Relieving the burden of mental illness in Nigeria

Mental illness is a brain disorder of one’s thoughts, behaviours, and/or emotions. Mental illness varies in severity depending on many factors, including type of illness. Some persons will need
assistance from professionals for a certain period of time, while others may need more long-term
care. Over the years, different theories have been formulated in trying to explain mental illness

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Today the dominant approach to mental illness is the bio-psycho-social model. This systemic approach identifies three aspects that have an impact on the health of the person: the biological (genetic and physiological); the psychological (emotional, cognitive and relational), and the social (i.e. the individual situated in their environment, culture and epoch). The future well-being and health of the ill person depends on how all these aspects are integrated and interrelated. This
means that the patient’s mental health is treated as part of the health of the whole person.

POSSIBLE SIGNS OF MENTAL ILLNESS

UNUSUAL OR DISORGANIZED BEHAVIOUR: Social withdrawal; sudden loss of interest in activities, school, or work; pacing, staring, talking and laughing to oneself; inability to sit still
or conversely being inert or apathetic; showing deterioration or change in personal hygiene and
appearance; excessive spending or destructive behaviour; changes in sleep and appetite and
uncharacteristic abuse of alcohol and/or drugs.

EMOTIONS: Giving inappropriate emotional responses; displaying hostility or uncharacteristic
anger; inability to cry or excessive crying; talking or thinking about suicide; excessive pessimism
or optimism; lack of empathy or compassion; uncharacteristic problems with relationships;
inappropriate laughter.

COGNITION: Having trouble concentrating; strange speech and conversation; memory impairments; disorientation to time, place, or person; problems with judgement; grandiose ideas; difficulty with responsibility; hallucinations and delusions.

HALLUCINATIONS: seeing, hearing, or smelling things that exist only in the person’s mind, e.g.hearing voices; feeling or seeing things crawl on their bodies; smelling imaginary smoke, etc.

DELUSIONS: Having false beliefs, e.g. believing one is a prophet, or paranoia, e.g. that one is
being spied

TYPES OF MENTAL ILLNESS
SCHIZOPHRENIA
Schizophrenia touches 1 percent of the population Nigeria. This is a disorder of the brain
that affects mental processing of thoughts, perceptions and moods. What all persons with schizophrenia have in common is the presence of one or more psychotic symptoms. The onset of the illness most often occurs in late adolescence or early adulthood. With early intervention and with the help of new medications, many of the symptoms can be relieved and make recovery possible.
The symptoms of schizophrenia are usually described in terms of ‘positive’ and ‘negative’.
POSITIVE SYMPTOMS INCLUDE: hallucinations; delusions; thought disorder; bizarre and disorganized behaviour; incoherent communication.
NEGATIVE SYMPTOMS INCLUDE: deficiency in flow of thought and speech (alogia); inability to experience pleasure (anhedonia); lack of emotional and physical expression (flat affect); isolation; social withdrawal; lack of motivation and interest (apathy).

BIPOLAR DISORDER- Also known as manic-depression, bipolar disorder is a mood disorder
characterized by cycles of depression and mania. A bipolar disorder episode can last from several days to several months. These cycles differ in intensity, with the frequency tending to
increase over the first ten years of the disease but to decline within twenty years of its first onset.
Bipolar disorder often surfaces in late adolescence or early adulthood. As in those with schizophrenia, persons with bipolar disorder can also experience psychosis. Persons who are diagnosed as having bipolar disorder experience ‘low’ periods of depression (as described above) and ‘high’ periods of mania.

SCHIZOAFFECTIVE DISORDER- This is a mood disorder although it is sometimes categorized as a form of schizophrenia due to the presence of psychosis. Persons with schizoaffective disorder have symptoms of both schizophrenia and mood disorder, although not at the same time.
Medications for both of these illnesses are available. Mood disorders are subdivided clinically
according to their severity, episodic nature and duration.

ANXIETY DISORDERS
At some time in life almost everyone experiences anxiety. However, a true anxiety disorder manifests itself when the fears and anxiety are so intense as to prevent normal functioning. It is
known that from 7 to 15 percent of the population suffer from severe anxiety disorder
Approximately two thirds of these people are also diagnosed with depression. Researchers
believe that anxiety disorders can be traced to hormonal/biological, psychological or neurophysiological causes. There are six types of anxiety disorder.

PANIC DISORDER- A person with panic disorder experiences sudden, brief and overwhelming ‘panic attacks’. The emotional symptoms of a panic attack consist of intense feelings of fear, terror and also a sense of depersonalization (i.e. a lost sense of personal identity or a feeling of unreality.

GENERALIZED ANXIETY DISORDER (GAD)- In contrast to panic disorder where the person experiences sudden and acute attacks, persons with GAD have chronic anxiety and worry
excessively about money, health, family or work, always expecting the worst even when there
are no signs of trouble. These worries generally interfere with the patient’s day-to-day routine
to the extent of affecting their entire life.

PHOBIAS- A phobia is a persistent fear reaction that is out of proportion to the reality of the
danger. People who have phobias are usually aware that their fears are excessive and irrational
and want them to go away but feel that they have no control in making this happen. Phobias
can be categorized as specific phobias (e.g. blood, elevators, dogs, water) and social phobias (i.e.
fear of being observed).

AGORAPHOBIA: Agoraphobia is defined as a subtype of panic disorder because it usually occurs in the context of panic. This means the person is not only afraid of the public place itself, but of the potential risk of having a panic attack while out in public. People with agoraphobia go to great lengths to avoid places and situations such as streets, crowds, open spaces, bridges, elevators and any situation from which escape might be difficult or where help is not available. Many people with this disorder are unable to leave their homes.

OBSESSIVE COMPULSIVE DISORDER (OCD)- As its name implies, OCD is a two-part disorder made up of both obsessions and compulsions. Obsessions involve worrying excessively
about something, which in turn often causes a great deal of anxiety or distress. Compulsions
involve the need to do something to help get rid of the anxiety caused by the obsession.
Obsessions are unwanted, disturbing, repetitive thoughts, images, or impulses that ‘obsess’ the
mind and are nearly impossible to control or dismiss.

POST-TRAUMATIC STRESS DISORDER (PTSD)- This is a serious disorder that affects a
multitude of people each year. In fact, in any given year 5 percent of the population can expect
to have PTSD. It can develop in anyone who has experienced or witnessed a traumatic event,
such as a car accident. Two people might experience the same event but have completely different reactions. One will not suffer any adverse effect while the other will continue to experience the traumatic event over and over again, sometimes for months or years. They often have flashbacks or recurring nightmares. They may begin to avoid situations or conversations that remind them of the trauma. They might experience sleeping problems and/or depression that
were not present before the trauma; inability to remember parts of the event(s); apathy; a feeling
of detachment, and a decrease in everyday functioning such as relationships and work.

PERSONALITY DISORDERS
Personality is defined as the psychological and behavioural characteristics of an individual that
remain relatively stable throughout one’s lifetime. It is the way the person views and relates to
the world. A personality disorder exists when the manner in which the patient views and relates
to the world is maladaptive and dysfunctional and clashes with accepted social norms. Therefore,
personality disorders can differ greatly from culture to culture. Personality disorders are
believed to be caused by both genetic factors and past life experiences. There are different types
of personality disorders. Two such examples are:

ANTISOCIAL PERSONALITY DISORDER- In the past, persons with this disorder were labeled ‘psychopaths’ or ‘sociopaths’. Antisocial Personality Disorder is defined as ‘someone having chronic insensitivity and indifference to other people, which has direct negative consequences for society’. People with this disorder are characterized by one or more of the following behaviours: social and/or sexual aggression; self-mutilation (e.g. cutting oneself); stealing; lying and recklessness that endangers others; lack of remorse or of moral concern, or of any sense of responsibility; an impulsiveness and tendency to be manipulative.

BORDERLINE PERSONALITY DISORDER- Persons with Borderline Personality Disorder are challenged by chronic feelings of emptiness, boredom and identity confusion. Their experience is one of intense and unstable interpersonal relationships; erratic mood swings; frequent displays of temper; potentially self-damaging impulsiveness and unpredictability. Self-mutilation is also associated with this disorder.

SUBSTANCE ABUSE
Although not necessarily labeled a mental illness, statistics show that from 20 to 50 percent of
the psychiatric population in Nigeria have problems with drugs and alcohol. There are a variety of different explanations for this. Many people confess that the drugs and alcohol help them to feel better and that they get some relief from the symptoms (i.e. are self-medicating), allowing them to socialize more. Another reason is that many people develop mental illness at a young age when they are still likely to be ‘experimenting’ with drugs in their peer groups. Drugs and alcohol, especially when mixed with medications, can put patients at a higher risk of relapse

CAN THE ILLNESS BE PREVENTED? YES OF COURSE
Reacting to the factors that might have led to increase in mental health issues among Nigerians, Dr Mapayi said the factors may be in two folds as the increase may not be true since mental health illness has always existed but people have labelled them wrongly due to ignorance. However, she added that the myths and barriers are being broken down as people are now willing to ask for help while those suffering from mental illness are now finding acceptance.
“On the other hand, we all know that in recent times the level of stress in the society has increased. Fuel scarcity, terrorist attacks and frequent kidnappings, internally displaced people in conflict situation, struggling small and middle businesses, underemployment, failing naira to the rest of the global economy, falling oil prices, rapid urbanisation, climate change are but a few of the factors that increase the risk of vulnerable people to mental illnesses”, she said.
In the midst of the demand of daily life necessities which may expose many to mental health illness, Dr. Mapayi said there are preventive measures that can be adopted to avoid mental health issues. The preventive measures she said can focus on reducing risk factors and enhancing protective factors.
“Practical steps towards prevention would include paying attention to the warning signs and talking to a therapist when one feels overwhelmed, getting routine medical care, taking good care of your body and mind, adequate exercise, good diet, enough sleep, a vacation now and again, stress reduction exercises and staying away from drugs and alcohol (sorry too be a spoilsport)”, she added.
Unlike the past when mentally challenged individuals are often shackled and beaten, mental health disorders is no longer a sentence to isolation as medications such as physical methods of treatments and psychotherapy are now available in hospitals with mental health professionals.
Commenting on the methods on treatment, Dr. Mapayi raised optimism on the effectiveness of methods used by trained professionals. “They are very effective and give clients the ability to live a productive life and engage with society effectively.‎ These treatments can be given in most good hospitals that have mental health professionals although the global acceptable standard that we are still aiming to achieve is to be abler to treat these disorders in all primary care centres, we are not there yet”.
Advising Nigerians on how they can maintain good wellbeing, Dr. Mapayi admonished Nigerians to learn to relax by taking a minute or two to stare into space or make out time to do what they enjoy. She however warned that these should not include alcohol, drugs, violence and other maladaptive coping mechanisms.
“Increase your physical activity, take an evening stroll, read for leisure, cultivate friendships, add humour to your life, pick up a hobby, volunteer, treat your body right. Build your self-confidence, pat yourself on the back from time to time, manage your stress or get help, live within your means, accept yourself and your limitations”, she stated.
On the factors that may be responsible for mental health challenges, Mr Agberotimi said it can be summed up into two which are the nature (genetic and hereditary) and nurture (environmental).

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