Mental illnesses ravage the country silently like a hand in the dark. In this darkness, traditional healing homes thrive as a psychiatrist caters for one million Nigerians.Kunle Falayi in this report, takes a look at the decline in the mental health system, herbalists’ healing methods and the situation forcing Nigerian psychiatrists to relocate abroad.
The herbalist launched into a rap of incantation. “Ohun a wi f’ogbo l’ogbo ngbo…” he began. The incantation was filled with words aimed at subduing the spirit troubling his latest patient, a young man of 39, whom he had travelled 40 km to pick up earlier in the day.
The Elekunmefa of Ise-Ekiti in Ekiti State, one of Nigeria’s southwestern states, Chief Sunday Adeiya, would occasionally spit on the head of his patient as he reeled out spiritual commands.
“He is my 35th patient this year,” he said.
Bejewelled with white beads on both ankles and red beads on a mound of hair which stood at the centre of an otherwise clean-shaven head like a rocket ready to go off, Adeiya looked formidable for the task at hand.
His patient is one of the 31.6 million Nigerians suffering from various forms of mental illnesses in the country. According to the World Health Organisation, only 20 per cent of these silent patients suffering from mental illnesses in Nigeria have got access to any form of treatment in the last 12 months. Out of this, only 10 per cent received a minimally adequate treatment.
Herbalists such as Adeiya have taken the reins of the mental health system of Nigeria, practising and profiting from a deficient system where government has simply relinquished responsibility.
“It is simply abnormal for traditionalists to be in charge of the mental health system of a country,” Founder of the Mental Health Foundation, Dr. Emmanuel Owoyemi, said.
But that does not seem to be a situation that would change anytime soon.
“Every year, I see more psychiatrists relocating abroad. I have had cause to appeal to some of them to stay. But the situation in this country is harsh. You cannot blame them,” Owoyemi said.
There are more Nigerian psychiatrists in the UK than in Nigeria, findings revealed.
One psychiatrist to one million Nigerians
According to WHO’s atlas on mental health, neuro-psychiatric disorders in Nigeria are estimated to contribute 6.2 per cent of the global burden of disease.
Eight regional psychiatric hospitals and few psychiatry departments in 12 medical schools across the country cater for the mental health of Nigerians in a ratio that is simply frightening and mind-boggling.
Even though the frequently quoted psychiatrist-population ratio is 1:10,000, a 2011 WHO statistics put the ratio of psychiatrists in Nigeria as 0.06 doctors to 100,000 Nigerians (less than one psychiatrist to one million Nigerians).
There are less than 200 psychiatrists in Nigeria currently, while all the psychiatric hospitals in the country have a capacity of 4,000 bed spaces at a ratio of 2.5 per every 100,000 Nigerians.
Since the universally acceptable psychiatrist-population ratio of 1: 10,000 was adopted by many countries, Canada and the US have upgraded. Canada now advocates a ratio of 1:6,500, while the Royal Australian and New Zealand College of Psychiatrists recently recommended between 1:7,500 and 1:10,000.
However, despite this huge deficit in the system in Nigeria, no ministry at any level in Nigeria has any desk handling mental health issues, according to the WHO’s Assessment Instrument for Mental Health Systems. With this and the dearth of mental health professionals in Nigeria, one may be tempted to think that very few cases of mental illnesses are recorded in the country.
Owoyemi, whose foundation has been at the forefront of a push for a more robust national mental health policy in the country, said that is definitely not so. He explained that there is simply a poor awareness of mental illnesses in the country.
“The opinion of many people is that if one has not pulled off his shirt and walked naked in the country, such person cannot be said to have a mental disorder. But this is absolutely untrue. There are many people with mental illnesses walking the streets like normal people,” he said.
The cases brought on regular basis to the herbalists visited also shed light on how dire the issue of mental health is in Nigeria.
“I have practised for more than 20 years,” Adeiya, the herbalist told our correspondent. “But in recent years, I have been getting up to 20 patients every month.”
As he spoke, Adeiya began the process of scraping off the hair on the head of his latest patient. With a daily dose of specially prepared concoction made out of roots and leaves with incantation to boot, he claimed he would never fail.
How does Nigeria rank with other nations?
To put how Nigeria ranks with other countries in the world in perspective, it is necessary to narrow it down to two countries with the closest population to that of Nigeria – Brazil and Russia. Then add to that another African country, South Africa, with a smaller population at just a third of that of Nigeria.
With a population of 173 million people, Nigeria has eight psychiatric hospitals with psychiatrists ratio of 0.06 to 100,000 people. South Africa on the other hand, with a population of 50 million, has 62 psychiatric hospitals with psychiatrists ratio of 0.27 to 100,000 people. Brazil with a population of 194 million has 208 mental hospitals with psychiatrists ratio of 3.07 to 100,000 people. Russia seems to fare best with a population of 143 million, the country has 360 mental hospitals with psychiatrists ratio of 11.61 to 100,000 people.
As it was since 1970
The last of Nigeria’s eight psychiatric hospitals was established in the early 70s when its population was 56 million – about one-third of its current population.
At that same period, Nigeria’s currency was so buoyant that one dollar equalled 0.7 Naira.
Economist, Mr. Henry Boyo, explained the significance of this on the lifestyle and aspirations of Nigerians.
“In 1970, a brand new car was about N6,000 (about N3.8m today which is approximately $23,700), a new tyre was N2 while a car battery was about N3. You could also buy four tins of Sardine for N2. A driver who earned N125 at that time would be able to afford anything worth almost $200 anywhere in the world at the time,” he said.
According to MeasuringWorth, $200 in 1970 was worth $2,020 in 2013, which means that the worth of N125 in 1970 is in the neighbourhood of N320,000 today, considering the devaluation of the naira which currently stands at N164 to $1.
Boyo said, “The purchasing power of Nigerians was much higher. An individual who earned N1,000 at the time would be a wealthy man. This was why there was much contentment and less aggression in the way people pursued their aspirations.
“The driver in 1970 was living far more comfortably than a driver in 2014. But now, the devaluation of the Naira has created a lot of problems including the brain drain which has brought about the dearth of professionals in many fields.”
According to experts, the economic hardship over the years has taken its toll on the mental health of Nigerians. It has created an emergency situation in the country’s mental health system, which has so far been largely ignored.
Psychologists say social malaise and aggression induced by economic hardship was far lower in 1970 than it is now, which is why it is frightening that Nigeria’s mental health system has remained largely stagnant.
Professor of Psychology and Head of Department, Ekiti State University, Olanrewaju Adebayo, explained that young people in Nigeria currently survive in “a state of anomie.”
Adebayo said, “Economic hardship is not the only problem one can ascribe the increasing social malaise in the country to. Society has become complex while the community support for individuals which existed in the past is no longer there. All these come together to create more stress.
“Nowadays, people are making efforts but they are no longer sure they would get results. Students are graduating in thousands every year without any hope of getting jobs. Family support is non-existent in some cases.
“In this situation, some young people begin to experiment with drugs. This, combined with their low self-esteem, creates psychological problems. This explains why there is an increase in mental illnesses in the country.”
Patients are brought to us from hospitals – Traditional healers
The inadequacies of the Nigerian mental health system have reprogrammed the thinking of many Nigerians. Churches and traditional healing homes have become the first point of call for families of patients with mental diseases.
When 39-year-old John Olusegun (not real name) developed a mental illness suddenly about 11 months ago, the first point of call for his family was a traditionalist on the outskirts of Akure.
“They told me they had been to three other herbalists before they brought him to me,” Adeiya said, as he finished shaving off the patient’s hair. “By the time they thought about me, he had become uncontrollable and violent.”
In Nigeria, as a result of a largely inadequate mental health system, psychological illnesses are seen as spiritual attacks rather than a problem that can be treated scientifically.
A week-long arrangement between Adeiya and family members of the patient, whose actual name would not be revealed for ethical reasons, had culminated in him travelling to Akure to pick up the young man.
“They told me they could not bring him themselves because they could not handle him. I don’t think there is any patient I cannot handle. I went there girded with charms and subdued him instantly. With incantation, he was compliant and I brought him here,” the herbalist said with pride.
In a dingy passage of a bungalow, which is constructed with a mixture of red earth and cement bricks, Adeiya prepared his patient for a treatment which he said would last at least two months.
Adeiya pointed a stick at the patient and commanded him to sit. The young man, who looked very aggressive, immediately sat down.
He would explain later that the stick was not ordinary. He said the stick had been ‘prepared’ and made into a magical command rod. The unkempt patient was heard muttering and shaking his head and right foot.
As soon as the patient sat down, the herbalist clamped a fabricated metal shackles on his feet to restrain him for the duration of the treatment.
The herbalist said it was time to take his patient into an “oracle room” for divination – his own version of diagnosis.
“You are welcome to come in but you would have to go through a short cleansing ritual,” the herbalist said. Our correspondent obliged. The room looked equally formidable; a dimly lit windowless enclosure with all the expected fetish and carved figures were in a corner decorated like a grove.
He recited more incantation before disclosing his diagnosis.
“He inherited the mental illness,” he said. “I must find out if there had been a case of mental illness in their family before. No matter the cause of his illness, I will heal him. I have never failed.
“Many times, people bring patients with mental illnesses here from churches and psychiatric hospitals. They prefer us because we heal them completely, unlike in psychiatric hospitals where they would depend on drugs for the rest of their lives. When I heal a patient, the illness never comes back,” he said.
Parked outside Adeiya’s semi-ancient building, which he has converted to living quarters for his family, two “oracle rooms” as he described them, as well as rooms for his patients, was a Cherokee Jeep, which he said was a gift from a thankful patient’s family.
In a country of 158 million people with grossly inadequate mental institutions, herbalists like Adeiya will always get a high patronage from families who could not get adequate help from the few available psychiatrists.
Adeiya with a patient
Adeiya’s confidence in his method would later resonate at the home of another herbalist and traditional healer of mental illnesses, Chief Idowu Anigbajumo in Owena-Ijesa, a border town between Osun and Ondo states.
At the back of Anigbajumo’s home, where he also houses his patients were three male mental patients. Some of the herbalist’s young children were playing around on the ground. It was a messy atmosphere as few goats, their kids and droppings littered the ground.
One of the men was obviously in a very bad shape. His two shackled feet were swollen while the rest of his body was emaciated. The patient had bloodshot eyes and had a sore at the back of his calf.
The feet of the other two were unshackled. The herbalist said they could not run away. One of them looked robust and his skin showed he must have been from an affluent home unlike the others.
“His father is a judge,” the herbalist said.
The look on his face seemed to say he would rather be somewhere else. But the patients were silent as the traditionalist took our correspondent on a tour of his ‘facility.’
When our correspondent first got to the backyard, the herbalist was tending to the contents of an earthen pot on an open fire, which he later explained as the concoction for the treatment of his patients.
The house bore a general look of a shambolic combination of patched cement blocks, walls of which have been blackened by soot, grime and dirt. In the building, a suffocating heat from the relentless afternoon sun pressed heavily on one’s scalp, reminding one of the good purpose the absent ceilings in the house would have served.
Anigbajumo’s little children played hide and seek in the backyard as the patients sat on benches with their heads bowed, unmindful of the children.
“That is how I treat my patients. We live in the same house and they eat the same food as my children and I. I don’t allow their families to bring food for them,” he said.
At the time of our correspondent’s visit, five patients were receiving treatment in Anigbajumo’s house.
“People from places I have not even heard of in Nigeria call me to come and pick patients for treatment. I always notice that they are people who can afford treatment in psychiatric hospitals,” he said
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