Tuesday, October 11, 2011

Mental illness: Brain disease, not unlike other medical diseases

Mental illness is an actual brain disease and as such everyone with a brain can develop the problem. As the World Mental Health Day is commemorated, experts say that at least one in four people would require a mental health care at some point in their lives and four
out of five know someone with a mental illness, thus the need for better funding of mental health, reports Sade Oguntola. Mental health issues are the most sensitive, but the least talked about. Paradoxically, one in four people will experience such difficulties at some point in their lives and four out of five people would know someone with a mental illness. It’s touching everybody, basically.
Unfortunately, since many persons with mental illness may display odd behaviours, the public’s lack of accurate understanding of this disorder, often results in fear, ignorance and stigmatisation.
Instead of recognising certain behaviours as symptoms of mental illnesses, the society often considers people who have them as criminals or violent people. But mental illness is an actual brain disease, not unlike other medical diseases. So, anybody that has a brain can develop a mental disorder.
Despite mental disorder contributing 13 per cent of the global disease burden, awareness and understanding of mental health and how it can affect different aspects of a person’s life, the community, nation’s development is limited in Nigeria.
“The seriousness of mental health problems in the country is beyond rhetorics and the age-old thinking of many people that mental health problems are due to a curse placed on an individual, a punishment from the gods or due to demons has prevented many with mental problems seeking medical treatment,” said Dr Adeoye Oyewole, the National coordinator, Stakeholders’ Forum on Mental Health Advocacy in Nigeria.
Good mental health is more than simply an absence of a mental illness.  In fact more people than can be imagined experience one form of mental problem and its attendant consequences. According to Dr Oyewole, “mental illness is not synonymous with a mad man on the street. Anybody can have a mental illness and it cuts across all age groups, gender and socio-economic classes. Poor mental health can affect people’s quality of life and the country’s economic development, so further pushing down African countries’ GMP. “
Paradoxically “an environment that does not allow people to maximally express themselves or to be gainfully employed after graduation leads to frustration. Many young graduates out of frustration have taken to the use of hard drugs like hemp, some to sophisticated armed robbers and yahoo-yahoo boys. Aside all these that are indications of poor mental health, even corruption in leadership is a mental illness.
“For instance, a contractor who was paid to repair a road and because of his negligence in doing this, his brother later died in a ghastly motor accident on that road would forever experience a mental anguish,” Dr Adeoye said. “Some women develop mental illnesses such as depression after child birth because of socio-economic problems, which make it hard for them to adequately care for their babies. Unfortunately, such babies would end up with poor cognitive development and also later in life more at risk of using hard drugs, abusing their own children as well and so on.”
Ironically, average global spending on mental health is still less than US$ 3 per capita per year. In low income countries, expenditure can be as little as US$0.25 per person per year, according to the World Health Organisation’s (WHO) Mental Health Atlas 2011 released on World Mental Health Day.
Unfortunately, “proper funding of mental health needs to be taken by policy makers in Nigeria as an emergency. Mental health is central to attainment of the millennium development goals, but still no provision was made for mental health in its implementation. Even the nation’s National Health Insurance Scheme did not accommodate mental health, despite the definition of what constitutes good health. This was actually what made the WHO to call for inclusion of mental health in all programmes of governments.”
What more, Dr Olayinka Majekodunmi, a consultant psychiatrist, Nueropsychiatry Hospital, Aro, Abeokuta, Ogun State, stated that there was a large mental health service gap in Nigeria. Many people have no access to mental health services at all. Across the low-and middle-income group of countries, more than three quarters of people needing mental health care do not even receive the most basic mental health services.
“In Nigeria, about 21 per cent of people with serious cases of mental disorders receive any treatment in a year. For instance, in many countries, between five and 10 per cent of cases receive any treatment for epilepsy.  Across Africa for example, nine out of 10 people suffering from epilepsy go untreated, unable to access simple and inexpensive anticonvulsant drugs which cost less than US$5 a year per person,” declared Dr Majekodunmi.
“Often when care is sought for mental problem, detection is often poor and treatment is often inadequate even though effective treatments are available for most mental health problems,” he said. Unfortunately, “there is a big gap in budgetary allocations and policy attention on mental health as well as manpower for mental health. For instance, 70 per cent of countries in Africa spend less than one per cent of their health budget on mental health. In many, there is actually no “mental health” heading, only guesstimates! This is unlike majority of European countries which spend more than five per cent of their health budget on mental health care.”
“While South Africa with a population of 45 million people had 320 psychiatrists, Nigeria with its population of 140 million only has 130 psychiatrists, with over two-thirds of them practising outside of Nigeria. Access to treatment is not just limited because of paucity of human resources, but also because of their mal-distribution, poor knowledge of people on mental illnesses and dearth of policy on mental health issues. Most specialist facilities are located in a few cities even though greater than 60 per cent of the population lives in rural areas.”
In ensuring adequate mental health, “a functional primary health care is crucial to any attempt to bridge the gap. Evidence abound that treatment for mental health problems, work – depression, schizophrenia, bipolar disorder, anxiety disorders, substance use disorders all have effective treatments.”
“With proper care, psycho-social assistance and medication, tens of millions could be treated for depression, schizophrenia, and epilepsy, prevented from suicide and begin to lead normal lives– even where resources are scarce,” concluded Dr Majekodunmi.

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