THE MONSTER WITHIN

A few weeks ago, a beautiful young lady reached out to me on a social media platform. She said that I had commented on a post about anxiety and she liked my comment and wanted to speak with me if I didn’t mind.

Of course, I didn’t

I could not remember the post or my comment but I wanted to hear what she had to say.

So I told her that it was fine to discuss.

Then she started...

"Please I am battling it, it is driving me crazy".

Crazy? That is putting it mildly, I said in my mind. Anxiety can be an unrelenting monster eating away all traces of joy in your life. It chooses a comfortable spot in your mind and occupies it rent-free.

I wanted to tell her that I understand completely; reassure her that all will be well. But I needed to listen first, so I listened with rapt attention.

She told me about all her physical symptoms, her constant hospital visits, her challenges staying alone in her house, and the suggestions from friends and family that she has a spiritual problem that requires a kind of exorcism to rid her of the "evil spirit" tormenting her life.

You see, anxiety convinces you that a non-existent problem is staring you right there in the face. It presents to you all the worst outcomes that might result from a normal (or not so bad) situation and orders you to freak out and worry about it.

You try to resist and shake off the feeling but anxiety says: "Nope, you will surely meet that doom you are dreading".? It proceeds to give you countless reasons why meeting that terrible fate is a done deal. No matter how hard you try to refuse the verdict, it tries harder to reinforce it.

In my friend's case, she believes she was having a stroke and will soon die. Granted, she had some real symptoms of full-blown panic attacks that sent her to the hospital emergency room a couple of times.?

Doctors will treat her physical symptoms and send her home assuring her that "all is well with her; it is all in her head”?

After listening attentively, I acknowledged her situation and assured her that she can and will crawl out of the deep dark pit of debilitating anxiety with the right help. This is not something you wish away or just pray away. (I believe in faith, I believe also that faith without work is stone-cold dead)

She needed the attention of a MENTAL HEALTH PROFESSIONAL?

I offered some words of encouragement and shared resources that helped me when I dealt with bouts of anxiety that can also help her deal with hers. I assured her that I am available and willing to listen to her anytime she feels like talking. It doesn't matter the time of the day or night.

I remember her call by 2:00 am one morning. The panic attack had started. The heart palpitation, dizziness, sweating, etc. were all happening to her. She was convinced that she was having a stroke and would soon fall and die; she tried to convince me too. But I told her: "Girl, you aren’t having no stroke and you aren’t dying. Your mind is lying to you!"

We talked for a while and before we said goodbye she asked me: "Nne, are you saying that I am not going to have a stroke, fall and die?"

“Yes! You aren’t having a stroke, you aren’t falling and aren’t dying”, I repeated. “But you'll need to see a mental health professional as soon as possible as self-help is not enough at this point, and going to a general practitioner will not help much either unless he refers you to a psychiatrist” I advised.?

OUR UNFORTUNATE SITUATION

The major problem we have in this part of the world (especially in my country Nigeria) is that we stigmatized almost every health challenge. People are scared to acknowledge and seek help for their mental health issues because they will be stigmatized and labelled “mad”. (Yes, here we still use derogatory terms like “madness” to describe any or most of the mental health spectrums that exist, like schizophrenia, delusion, psychosis, etc.)

Why will I go to see a psychiatrist when I will be termed "Werey", ‘Onye-ara", Craze-man or a mental case if people find out that I went to consult one? Why will I be seen going into “Yaba left” (“Yaba left” is a street name for the Federal Neuropsychiatric Hospital Yaba, Lagos. The most popular mental health treatment centre in Nigeria and one only 8 run by the Federal Government)

According to the World Health Organization, about 1 in 4 Nigerians is suffering from a form of mental health challenge. This is about 50 million Nigerians out of a population of over 200 million.

People suffering from mental health problems in Nigeria are in what I can call “double jeopardy”. Because mental health issues such as anxiety, depression, etc. do not present with physical symptoms like swollen lips and red eyes, friends and family tend to ignore the complaints and behaviours of their loved ones indicative of mental health problems. When sufferers complain too much, they are taken or pressured to consult faith healers and spiritualists who will most times subject them to dehumanizing practices (this sometimes involves such abuses as flogging, chaining, starving, burning, etc.) in the attempt to cast out the “evil spirit” causing the problems and thus heal them. This is on the one hand.

On the other hand, those who are enlightened enough to seek professional mental health care for themselves or their loved ones, are met with the unfortunate dearth of government-sponsored mental healthcare systems. There is an abysmal level of infrastructure and trained manpower to tackle the mental health burden that bedevils the country. Consulting privately owned mental healthcare facilities is usually expensive and out of reach to low-income persons who are the majority of the population.

SCARY STATISTICS

My heart bled when I read the report of the WHO-AIMS (World Health Organization and Assessment Instrument on Mental Health Systems) study on the Mental Health System in Nigeria. According to the report published in 2006: “There is considerable neglect of mental health issues in the country. The existing Mental Health Policy document in Nigeria was formulated in 1991. It was the first policy addressing mental health issues and its components include advocacy, promotion, prevention, treatment and rehabilitation.?

Since its formulation, no revision has taken place and no formal assessment of how much it has been implemented has been conducted. Though a list of essential medicines exists, they are not always available at the health centers. No desk exists in the ministries at any level for mental health issues and only four per cent of government expenditures on health is earmarked for mental health”.

Recent studies show that the situation has not improved to date. This, unfortunately, is a conversation few people in authority are willing to have.

A recent study by the Lancet Global Health reports: “...In 2003, a Mental Health Bill was put forward to the National Assembly of Nigeria. With little support and no progress for more than 6 years, it was withdrawn in April 2009. This Bill was presented again in 2013 when the National Policy for Mental Health Services Delivery set out the principles for the delivery of care to people with mental, neurological, and substance abuse problems. Again, facing scant support, it has yet to become law...”

WHAT IS THE WAY FORWARD?

To tackle this critical issue of mental health challenge ravaging our society, I recommend the following:

• Reorientation - There should be a total shift in the way that we as a people view and treat mental health challenges and their sufferers. When we stop stigmatizing and forcing them to partake in dehumanizing exorcisms and treatments, sufferers would be more willing to speak out about their situation and seek the needed help
• Government Policy - The government should become deliberate in formulating policies that will address the issue of mental healthcare delivery in Nigeria. Members of the National Assembly should throw their full weight behind the Mental Health Bill and pass it into law.
• Increased Budgetary Allocation of Fund for Mental Health Care – The 4% of the healthcare budget that is allocated to mental healthcare is a paltry sum when compared to the burden of mental health issues in the country. This should be increased significantly if we are to see any positive change in the mental healthcare situation in the country.
• Train and Equip Primary Healthcare Providers to Dispense Appropriate Level of Care to Mental Health Patients - Primary healthcare facilities located in all communities are closer and more accessible to sufferers. Therefore, healthcare providers who work in these health centers should be given the necessary training that will equip them to provide at least the first line of care to? mental health patients

Also, mental health departments should be established in these health centers to attend to mental health patients specifically

• Advocacy and Sensitization Campaigns - There should be increased awareness about mental health problems. The government, NGOs, the media, social entrepreneurs, celebrities, civil society organizations, individuals, etc. should all join in sensitizing the public about mental health problems. Many people who have mental health challenges do not even understand what is happening to them. Their loved ones also do not understand the challenge and so do not know how to help. It is expedient that mental health problems receive as much attention as other health issues like malaria and STIs.
• Curb Substance Abuse - According to a study by the National Bureau of Statistics in conjunction with other relevant bodies, 14.3 million Nigerians ages 14 to 63 (any nation’s productive population group) use hard drugs. 3 million of this number are already addicted to drug use and suffer drug-related physical and mental health challenges.1 in every 4 drug users is a woman.

SUMMING IT ALL UP

The solution to drug abuse should be an all-inclusive effort by the government, religious bodies, civil society groups, Social Media Influencers, NGOs, etc. The government should provide more jobs and business opportunities to youths and also review existing drug laws to involve stiffer penalties. More funds should be allocated to relevant government agencies to increase the fight against drug abuse in the country. Community-based awareness and sensitization programs should be intensified. Programs targeted at secondary school students should be enshrined in the school calendars where experts and representatives of relevant bodies go to schools to educate the young minds on the adverse consequences of drug abuse

Parents on their own part should begin early to educate their children on the dangers of drug abuse and also monitor them. The most effective training method in this regard is to lead by example. Parents who want their children to avoid drug abuse, should not abuse drugs themselves.

Mental health challenge issues should become a constant conversation among professionals and other stakeholders. We need to face the demon in order to overcome it. Whether you’ve had a mental health challenge in the past, are currently battling one, have a loved one who is experiencing it or even if you have not dealt with one yet, you are a stakeholder in the problem. I charge you today: be part of the solution!

PS: My friend is now receiving care from a psychiatrist and she is making great progress. It is my utmost hope that she recovers fully!

Photo Credit: Photo by Uday Mittal on Unsplash