mental disorders, such as depression and anxiety, there is a return of five dollars in improved health and productivity,’ he said.

What is the plea today?

The paramount demand by stakeholders is for a concerted fight against mental illnesses.

President of WFMH, Dr. Ingrid Daniels appealed for more collective action.

‘We must turn words into actions. We need to see concerted efforts being made to build mental health systems that are appropriate and relevant for the world today and tomorrow.’

The UGMH boss, Elisha London spoke similarly. ‘With so many people lacking access to good and appropriate services, investment is needed now more than ever.’

‘Everyone, everywhere can participate in this year’s campaign. Move for mental health, and help make care and support accessible for everyone,’ he stressed.

Given the peculiarities of this country and the continent, governments and relevant authorities really, need to find the political will to prioritize mental wellness with all fervour and funds.

.Ojukwu, a journalist and Fellow of Hubert H. Humphrey Fellowship, is a notable campaigner for sustainable development, justice and peace.

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