‘21 Million Nigerians Have Psychiatric Disorder’

With the population of persons in Nigeria who needs psychiatric attention, it is worrisome that the country has a few neuropsychiatric hospitals and trained psychiatrists. The Medical Director, Federal Neuropsychiatric Hospital (FNH),Yaba, Lagos, Dr. Rahman Lawal in this interview with Martins Ifijeh talked about the need for state governments to set up neuropsychiatric hospitals in their various states, among other related issues

The challenges as the medical director of FNH

I wouldn’t say there are no challenges, because management in itself is all about challenges. Specialist hospitals like ours are associated with challenges ranging from administrative, running of the hospital, trying to put up infrastructure and majorly financial challenges.

These challenges are there, because we are constantly looking for ways to improve our quality of services as this is what we owe the people. Our believe is that, as we continue to push, we will be able to raise standard and quality of practice to meet international standard such that wherever one comes from anywhere in the world, we’ll be able to give such persons quality health care as it is obtained in developed countries.

Challenges that have been surmounted

Life is all about continuos exercise, but so far, we have tried in terms of infrastructural

facilities, we have also tried to improve on the quality of training of resident doctors, we have also tried to improve the welfare of our staff with the finance at our disposal by way of sending them for training and where possible we organize in house training too. Today we have over 500 bed spaces.

Inadequacies of Neuropsychiatric hospitals in the country

On the federal government’s part, I will say they have done a lot. We were previously having three neuropsychiatric hospitals in Nigeria, but today we have eight. I think going by our population, it’s now up to the state governments to set up neuropsychiatric hospitals in their various states. I know some of these states have, but they are very few. If every state set up neuropsychiatric hospitals then the burden of patients not able to access treatment promptly will reduce drastically.

For the state governments that can’t establish any, they can have a neuropsychiatric department in their various general hospitals or health centres and then provide specialists to manage the department. Because there is no way the few psychiatric hospitals we have in the country can cater for the entire population. That is why we must bring treatment closer to the people.
The number of qualified psychiatrists every year is increasing, so we should take advantage of that and increase psychiatric facilities all over the country. It’s not that we have enough doctors, but let’s maximise the ones we have to capacity by putting more facilities in place.

With the population of persons in Nigeria who needs psychiatric attention, it is worrisome that we have only few neuropsychiatric hospitals and trained psychiatrists in the country making it difficult to meet the medical needs of the people.It is cost effective, if specialist hospitals like ours are located in every area of the country. Most times we admit people here who come from the eastern and northern parts of Nigeria. The distance itself is enough to discourage any patient. Even though we don’t have enough psychiatric hospitals, but we have general hospitals all over. I would recommend that each general hospital establish a neuropsychiatric unit so that psychiatric treatment will be closer to the people than the current status.

On subsidizing neuropsychiatric treatment in the country

Infrastructure and finance are also major challenges of every psychiatric hospital in the country. Financial challenge is the biggest issue of any specialist hospital. To have psychiatric illness in our country is to carry a stigma. Such a person will likely not have enough to maintain himself in terms of treatment, because majority of these patients are unemployed, or some may have lost their jobs, because of the ailment, some may have been deserted by loved ones. Even the ones employed may have low earning power. So, like in any other parts of the world, Nigeria has also subsidised treatment for psychiatric patients so that the poor can as well benefit from quality treatment.

Our patients are being fed here free-of-charge while they are also given bed space free-of -charge. So what they are only payingfor is just the actual treatment. We have really subsidised treatment. In as much as people still want more subsidy such that treatment won’t be much of a problem to especially the poor members of the society, I will say government has reduced cost of treatment such that patients don’t pay as high as they used to.

I hope you know the money paid for treatment in this hospital is not even enough to run the administrative activities of the hospital. So government is not banking on that to run the hospital. We have over 300 staff here and their salaries are not coming from the money generated through treatment. Government is paying salaries and putting up infrastructures and other facilities itself, so that we will be able to offer quality service to the public. That is also subsidy. I wonder how much patients can pay that will take care of the salaries of 300 staff in this hospital.

It is not when we tell patients to pay N10,000 instead of N50,000 that we’ll be said to have subsidised treatment. All other things we have done is even more subsidy.Today, we have over 500 bed space in the hospital and no patient is asked to pay for space or even feeding. This is because that area has been subsidised by 100 per cent. So, government is doing its best. Even on several occasions we end up paying medical bills for the patients that have over stayed and nobody is forth coming to pay their expenses or discharge them.

On number of psychiatric personnel in the country

Though the numbers of professional psychiatrists we have now have increased compared to before, the country still needs more personnel. I am advising that more doctors specialise in psychiatry. Let it not be that we don’t have enough personnel to man neuropsychiatric hospitals or neuropsychiatric units of general hospitals, when eventually we have more psychiatric centres in the country. According to statistics, about 12.5 per cent of Nigerians have one form of psychiatric disorder or another, which is about 21.2 million Nigerians. This is why we need more hands; more psychiatrists, more health workers and more health facilities, so that we will be able to cope with treatment and management of psychiatric issues in Nigeria.

On brain drain in the profession

One of the major challenges we are having is that a lot of our trained psychiatrists are practising outside the country. If we have a lot of them in the country, we wouldn’t say our personnel are not enough. They are out in search for greener pasture in countries where they are paid more. In as much as government is doing enough, I will advise that the profession should be made more attractive in terms of renumeration so that we won’t continuouslyhave issues of brain drain. At present, we only have about 150 practicing psychiatrists in the country which is grossly inadequate.

Misconceptions and myths around psychiatric illness

There are lots of myths and misconceptions surrounding psychiatric illness in Africa, especially in Nigeria. There are people who refuse to visit the hospital or bring their sick ones for treatment, because they believe psychiatric illness is a spiritual issue. Hence, they would prefer to take such patients to spiritual healing homes or faith organisations so as to get cure through spiritual means. Majority only take neuropsychiatric hospitals as their last resort. And you know when cases are not presented on time, they are often more difficult to treat. This is one of the reasons people don’t present their cases to the hospital, thereby preventing such persons from getting proper medical attention. So, what I do is that when I come across such persons, I tell them to bring their sick loved ones to the hospital whilst educating them that there are drugs for the treatment of the illnesses. People should understand that psychiatric illness is also like other illnesses which require medical attention. And now we have good drugs just like the ones in developed countries.

On incessant strike action by health professionals

Workers in the health sector have no reason going on strike, because of the importance of the sector. Imagine the police or military saying that unless the government gives them what they want they won’t go to work. It is the same for workers in charge of electricity in the country. There are some services that must not go on strike and this is the group the medical sector belongs. Continuos strike will destroy the sector. If health professionals are on strike and someone has a road traffic accident and has a broken leg, it therefore means no hospital will attend to that person and this will encourage them to patronise traditional homes or faith healers who are unprofessional in administering these treatments.

To avoid these continuos strike actions and for the health sector to move forward, there should be a working relationship between every professional in the hospital ranging from doctors, nurses, pharmacists and other health workers. The disharmony among health professionals didn’t just start today. The issue has been there for a long time and that is why a radical and comprehensive solution needs to be found.

culled from thisdaylive.com