On behalf of the Nigerian Doctor, I welcome you all to our secretariat to join us celebrate the World Health Day. At the first world health assembly in 1948, the World Health Organization (W.H.O) sponsored 7th of April, every year to raise global awareness by highlighting a priority area of health concern. This year, the theme is “Depression: Lets talk”. This theme is apt and speaks to the ability of individuals with depression to function properly at the family level, at work and the society at large. While only 1% of the global health workforce provides mental health care, 1 in 10 people globally has a mental disorder.
There is therefore, a wide human resource gap between services delivered and that which is expected. NMA salutes this year’s choice, as people in Low to Middle -income countries loose close to 30 years of their lives and are more likely to be psychologically less healthy and receive little or no healthcare.
The W.H.O in 2014 said over 45% (almost half) of the world’s population lives where there is about 1 psychiatrist to every 100,000 people. Here in Nigeria. from this statistics, we do not need a Noble laureate to remind us that relying solely on specialist to provide the services needed in the mental health sector will not be sufficient. In Nigeria, the average loss in earning in 2002 among mentally ill patients was about N60,126 which translates to about 40% of GDP per capita, this translates to an annual loss of 21.6 billion naira for one country. Ratio of Psychiatrist to other Mental Health Professionals is 180/5,200.
As we celebrate another world health day with focus on depression, let us ponder on rights of people who labor under this illness by treating them with respect and dignity. Promote their autonomy and right to independent living in our communities, offices, within our families and ensure their privacy in clinical settings. 4.2% of Nigerian population suffer depression and this figure does not exclude children. Despite the heavy socio-economic burden caused by depression, Nigeria do not have a mental health policy that has been implemented and with the exception of a few states (Lagos), most local government areas in Nigeria have no organized mental health programme for its citizens. A national strategy to address mental health problems in Nigeria by governments at all levels is needed, one which should lay emphasis on prevention.
On this World Health Day, let us commit ourselves to those who suffer depression to ensure they no longer suffer in silence. People with mental illness are the most neglected. This is largely because people with mental illness are considered to be defective in character or under a punishment for spiritual deviance. We must ensure that stigma and misconception about depression do not replace medicine and science have taught us about the condition and the fact that it can be treated.
In other words, we should not stigmatize or discriminate against people with mental health disorders particularly depression and unless the society embraces and openly talk about depression, we stand the risk of driving them to extreme hopelessness and despair, leading to deliberate self harm and suicide.
In view of the manpower and treatment gap associated with mental health, the available professionals must retrain themselves and serve as advocates for their patients. Any imminent risk of suicide must be communicated to all staff involved in the treatment and “significant” others in the life of the patient. Recent incidents in Lagos must draw our attention to the fact that there are many other who commit suicide and die unnoticed. As part of our corporate responsibility to the mental health community and the society at large, the Nigerian Medical Association will work closely with the National Assembly to pass a comprehensive bill on Medical Health in Nigeria. We commend the interest of some members of the National Assembly in trying to resuscitate the MHB (Mental Health Bill).
Considering the high cost of health care to millions of Nigerians, the NMA will also continue to pursue Universal Health Coverage (U.H.C) for all Nigerians. The World Health Day, provides us as a nation, an opportunity to reflect and internalize the great opportunity UHC offers us all, particularly people with mental health challenges where access to affordable healthcare remains a daunting challenge. The NMA envisions a Nigeria where issues of poverty, social justice, provision of packages of basic health care and other social services will leave no one behind, reach or poor, urban or rural residents, public or private sector employees and artisans. Governments at all levels as well as the private sector must embrace UHC as a creed of health for all and not only health professionals.
As members of the Press, our Society depends on you and I urge you to make UHC and the plight of mentally ill patients an ongoing national dialogue that budgets across all tiers of government will be based on. Nigeria needs to accelerate through awareness program with competent and committed leadership to the successful implementation of UHC that will lead to a social dynamic that captures all those who suffer depression and other mental illnesses.
We call on the federal Ministry of Health to improve on the current level of rendering mental health services across the country with deliberate efforts at reaching our rural communities. This can be achieved through basic training in identification, diagnosis and treatment of people with depression by primary health care givers. Nigeria has already integrated mental health as the 7th component of PHC in the country. What we need is the training of personnel in rendering basic mental health care to those in need.
Fighting Stigma of Depression
One of the major roadblocks towards a full recovery and integration of people with depression is the tendency to stigmatize depression and those who suffer from it. People are more willing to own up to a cancer or recovery from a stroke than sharing their life and struggle with depression! Those who suffer depression are seen as weak and “too” emotional and therefore not deserving of any support. There are also institutional and structural practices that tend to promote stigma and hiding of depression. This is because, those who admit to having depression and other mental illnesses stand a good chance of losing their jobs. Stigma very often pushes patients with depression to suffer in silence surrounded by shame of their very often treatable conditions.
The stigma of being depressed is compounded by our culture, that view such individuals as unproductive members of our society, making such individuals feel as if they are “nobody” in our society. People with depression bear intense emotional pain and should be seen as courageous and strong individuals, than the stigma we attach to them. Also most policies on stigma in Nigeria are old (formulated before 1960).
Studies show that 78% of Nigerians will be upset working with someone with mental illness and 83% would be ashamed if people knew they have a relative with mental illness. Stigma impacts on the individual, the family and the society. About 800,000 people commit suicide every year and 85% of all suicides occur in LMIC. 90% of people who commit suicide have Mental Health issues with depression as the leading cause in Nigeria. Suicide is increased 4 fold among those with anxiety disorders, 6 fold among those with substance use disorders and listen to this, 18 fold among persons with depression!!!
Response of government to stigma and Mental illness has been grossly inadequate and when treatment comes, it is usually late and frequently inappropriate. About 78% of people needing Mental Health treatment in Nigeria do not receive treatment in the preceding 12 months that they are seen by professionals. Depression also increases the risk of coronary heart diseases, angina, myocardial infarction as well as stroke and type II diabetes.
A mental health policy properly implemented will address neglect of Mental Health services, improve community ignorance of Mental Health issues and redress the delay in accessing health services. The society should be encouraged to “talk depression” to help victims release the toxic feelings of guilt, blame and shame they might have internalized. For those who are depressed, they can with our help, bring forth the inner qualities of courage, patience, determination and perseverance that they often demonstrate but ignored by us. On this day of World Health Day with the theme “Depression – lets talk” I call on all Nigerians, to kick-out the stigma associated with depression which can lead to suicide.
Nigerians, lets talk, because “there is no health without mental health”.
I can not end this conference without a word on the epidemics of Cerebrospinal meningitis (CSM) particularly ravaging certain parts of the country. Already more than 300 deaths have been recorded. While NMA commiserate with the families and state governors of the affected places, we commend the efforts put forward by the various agents of government controlling the spread of the disease. The NMA has started some assistance in providing medicaments to the affected states apart from massive mobilization of her members to man isolation camps in the affected places.
NMA condemns in totality the reactive measures on the epidemic. These measures of poor immunization of the citizens against an infection that is already established is late and ineffective based on the epidemiology of the disease. For immunization to be effective it must have been administered around the month of November 2016.
We want the National Centre for Disease Control (NCDC) and other government agencies to be more proactive in the approach to our emergencies. Early release of budgetary provisions for various health programmes must be part of the change mantra of this administration.
Various epidemiological studies have been conducted in the past on the trend of CSM. The country has a pattern of climate change and we should have emergency medical preparedness plans that should be activated routinely to avert disasters.
We also condemn statement ascribed to one of our Governors that CSM is a curse from God for people’s fornication and adultery. NMA advises that our leaders should stay with the citizens to understand their plights and avoid unnecessary journeys outside the states they seek to govern. Long distance journeys have been highly associated with Sexually Transmissible Diseases(STDs) and HIV/AIDS infections. CSM is an infection caused by Nisseriea meningitidis bacteria.
Nigeria was able to produce her vaccines in 1947 to fight the small pox epidemics. What has gone wrong with this Yaba vaccines production laboratory since 1991 is embarrassing. in the health sector is lack of continuity of policies and programmes. We demand immediate resuscitation of local vaccine production (LVP) at Yaba and expansion of the scope of LVP at National veterinary research institute, Vom. Researches as far back as 1975 showed the various epidemics of CSM as to the type of strains. It is embarrassing again to note that this epidemic has taken us unaware.
Our pharmaceutical industries should be challenged and supported to produce our consumables. This should be the new order instead of budgeting huge sums of money for importation of vaccines and other consumables.
Massive public enlightenment programmes to our populace will go along way to prevent the communicable diseases.
The working environment of all health workers must be safe as they risk being infected if the working tools are not uptimal and up to date.
Prof. Mike O. Ogirima