Dr Sunday Osasu Olotu, medical director (MD) of Federal Neuro Psychiatric Hospital, Benin City provides insight into the rising cases of mental imbalance in the country and the reasons in this interview with Felix Omoh-Asun
Sometime ago, a former health minister said over 64 million Nigerians suffer mental imbalance. Why this high figure?
I will not accept that same figure you just quoted. We in the parlance of psychiatric don’t have the exact figure but we notice there is a trend. The trend of mental disturbance is increasing, the trend of hospital admission is increasing, the trend of presentation of new cases is increasing, and from our local instances here I think there is increase.
Why do you think this is so?
Generally social perimeters affect mental health. Other aspects of our economy indirectly affect mental health. Example is road, communication problems. Bad road, bad environment can lead to increase accident rate. And with accident, people can injure their brain, head or spinal cord or other damage that can be permanent. Such injuries to head and brain can lead to mental illness.
But sir, it this not juxtaposition of a generation of technologically and scientific advancement, where inventions are high?
Yes, that is the paradox of scientific, technological advancement. The more advanced we are, the more it has a collateral influences on the environment. That changes our eco-system and that itself brings about some consequences. Ideally, the way God created the universe if left like that; it will be clean, pure and benevolent for everybody. Imagine the cases of drugs and alcohol abuse that is today prevalent. In indulging in alcohol and dangerous drugs, people damage their brain. Imagine no light, no water, I cannot pay my children’s school fees, a man goes to work but the work does not bring him money to meet his needs, all these can cause stress. There is a level of stress everyone can absorb, if it goes beyond that he breaks down mentally. All these factors put together is what is scary about mental health.
What is the difference between mood disorder and a psychiatric case?
Mood disorder is a class of psychiatric disorder itself. However, because people are subject to mood changes it is not all mood changes that are qualified for psychiatric case. I can get up and ask my driver let’s go out only to discover he has not washed the car I asked him to wash since morning, I can have a burst of anger that does not mean I have mood disorder. I have just been angry about something, after some while my mood returns to the normal state. So, people have changes of moods based on variation in the environment as it affects them, or them affect the environment. But once that variation becomes persistence, and large enough and consistence not only to my driver but to my wife, to my children, to my mother, to co workers, then there is a problem. It now moves to a psychiatric case.
It is said there is about 200 psychiatrists throughout the nation. Why this low attraction to the profession?
The figure you just quoted I don’t know where you got it from. To me it is less than 200. Psychiatry has always been part of internal medicine. It was after sometime it broke away from internal medicine to be in a class of its own. It was disfavoured right from the very beginning and that unfavorable status has been affecting its growth all this while. Compared to others inside medicine, it is not favoured. So people would rather study other aspects that have attained the status of prominence over the years than to come into psychiatry. Additionally, it is a discipline that people look at as an outcast. They look at the patients as an outcast, the clinicians, the doctors, the professionals as outcast and all the methodology around mental illness. I think that is why it is like that.
Will this be the reason that health policies drivers are not also keen on establishing more psychiatric homes despite rising cases?
That is correct because the fore drivers of health policies are doctors in other areas. It is first love, first serve. So once they are there to make policies or money to be divided or things to be shared their first thought goes to those primary, primary, first, first areas. May be until psychiatry begins to delve into other areas more than psychiatric e.g into health economics, politics, health management, international policies, rather than psychiatry being an addendum to other qualification and credentials and they begin to occupy position, there might not be paradigm shift that will be profitable to psychiatry in the near future. I think government should make a deliberate effort to shore up the fortunes of psychiatry because I believe the brain is the most important organ in the body. It initiates and drives every behaviour. So, we need to take it step by step. We should first have a national policy on mental health, then move from there to national mental health act by the National Assembly, by the time we put into place and the social paradise of government made and carve out, that is to cater for the jobless and have not, then we will remain the same. Not everyone you see on the street who looks mad is really mad. It might be because of social problem.
You talked about stigmatization of both the patients and the professional, how do we check this?
One, there has to be a total re orientation right from the grassroots. It should start from primary health care with the professional talking to people in that community that mental health is not what they think. By the time you preach at health care centres, at the hospital, private, states and federal hospitals, do promotions, awareness campaign, it will be positive for mental health. The other angle is engaging opinion leaders, big shots, community leaders, elders who have so much carriage to speak about mental health. If, for example you see the Pro Chancellor of University of Benin, the Emir of Kano, Abubakar Sanusi, comes on air in NTA and says ‘please let’s respect the mentally unwell people in the society especially those who have been cured, there is treatment and cure; and Dangote goes to another station says the same thing or the President himself as he did during the campaign for polio immunization, he went there with the health minister, do this for a while I am sure the attitude will change towards mental health.
Is there post event by the hospital for discharge patients?
That is one of the problems I am saying in the total care for the mentally unwell people in the country. I was in the U K for training apart from the government that pays whole or part of their treatment, there are in between agencies for intervention that help to rehabilitate them. Social welfare is one of them. Those who cannot buy drugs, they are helped, likewise those who have difficulties in learning a trade are helped. There are agencies recognized by government liaising with health workers to identify discharged mental health patients to train and empower. There is always a short gap between the hospitals and their homes. Those things are totally absent in Africa and Nigeria society. So you give medicine to provide cure and this is done. And the man who has for a long time been unwell is discharged but unfortunately no government, no agency, no member of the family is ready to follow him up thus he becomes a big burden on the immediate family. Meanwhile, he is supposed to continue with a little treatment afterwards. Before you know he has relapsed into the same condition. The new method of bio psycho social medicine (physical, mind and environment) are what the drugs are meant to correct. If one is out of it, the three pro-model is no longer complete. After a while the person goes back into the former self. Meanwhile, the post treatment is what concerns everybody- the society, government, corporate bodies, health sector, social sector are all needed here.
There is a saying that mental health is very expensive that is why majority of the patients go to spiritualist and traditionalist for treatment. How far is this true?
I will not say this is true in treating mental illness. All I have to say when compared with other illness, it is not true. What of transplant. The main issue that increases the overhead cost is the revolving I just spoke about. You come in for the first time you are treated, and then go, only to come the second time, third time so on and so forth and by now you are accruing cost. Then people will now say it is costly.
Any point of convergence for English and traditional or spiritual healing?
The spiritual and traditional people do not have the science for mental illness. So there is no point of convergence, if there it is the point of imitation. They buy our drugs dilute it in alcohol and herbs to give to them. They do English treatment disguising they are using herbs. To me this is a fallacy.
Your regime is most petitioned in the history of this hospital. Why was it so?
The only thing I have to say is in a parable. That is it is the tree by the road side is most stoned. I am by the grace of God the most trained psychiatrists, outside my predecessors in office, presently in this place. I am the only one who has gone abroad for training. So I had both local and foreign training. I had a working training in one of the best hospitals that concerns mental health- Cambridge Homecare Trust in the U K. That made me outstanding to those who competed with me this position of medical director of this hospital. I have wealth of experience local, national and international. I have a network of experience and exposure. As so people are bound to be jealous and envious especially some who came to the interview with me I was their boy. There is to say I was their junior in training. There is where all my opposition came. They remained here while I was developing myself. That was it. Of course I came first in the interview; I did not lobby anybody for the position
What worked for you that you were able to survive all the petitions?
What worked for me was that I have stayed focused and ready to take the mandate given to me by the President. My personality is that I am conscientious about what I do. I never say die or lose hope. So whatever it will take me to get at that goal, first legitimately, I will explore all to get to that goal. I am a workaholic.
This place has taken a new shape, with new structures here and there. How did you do it?
It is about determination and looking for novel way to be creative. One of the things I was exposed to in the U K is what is known the ‘lean concept’. That is one of the concepts that transformed the Japanese company when Toyota motors first came out. It is looking how best to identify wastages and leakages, and shut them out of the system. And look for legitimate short cut to keep you to output and performance, using same resources. That is it.
What would you want to be remembered for when your tenure ends?
By grace of God I want to be given opportunity for another tenure so that I can consolidate on what I have started and open new frontiers so that my successor can add to that. My first tenure ends in a about a year’s time. As I said earlier on, we pray that our children should be than us. That is my prayer for whoecer succeeds me. I want to be remembered for bringing unionism under decency, bringing co operative society to a sense of decency. We have a hospital now that is progressive rather than conflict union, conflict government. The industrial harmony was achieved by bringing to an end a reign of impunity. Government appointed a medical director and some workers say no we don’t want him. In a civilized society the workers are supposed to be loyal to the government. We got to a point that we said management was accommodating enough we have to follow the civil service in dealing with indiscipline and impunity. And I think I have done well.