"Research played a significant role in shaping policy and improving implementation of health programmes to provide empirical data to address challenges in our society and must be well harnessed."-Dr Nsiah-Asare
Mental disorders have an enormous individual and societal financial burden. In view of the current economic hardships/ "recession" /"unfriendly policies" in the country, it is appropriate to look at the economic burden of mental health disorders.
Only 3.3% of the Nigeria health budget is allocated to mental health care. How will this amount will be operationalized to address the surmounting challenges in the sector leaves much to the imagination. Funding have direct links with mental health policy implementation, whereas there is no national agenda or focus on mental health care.
In general terms, several countries in Africa are better resourced in regard to mental health personnel. Countries such as South Africa, Egypt, and Kenya have more psychiatrists per 100,000 persons and also have higher proportions of psychiatric beds. Also, many countries in Africa also give better official attention to mental health issues.[1]..
Very few studies have addressed the issue of loss in earnings both at the individual and societal level associated with mental illness in Sub-saharan Africa. A study by Esan OB1, Kola L, Gureje O.[2].. (largely hospital based, localized, and have addressed only a few mental disorders using small representative sample of 1,889 Nigerians aged 18-64 years in an epidemiological survey) examined the impact of mental disorders on earnings of affected persons.
Very few studies have addressed the issue of loss in earnings both at the individual and societal level associated with mental illness in Sub-saharan Africa. A study by Esan OB1, Kola L, Gureje O.[2].. (largely hospital based, localized, and have addressed only a few mental disorders using small representative sample of 1,889 Nigerians aged 18-64 years in an epidemiological survey) examined the impact of mental disorders on earnings of affected persons.
Quick Facts
- Few studies have addressed the issue of the cost of mental illness in Sub-saharan Africa, with results indicating that impact appears more severe in males..
- In the U.S., it is estimated that about 79 billion dollars represent the indirect costs associated with mentla disorders; of these, 63 billion dollars reflects the loss of productivity due to illness.
- In Canada, the economic burden of mental illness in 2003 was estimated to be about $34 billion ($1056 per capita), with depression and schizophrenia accounting for about $5 billion and $2.7 billion annually, respectively.
- The WHO in 2005 estimated that mental health conditions cost between 3% and 4% of the gross national product in European Union member countries
The version 3.0 of the World Health Organization Composite International Diagnostic Interview (WHO-CIDI) was used to assess mental disorders. Respondents were also asked to report their personal earnings before tax in the past 12 months, while authors predicted personal earnings in the same period from information about 12 month and life time DSM IV mental disorders among respondents [2].
Results found that mental disorders have an enormous individual and societal financial burden. This impact appears more severe in males. Specifically, a 12 month prevalence of Serious Mental Illness (SMI) was found in 0.5% of the sample while other 12 month disorders had a prevalence of 4.83%. The prevalence of other lifetime disorders was 4.14%. The mean annual impact of serious mental illness was 60,126 Naira (US$ 463). At the level of the society the annual impact was 21.6 billion Naira (US$ 166.2 million)2].
RELATED:The Mental Health Budget:1,888 per citizen? Where is our Mental health Policy?
IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Mental disorders have enormous negative impacts on earnings both at the individual and societal level. This analysis highlights the financial value of lost earnings in the absence of such disorders[2].
IMPLICATIONS FOR HEALTH POLICIES: An increase in spending on mental health based on proportionate economic burden of mental disorders may substantially reduce financial losses due to mental disorders[2].
IMPLICATIONS FOR FURTHER RESEARCH: In the present study, only the indirect health care costs have been assessed. Future research should consider direct costs[2].
Core Challenges
There are 3,105 mental health professionals (private&public practice), with a ratio of 11 mental health professionals per 100,000 people in Nigeria (only 42 psychiatrists (0.15 per 100,000) and 20 psychologists (0.07 per 100,000). This lack of specialized personnel also means that, according to the WHO-AIMS report, physicians in Primary Health Centers (PHCs) are allowed to prescribe psychotropic medications without restrictions. Other challenges include; a relative lack of training and research in the area of mental health, no coordinating body to oversee public education and awareness campaigns on mental health[3] (9jaMindWorks was born out of the core need for public awareness on demystifying, destigmatizing, advocating for mental health/illness).
Social and main stream media has brought to the fore recent suicides, suicidal episodes, depression, substance abuse-sexual abuse(sustained minor/girl child rape/molestation by biological father/close friends) related disorders recorded nationwide, with painfully no national statistics on the accurate number/ages/persons affected. Talk less of a national agenda or framework by decision-makers to address or pay attention to the mental health sector.
Given these challenges, I wonder how will the 3.3% mental health budgetary allocation be operationalized to address the issues? Although it is never easy to formulate and implement public policies, the updated National Mental health Policy 2013, with decentralized mental health services is not being implemented. There is a great deal of scientific evidence that could make them effective and equitable. Yet in the past years decision-makers have most often forgotten about equity in their policies.
Recommendations
The number of Nigerians suffering from mental illness is on the increase due to the on-going economic, and both men, women, adolescents and children in on-going conflict/insecurity at the middle belt and North East are also most at risk, if the neglect mental by the government is unattended to. The integration of community mental health care services into mainstream healthcare as stipulated in the yet-to-be- implemented National Mental health Policy will improve the mental health reserves of those affected.
There is also the urgent need for passage of the Mental Health Act into law by the National Assembly, if not, the lack of adequate mental health infrastructure, low numbers of professional personnel, training and research pose a threat not only to individual's mental health reserve but also with adverse economic loss nationally. More importantly, the prejudices, discrimination, stigmatization and abuse of the mentally ill will never end.
Clear concepts of what constitute mental health by institutions/individuals with decision-making power, vision, and political will are key ingredients required in improving the poor mental health services in Nigeria.
Let us join heads and vioces together in putting a STOP to the prejudices, discrimination, stigmatization abuses. It begins with you. Share this story with the #STOPtheAbuse #TheMentallyillAreHumans2 #FacetimeMental@9jaMindWorks
References
1. Ministry of Health, WHO. WHO-AIMS Report on Mental Health System in Nigeria. Ibadan, Nigeria: Ministry of Health and WHO; 2006.2. J Ment Health Policy Econ. 2012 Jun;15(2):77-82; PubMed.gov
3. Oye, Gureje. "WHO-AIMS Report on Mental Health System in Nigeria" (PDF). www.who.int. Retrieved 22 January 2017.
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