A Neuropsychiatrist, and Head, Mental Health Department, University of Abuja Teaching Hospital, Dr. Ifedilichukwu Uchendu, has lamented the lack of attention being paid to mental health in the country given the rise in drug abuse. In this interview with AJUMA EDWINA OGIRI, Dr. Uchendu, who is also the founder of Centre for Information and Prevention of Mental Disorders (CIPMED), makes case for a state of emergency on mental health.
State of mental health in Nigeria
Let me start by saying that mental health has been relegated to the background by both the health professionals and the society. The reasons sometimes cannot be far-fetched. One, think about the stigmatisation, secondly the ignorance of what mental health is all about, thirdly is the myths about mental health. People believe it is “spiritual”. So, because of these points, people tend to shy away from presenting to the professionals or authorities that are supposed to be there for them.
The one that is actually quite worrisome is the attitude of government; both at the federal, state and local government, towards issues concerning mental health. When you look at all specialities of health, you will find that mental health has actually been relegated to the background by both the ministry of health of various states and even at the federal level. I often tell people that any society that neglects their mental health is really in for trouble, because when the World Health Organization (WHO), was defining what health is all about, it said health comprises of both the physical, mental and the social well-being of the individual.
Unfortunately, more attention is being paid on the physical, not knowing that the physical can be affected by the mental which is the better aspect of health.
believe that with what we are passing through in Nigeria today, the government should declare an emergency on mental health, because of what is happening all over the country. There is stress all over, financial difficulties, challenges, loss of jobs, deaths among others. All these things are actually affecting people’s mental wellbeing. Unfortunately, how many of these people are having access to mental health professionals?
We have an association called Association of Psychiatrist in Nigeria (APN). It is an umbrella association that comprises of all psychiatrists; those that are already consultants and those that are still in training. The association has been trying her best to draw the government’s attention towards mental health, but unfortunately, at the end of the day, no matter what happens they will tell you the fund is not there. But they have so much funds to equip and buy a lot of other things for physical health, and when it comes to mental health, there are some government institutions that don’t even have a ward for mental health patients in Nigeria.
Drug abuse in Nigeria
Talking about drug abuse, a lot of youths have tried to find solace by using different drugs to help alleviate or ameliorate some of the stressful situations they are passing through. This has consequences on their mental health. This is an area that need urgent and critical intervention by not just the government, but by the society at large.
The problem is that the use of all these drugs of addiction are quite common. You will find out that from the age of 11 to 35 are the age range that are mostly affected by this drug abuse or misuse. When we talk about drug abuse, there are those we call legal drugs and the illegal ones.
The legal ones are the ones that are being prescribed or administered by doctors for treatment, but unfortunately some people go ahead to abuse them. Examples are drugs containing codeine. We have benzodiazepine, ketamine, Pentazocine among others. These are analgesics, some of them are used during surgical intervention. There are other drugs like cannabis (Indian hemp), cocaine, heroin, solvent solutions that these youths lay their hands on and abuse. All these drugs affect their brains in the process. Most pharmacists that I know want to insist on selling these drugs on prescription, but where we are having challenge is the chemist; those ones that are not really licenced or not professionals, are the ones who sell these drugs. There are others who buy and sell these drugs illegally to people who use them.
Another drug often abused by people is tramadol. Tramadol is an analgesic. One of the consequences of abusing tramadol is that it causes seizure, what we call epilepsy. By the time you start having seizure, your cognitive functions will start going down. With time you will not be able to memorise, you won’t be able to read and be focused or face your academics. That is why in many universities or secondary schools today, you will find drop outs because of the use of drugs.
People also abuse paracetamol, valium-5, and other common drugs. Unfortunately, some of these things emanate from what I call ‘Nosocomial abuse.’ Somebody will go to a doctor and tell the doctor that he or she is not sleeping well, and the doctor will innocently or ignorantly prescribe Valium 5 or Lexotan. Once they start taking it often, they get addicted to it.
When people come to me and complain they are not sleeping well, first of all I will want to find out why you are not sleeping well, what is the cause of your lack of sleep? Because sleeping disorder is something universal. There are certain stressful conditions that you might pass through that will make you lose sleep for sometimes. That does not mean you should have to start taking sleeping pills. There are medications that are not addictive that you can be given that gives you natural sleep and after few days you are off it.
Effects of drug abuse
Drug affects people’s mental state in several ways. One, it affects what we call the cognitive function. Cognitive function is the ability for one to be able to read, write or see something and be able to retain and reproduce it when needed. Ability for one to be able to plan and remain focused. You will find out that these functions are usually lacking in people who continuously abuse drugs. Most of them will not be able to learn even vocational trade. Some of them will not be able to continue with their school because they are easily distracted.
Also, you cannot talk about crime without drug abuse. 99 per cent of people who want to go into crime, will want to alter their senses. Not all of them have that heart, but immediately they take these drugs, it changes their sense of reasoning. So, in crime prevention if we have less of drugs in the society, the police will have less job to do. Some of them go into crime to make sure they continue to get money to buy these drugs.
Stigmatisation of drug addicts
There is a dire need for us as a society to really know that it is not like in the past where somebody, who is a drug addict is thrown away or stigmatised. I want people to actually see them as people who are sick and need help. Most times people just assume they know what they are doing. If they had their way, they will not be where they are. They need experts who understand the mechanism, who understands what is going on in their minds, and will be compassionate and not judgemental, who will let them know they have made a mistake and can come back. I believe in giving them the knowledge they need and helping them out to understand themselves.
At least 60 to 75 per cent of the people we have managed in the little time of my practice, came out clean and are doing fine. Other ones probably had to continue being on their medication to stabilise mentally.
Curbing the trend
We need to do what I call ‘demand reduction’. Some government agencies like the National Drug Law Enforcement Agency (NDLEA), try as much as possible to reduce the supply by going out to look out for those that supply them; the traffickers, but when you do what is called ‘demand reduction’, you reduce the demand for a particular product.
Demand and reduction also entails creating awareness, getting people to understand the consequences of using these drugs. If we do not tackle substance abuse on time, the future of Nigeria will take God’s grace, because these are the youths we are hoping to hand over the country to in future, but these are the ones that these drugs are actually affecting their mental state.
Treatment and cost
Some come on out-patient basis while some others come for admission. Before now, the number was much more, but because of the economic situation in the country, some try to see if it’s something they could manage probably as an out-patient basis. We attend to about 100 to 200 patients in a year.
It is expensive managing it because it is a team work. It is not something that one person does. We look at people in totality. When people come to me, I use the model I call ‘biopsychosocial model’; that is your biological, psychological and social.
We must have a team that are experts in these areas, that will look at the person’s social life and how it has affected the drug use and how will it affect the treatment. We have a team of qualified clinical psychologist who also contribute, then we have a team of good and qualified medical doctors. Most importantly, we feed our patients on special diets. We do not just give them any kind of food.
Role of parents
Parents need to watch their children as soon as they become teenagers or from the age of 10. Research has shown that children from ages 10 or 11 are already abusing drugs. There is a need to know who your children’s friends are. You need to be very vigilant when they are home, know the things they watch and the things in their room.
There are other things we have to look out for, like when your child goes out and comes back and his or her eyes are red, there is problem. When your child goes out and comes back very late and goes straight to his room and sleeps off immediately and does not wake up until 12noon the next day, that is a signal that there is a problem.
I believe that parents need to have a knowledge of these drugs and be able to start teaching their children so they can have a knowledge of these drugs before they start associating with people. Try to teach them the dangers of these drugs and what negative effect they cause when taken.
Most of these drugs are introduced to these children while they are in boarding schools or hostels in the universities. A child may be having a problem of sleeplessness and a friend who may be on one of these drugs can offer him. When the child takes it and feels better, he will go for that drug tomorrow when he can’t get little sleep. Some might be stress, and when a friend offers him a drug and it helps him, he will start taking that drug anytime he is stressed. Naturally every man is meant to undergo one form of stress or the other.
Some might be introduced to these drugs when they go for parties and clubs. There is the need for us to educate the populace and create awareness on the dangers of taking drugs; one it ruins their future, like I use to tell people “if you do not stop drugs, drug will stop you.”
