The COVID-19 pandemic has disrupted or halted critical mental health services in 93 per cent of countries worldwide, while the demand for mental health is increasing, a new World Health Organisation (WHO) survey said.
The survey revealed that over 60 per cent reported disruptions to mental health services for vulnerable people, including children and adolescents (72%), older adults (70%), and women requiring antenatal or postnatal services (61%), among others.
While many countries (70%) have adopted telemedicine or teletherapy to overcome disruptions to in-person services, there are significant disparities in the uptake of these interventions.
More than 80 per cent of high-income countries reported deploying telemedicine and teletherapy to bridge gaps in mental health, compared with less than 50 per cent of low-income countries.
However, COVID-19 pandemic experienced in 2020 globally can lead to neurological and mental complications, such as delirium, agitation, and stroke.
People with pre-existing mental, neurological or substance use disorders are also more vulnerable to infection – they may stand a higher risk of severe outcomes and even death.
As a result of COVID-19 pandemic, there is no doubt that there is hunger and economic hardship. Many people lost their jobs, while many are also struggling to earn sustainable living wage.
Some people were psychologically affected, some others were socially and emotionally affected due to the pandemic. Also, some have the ability to overcome, while others do not have such abilities, which leads to psychiatric illness. Hence, the increasing incidence of depression, attempted suicide, deliberate self-harm and other forms of mental illnesses, among Nigerians.
According to WHO, no fewer than 800,000 people die every year through suicide, which equates to one suicide every 40 seconds, and about 85 per cent of suicide occurred in low and medium-income countries, including Nigeria.
Suicide prevention remains a universal challenge. Every year, suicide is among the top 20 leading causes of death globally for people of all ages.
This, however, was worrisome to mental health experts, especially with the global outbreak of COVID-19 pandemic.
Commenting, a Psychiatrist, Dr Samuel Aladejare, decried the increasing incidence of mental health cases, attributing the development to COVID-19 and its attendant economic hardship.
Aladejare, a Resident Doctor at the Federal Neuro-Psychiatric Hospital, Yaba, Lagos, said the pandemic and the resulting economic recession had negatively affected many people’s mental health.
According to him, it created new barriers for people already suffering from mental illness and substance use disorders.
“Even, in our wards now, we see lots of people coming down with depressive illnesses – attempted suicide and deliberate self-harm.
“By the time we look at the primary causes of these illnesses, it is usually traced to financial or economic challenges,” he said.
Aladejare, therefore, advised Nigerians to manage their earnings properly to guard against psychiatric illnesses as a result of depression and economic hardships.
He told them to learn to plan with whatever they earned and avoid setting unrealistic goals, which he said could lead to illicit acts and unhealthy medical conditions.
Aladejare said there was need for Nigerians to set their goals and targets according to their capabilities and financial resources, rather than setting goals that their finances could not carry.
The expert said that setting goals above one’s capabilities could lead to emotional or mental illness in the course of achieving the target and could make one to be involved in illegal activities in life.
“Many Nigerians are fond of placing their hands where they cannot reach; which is responsible for the incessant increase in criminal acts and social vices in the country today.
“Good mental health is absolutely fundamental to overall health and wellbeing. As individuals, we have to try and manage our finances; make do with what we have.
“That means I have to roll with the economic situation at any time, so as not to allow my emotional and mental state to be affected by it.
“We don’t want more people to break down with psychiatric illnesses, because of financial or economic challenges occasioned by the pandemic,” he said.
Also, in his remarks, Dr Cecilia Ogun, the Medical Director, Federal Neuro-Psychiatric Hospital, Yaba, Lagos, decried the effects of COVID-19 pandemic on mental health service delivery and services of the hospital.
Ogun said that the methods, procedures and system of operations in the hospital were all affected by the pandemic outbreak.
She said outbreak of Coronavirus led to increase in economic hardship and corresponding increase in psychiatric cases across the country.
The medical director said that patients were being attended to in an open space to pave way for proper social distancing – in line with the Nigeria Centre for Disease Control (NCDC) directives.
This, she said, was with a view to curbing the spread or contraction of the deadly Coronavirus, adding that there had been strict adherence to COVID-19 safety protocols in the hospital since the outbreak of Coronavirus till date.
According to her, research revealed a high burden of psychological/psychiatric morbidity among persons treated for COVID-19, particularly persons who have prior emotional concerns.
She emphasised the need to pay more attention to mental health of people during disease outbreaks and incorporate psychosocial intervention as part of the interventions.
“The COVID-19 pandemic has impacted the lives of millions of people around the world, and is likely to result in mental health problems among those with no previous mental illness as well as exacerbate the condition of those with pre-existing mental health problems/disorders
“Stress induced by COVID-19, if not properly managed, can lead to severe psychological and psychiatric illnesses.
“We have already observed increased incidence of new psychiatric cases and relapse in our institution.
“The pandemic has negatively affected the mental health of many people. Barriers have been created for people already suffering from mental illness and substance use disorder.
“Recently, neuro-psychiatric complications of COVID-19 infections are being reported, and all these have stressed our already existing fragile mental health system.
“Thus, it makes it imperative for us to change our approach to delivering mental health services to our numerous patients in order to protect both staff and the clients,” Ogun said.
She, therefore, advised Nigerians not to relent in their fight against the spread and contraction of the Coronavirus.
The medical director said people should continue to maintain the laid down safety measures against the spread and contraction of the novel Coronavirus disease.
Contributing, a Professor of Nursing, College of Medicine, University of Lagos, Prof. Fatai Badru, appealed to the government agencies and international donor organisations to pay more attention to mental healthcare delivery.
Badru, also a psychiatric nurse, said there were more people with mental problems than those living with HIV/AIDS and other diseases.
“Those living with the condition are significantly more than those living with HIV/AIDS,” he said.
The expert said that more attention was being given to people living with HIV/AIDS than those with mental health challenges.
He said the devastating effects of COVID-19, among other challenges, had left several people in need of psychiatric evaluation.
“Mental health is as important as physical health. But you find out that agencies of government and international organisations focus more on catering for the physical needs of people rather than mental needs.
“Nigeria has mental health policy, but this policy is not being implemented.
“For too long, mental disorders have been largely overlooked, in spite of the fact that they are found in all countries.
“Mental disorders are found in women and men at all stages of life, among the rich and the poor, and in both rural and urban settings.
“If people with mental disorders fail to receive the treatment and care they require, they risk becoming marginalised by society and may descend into poverty and homelessness,” he said.
Badru said lack of political support, inadequate management, over-burdened health services and resistance from policy makers and health workers had hampered the development of coherent mental healthcare system in the country.
The psychiatric nurse expressed concern that “triggers of trauma” were on the rise due to economic challenges in the country, especially with the outbreak of pandemic.
Badru listed such challenges as financial imbalance, joblessness, underemployment, insecurity and family/relationship problems, among others.
He said that as a result of the development, cases of mental health would continue to increase, unless urgent measures were taken by government to resolve the numerous the challenges.
According to him, several people, especially those in rural communities, in need of psychological evaluation and support, could not access them due to the poor state of mental health institutions.
The expert urged Non-Governmental Organisations (NGOs), governments, agencies, international donor organisations and families to work together to address the issues of mental health.
Badru also urged the Federal Government to make building a mentally stable society one of its major priorities by ensuring that basic necessities of life were made available.
Another Psychiatric Nurse, Mrs Veronica Ezeh, who works at the Federal Neuro-Psychiatric Hospital, Yaba, said the pandemic itself was suicidal.
According to Ezeh, it left many people in agony and contributed to increase in suicidal cases due to several reasons.
They include burnout syndrome by the health workers, loss of jobs, marital disharmony, infidelity, loss of beloved ones, failure to meet family needs and financial problems.
She said there was need for multi-sectoral efforts of all stakeholders toward the control and prevention of suicide, adding that everyone has a role to play in either controlling or preventing suicide in Nigeria.
Ezeh said the prevalence of suicide made it pertinent that holistic approach should be adopted to address the causes in Nigeria.
She said there was need for collaboration among parents, guardians, educators, policy-makers, organisations, governments and private sectors in the fight against suicide.
The expert said the efforts must be comprehensive and well integrated, noting that a single approach alone could not make an impact in its prevention.
The psychiatric nurse, however, identified stigmatisation, cultural belief and lack of awareness as some of the challenges facing prevention and control of suicide in the country.
She said the factors needed to be addressed urgently to stem suicide rate.
Identifying and proffering solutions to the causes of suicide, Eze said, remained the first step to be taken in tackling the issue.