by Obinna Nnewuihe

There was a way he looked at me that made me feel uneasy. I mean here I was meditating peacefully in church and a familiar face from within the congregation kept staring. He finally decided he had observed enough and convinced himself to bring up a conversation with me.

“Hey doc; sorry o; but why will a doctor commit suicide?” I hadn’t even had enough seconds to put my response together before he followed with his next line of thoughts. “See ehn doctor, if there’s anything you need or someone you need to talk to, please don’t waste time to talk to me oh; let something else not go and happen.” He looked concerned, he seemed sincere; he really wanted to help his doctor friend.

You see, in the space of a few days- myself and millions of my colleagues, especially in Nigeria, have suddenly become endangered species. With the news of the medical doctor who committed suicide by jumping into the lagoon a few weeks back, there has been renewed media attention on mental health challenges in Nigeria. Families are concerned and looking out for any suggestive attitude, colleagues are wary of that overly ‘quiet’ partner, articles have been written and finger pointing has been served round.

In our usual way, we would look at the current mental health system that exists and policy options for improving Nigeria’s mental health delivery framework.

First off, the document guiding Nigeria’s delivery of mental health services was first formulated in 1991. Following then, no revision or amendment has been made to this document and little has been done by way of assessment to see how much its implementation has contributed to reducing the burden of mental health challenges in the country.

By and large, our national plan for tackling mental health challenges is centralised around service delivery in standalone neuropsychiatric hospitals. We have 7 stand-alone hospitals- 6 of which are federally funded. Even if you didn’t know any, you at least know ‘Yaba left’

Many stakeholders in the mental health space have continually pushed for decentralising mental health services. It is thought that is usually easier to say you are going to the general hospital than to say you going to Aro or ‘Yaba left’. By driving greater inclusion of mental health service delivery in integrated health systems, we may achieve better acceptance of mental health issues and reduce the stigma that stifles progress in Nigeria’s mental health delivery framework.

Mental illness is said to be peculiar for several reasons- chief of which is the spiritual and cultural dimensions attributed to its cause and possible treatment. Already this sets a barrier to forging development in this field, especially in our environment where funding for even basic ailments is lacking, let alone an ailment believed to be beyond the human or medical territory.

Perhaps the feeling of concern and use of medical care that could be obtained when one is bleeding or has a headache may be replicated when one likewise, is said to be depressed. Rather than tell someone who has difficulty carrying out tasks they previously enjoyed to ‘snap out of it’ and saying that ‘Africans don’t get depressed’ could we look at the symptoms of mental illness as conditions that need evidence-based solutions?

With respect to suicide in the Nigerian context, we are only recently setting up hotlines for suicide prevention- which I must say is a step in the right direction. Approaches that serve to break the barriers to access are urgently needed, especially in mental health. However, deeper concerns exist around the sustainability of these hotlines. First off, the numbers to call are much too long and rather difficult to remember. There are also some questions about these numbers: are they toll-free? How long shall the hotlines run? Who is funding? How long will the funding run? Who are those responding to the calls and how have they been trained? Is this a nationwide hotline? If no, how will it be replicated across board? Do we wait for another suicide in another state before commencing a hotline for that region?

Depression is a major mental health challenge and a leading cause of suicide. Is a depressed individual likely to call a hotline? Do we have locally developed solutions for managing depression with proven positive effects?

Many questions beg for answers…

In our evaluation of Nigeria’s countrywide approach to mental health and suicide, let us take a quick look at the law. Our criminal code has a slightly different take on suicides and an attempt to commit one.

“Any person who attempts to kill himself is guilty of a misdemeanour, and is liable to imprisonment for one year”

Criminal Code of the Federal Republic of Nigeria, Section 327

If this law has served to deter individuals from committing suicide is something that probably needs to be studied in depth, but I’m not

If this law has served to deter individuals from committing suicide is something that probably needs to be studied in depth, but I’m not favourably aligned to the use of punitive measures in attempting to resolve an action that could be from an actual medical ailment.  It may serve instead to cause people to use more extreme measures in committing suicide in order not to be ever discovered and face jail term.

What we need instead is access. Access to mental health services! We currently struggle with an abysmal number of 1 psychiatrist to over a million Nigerians and the figure doesn’t seem to be changing soonest. In an age where technology has reduced age-old barriers and served as a social leveller, we may employ remote consulting services for mental health issues. Instant messaging platforms-either SMS/ internet-based that ensure anonymity could be deployed to get individuals to share and receive help on mental health challenges. Follow-ups to integrated referral centres or stand-alone centres as currently exist could then be scheduled with utmost ease and privacy. It is my take that if first contact is easy to access, we would go a long way as a nation in stopping tragic mental health deaths, long before they occur.

Now that we are bothered about suicide rates, what would we do differently?

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Op–ed pieces and contributions are the opinions of the writers only and do not represent the opinions of Y!/YNaija