Mental Health: How a lack of education & funding has led to the inhumane care of mental health suffers

Globally, poor mental health has become a very prevalent issue in the past five years. In 2018, one Nigerian hospital in Lagos saw a 22% increase of new patients being admitted due to mental health conditions and a 50% increase in the number of patients struggling with substance abuse. Sadly, because of serious shortcomings in the healthcare and welfare budget, Nigeria has not been able to keep up with the growing knowledge of the causes and characteristics of mental health illnesses, meaning that outdated methods of treatment remain.

Human Rights Watch released a report earlier this month on their investigation into mental health facilities in Nigeria and the treatment of the patients by staff. In 8 states they visited 28 facilities of various types: federal psychiatric hospitals; general state hospitals; state-owned rehabilitation centres; Islamic rehab centres; traditional healings centres and Christian churches.

What they found was disturbing

The report described the shackling and chaining of patients’ limbs and ankles to limit their movement, supposedly for their own safety. One woman was found with her leg pegged down to a tree trunk where she had to eat, sleep, urinate and defecate. It was not rare to find patients who had been chained for months or even years, sometimes as punishments for misbehaving. The oldest found chained or shackled was an 86-year-old man, the youngest, a 10-year-old boy.

In one case at a state-owned rehabilitation centre, an HIV+ woman was chained to her bed to “stop her from going around the men”, one nun admitted. At the same facility, another woman was found chained naked to her bed. Leaving extremely vulnerable women in that capacity begs the question of the nature of the intentions of the staff in charge.

In addition to restraining patients, staff admitted to the use of slapping as a punishment and many patients showed scars on their arms, chests and backs from floggings by the staff. Flogging and whipping were found at Islamic rehab centres, whilst at Christian healing centres and churches, patients described how they had been forced to fast for up to three days at a time as punishments and “treatment”.

Stigma

Deep-rooted stigma has remained as one of the major obstacles to the advancement of mental health treatment in Nigeria. Historically, the general belief in Nigeria of the causes of mental health conditions was put down to preternatural or supernatural forces, witches, evil spirits and even God. Much like medieval UK, these ‘outcasts’ were burned, hanged, mutilated, abandoned or restrained, often in public displays. Stigma still exists in Nigeria today, leading relatives to admit their loved ones to religious or traditional healers where herbs and traditional methods are used instead of official prescription drugs administered by trained professionals. It was reported that staff would pin down patients in an attempt to force them to swallow the herbal medicine.

Much of the treatment that is undergone at these facilities is without the consent of patients. At the psychiatric hospitals and state-run rehab centres, Human Rights Watch found that staff forcibly administered both oral and injectable medication as well as the old fashioned electroconvulsive therapy (ECT).

Not only is much of the treatment non-consensual, but it was found that in 27 out of the 28 visited facilities, all residents had been unlawfully detained, did not enter voluntarily and could not leave if they wished.

Societal attitudes towards those with mental health conditions seem to not have advanced in the same way that the West has in recent years (most likely due to their deep-rooted faith in religion and tradition). Those suffering from mental health illnesses are seen as dangerous, suspicious, unstable, unreliable, irresponsible and homicidal, which explains why they are restrained by heavy objects – to limit their danger to others.

Funding and Educating

Due to a lack of funding and education around this topic in Nigeria, it is estimated that only 10% of those who are in need of mental health care have access to it. Nigeria has less than 300 psychiatrists for a population of around 200 million people, where it is estimated that around 50 million (25%) suffer from various mental health conditions. Furthermore, much of the available professional care is expensive and therefore only readily available to wealthier citizens. Al Jazeera reported that around 9/10 doctors in Nigeria seek employment in other countries and at least 12 doctors a week leave Nigeria for the UK where they can earn twice as much than at home. The absence of professional psychiatrists drives desperate families to traditional healers who have an extremely limited education about the issue.

Human Rights Watch called for the Nigerian government to:

• Completely ban chaining
• Investigate all state and private institutions in all 36 states and Federal Capital Territory with the goal of stopping chaining and ending abuses
• Ensure that people rescued have access to psychosocial support and social services, including services for children
• Train and sensitize government health workers, mental health professionals, and staff in faith-based and traditional healing centres to the rights and needs of people with mental health conditions
• Conduct a public information campaign to raise awareness about mental health conditions and the rights of people with disabilities, especially among alternative mental health service providers and the broader community
• Progressively develop voluntary and accessible community-based mental health and support services, in consultation with people with lived experiences of mental health conditions

Just like in any specialised medical situation, the patients deserve and desperately need someone who knows exactly what they are talking about. The demands made by Human Rights Watch are considered and long-term, however, they will be hard to implement without the proper funding and training of professionals. Nigeria must also to find a long-term solution to entice their own doctors to remain in their home nation to treat those in need. But in reality, how long will it take for Nigeria to de facto ban chaining and violence against some of their most vulnerable citizens?