Problems and critical reforms in mental health care: an examination of Nigeria’s situation

Abstract

The World Health Organization (WHO) emphasizes the significance of mental health to our overall well-being, influencing our cognitive, emotional, and social interactions [1]. Despite a global rise in mental health awareness, Nigeria continues to experience a significant mental health crisis. With an estimated population of 200 million and a total workforce of 250–350 practicing psychiatrists in the country [2,3], this estimate reflects a low psychiatrist-to-population ratio of 0.174 psychiatrists to 100 000 Nigerians. Therefore, it is projected that up to 20% of the population may be affected by mental health issues [3]. Consequently, many of these individuals have limited access to mental care, rights protection, rehabilitation, or support. A 2019 survey by the Africa Polling Institute and EpiAFRIC revealed that many Nigerians attribute mental health disorders to drug abuse, evil spirits, or brain disease, often seeking help from spiritual houses[4]. Mental health care in Nigeria is severely deficient, as highlighted by the WHO’s AIMS assessment, which points out the inadequacy of services, funding, treatment access, and a shortage of mental health professionals[5]. Non-Western psychiatric treatments, often sought due to the lack of services, can lead to human rights violations rather than relief; hence, it is crucial to prompt the primary healthcare system and various government levels, along with their collaborators, to kick start or implement policies supporting community-based mental health services. The goal is to ensure the accessibility of these vital services at the community (primary healthcare) level, fostering mental health promotion and the treatment of mental illnesses[6]. In our discussion, challenges leading to a high prevalence of mental illness coupled with low access to care, particularly in rural areas where there are financial barriers, have contributed to the high prevalence of mental illness. In the years following the 2001 Abuja Declaration, where African leaders committed to allocating at least 15% of national budgets to health, Nigeria’s budgetary allocations to the health sector needed to catch up to this target. The highest allocation was 5.95% in 2004 and 2012, with most other years ranging between 3.6% in 2002 and approximately 5.5% from 2003 to 2006 and 2011 to 2015. From 2002 to 2018, only approximately 4.72% of Nigeria’s national budget was allocated to health[6]. Despite the low funding allocation in Nigeria’s health sector, mental health has no definite fund stigma, and cultural issues impede service access[7]. Furthermore, the lack of community-based mental services continues to affect mental healthcare delivery in Nigeria, the total dependence on primary healthcare services for care delivery is prevalent in local communities, and notably, these local communities do not provide mental care services such as counseling, early detection, treatment, or rehabilitation that serve rural communities[8]. Stigma and lack of awareness also contribute to the lack of mental health in Nigeria, and myths and misconceptions cause many individuals to see mental illness as a personal failing or supernatural curse, breeding shame and secrecy. Most individuals with mental health disorders prefer to stay indoors. Seeking professional help is seen as a weakness, so people suffer in silence to protect their family history and avoid the occurrence of social stigma that could arise in the social gathering of marriage among associated families. The general public has little understanding of mental health issues – the causes, symptoms, or available treatment – and often attributes mental illness to evil forces or individual shortcomings[8]. Traditional and religious healers play a significant role due to their cultural relevance, and harmful cultural beliefs also reinforce stigma, making traditional healers a frontline and frequently consulted due to long superstitions about mental afflictions, hence delaying evidence-based psychiatric treatment[8]. Disparities in mental health services are influenced by gender, economic status, cultural stigma, and geographic location[6]. Addressing these disparities requires workforce development, financial mechanisms, cultural sensitivity, and policy reforms. Nigeria’s mental health policy is outdated and underfunded, leading to fragmented care and insufficient early intervention strategies[9,10]. Societal attitudes and human rights issues hinder mental health care in Nigeria, fueled by stigma and discrimination rooted in cultural beliefs. Widespread misconceptions lead to social isolation, deterring help-seeking. Human rights violations, including forced institutionalization, worsen challenges for individuals with mental health conditions. Inadequate legal frameworks exacerbate these issues. Solutions involve public awareness campaigns, legal reforms, community engagement, and professional training to create a more supportive societal environment for those facing mental health challenges. Finally, we propose the following recommendations: The importance of community-based mental health services and the integration of mental health care into primary healthcare systems is necessary, and this could be achieved by decentralizing services and training local health workers, which can foster early intervention, cultural sensitivity, and holistic care. Legal reforms and community-based care are vital for Nigeria’s mental health system. Legal changes aim to safeguard human rights, emphasizing consent, autonomy, and anti-discrimination. Access to legal counsel is crucial for enforcement. Bringing community-based services and mental health care closer to where people live will reduce geographical barriers and increase accessibility, especially in rural areas. Furthermore, integrating mental health services into primary care settings, which are more widely available, can further enhance the reach and early detection of mental health issues and ensure better patient health outcomes in total health care delivery. Training local health workers and involving community members in the design and delivery of services. This will ensure cultural relevance and acceptability. This approach will help address stigma and misconceptions by incorporating local beliefs, values, and practices in a respectful and evidence-based manner. By promoting a holistic approach, community-based services can adopt means of addressing not only mental health but also related social, economic, and environmental factors that impact well-being. This approach can facilitate better outcomes by addressing the multidimensional nature of mental health challenges. Involving traditional and religious healers, when aligned with evidence-based practices, can leverage their cultural relevance and enhance the accessibility of mental health support. However, it is crucial to ensure that their practices are standardized and aligned with ethical and scientific principles to avoid potential harm.