Voices from the field: Mental health and primary care in Benue State, Nigeria
Philip Ochi Ode is the Project Coordinator of the Benue State Comprehensive Community Mental Health Programme (CCMHP) in Nigeria, which has been scaling up mental health services in Benue’s primary care facilities since 2010. In celebration of the 21st birthday of the disability and development organization CBM, a key partner of CCMHP, Philip was asked to reflect on the impact that CCMHP has had on the lives of people living with psychosocial disabilities in Benue State. Here, Philip shares a brief summary of his responses to CBM’s questions with MHIN Africa.
What are the main challenges that people living with psychosocial disabilities face in Nigeria?
From our experience, it seems most people living with psychosocial disabilities in Nigerian society face difficult living conditions. I would say there are four main challenges:
- Communities’ negative attitudes: Mental health and psychosocial disabilities are generally perceived as spiritual, and often seen as punishment for wrong-doing. That is why most people who start exhibiting signs of a mental health condition (especially in rural communities) will first be taken to a traditional or faith healer. If they begin to behave destructively or aggressively, it’s considered normal to hold them against their will. Harsh treatments like beating, burning, cutting, and ostracization may follow. People with severe mental health conditions may end up in prison, if their families cannot cope with their behavior.
- Low priority of government: In Nigeria, there are budget allocations for mental health, but details about the actual expenditure are not available. The primary sources of mental health financing (in descending order) are: (1) out of pocket expenditure; (2) taxation; (3) grants; (4) social insurance; and (5) private insurance. The country does not have disability benefits for people with psychosocial disabilities.
- Dearth of mental health professionals: There is one psychiatrist per 100,000 population in Nigeria. This indicates the huge gap between those who have access to services and those who actually need care. Some people have never received treatment for their condition.
- Increasing cost of medications: Due to the devaluation of the local currency, prices of imported drugs have surged, contributing to the high cost of treatment for those who rely on medication on a daily basis.
Is treatment and support widely available?
According to policy, mental health services should be available at the primary care level in Nigeria. But in practice, relatively few primary care facilities have the trained staff and equipment necessary for implementation. Training on mental health is provided for primary care professionals at Schools of Health Technologists, but this training does not adequately prepare providers for the identification and management of mental, neurological and substance use conditions.
Care of people with mental health conditions is mostly carried out by faith-based and traditional healers, although there is increasing awareness about the treatability of mental health conditions using medication and appropriate psychosocial interventions. Most of the orthodox treatment services are provided at psychiatric hospitals and tertiary institutions located in urban centres that are often distant from rural communities. There are a few mental health rehabilitation centres in Nigeria that provide residential care. Though relatively new, community mental health now seems to be the preferred strategy for scaling up access to care. It started from the mid-2000s, with pockets of pilot implementation projects happening simultaneously in the South-West, South-East and Middle-Belt regions of Nigeria.
Can you tell us a bit about CCMHP and how you came to be involved with it?
CCMHP is a CBM-supported program that aims to improve the quality of life of people living with psychosocial disabilities in Benue State, by integrating quality mental health services into government structures and facilitating peer-to-peer support and empowerment. The program is implemented by the Methodist Church Diocese of Otukpo, in partnership with Benue State Ministry of Health and Human Services, and Federal Medical Centre, Makurdi.
I became involved in CCMHP at its inception in 2011 when I was hired as the Project Coordinator. Prior to this time, I was the Program Manager for a local NGO supporting people living with HIV and orphaned and vulnerable children. I wanted to work at CCMHP in order to contribute strategically to a neglected development issue that places a huge burden on individuals and families.
Over the years, CCMHP has conducted capacity building of community health workers and general nurses (who are government staff), enabling them to identify and manage common mental health conditions within their settings and refer complex cases to the Federal Medical Centre (one of the tertiary hospitals in the state), where there are consultant psychiatrists. A drug revolving fund scheme was put in place by CCMHP to provide access to good-quality essential psychotropic medications at affordable prices. CCMHP also facilitated the formation of community-based self-help groups, to reduce stigma and increase participation of beneficiaries in the project and in society at large.
It was not easy from the outset, but with concerted efforts, working with CBM and other local collaborators—including state and local government council authorities and project beneficiaries—mental health services have been established in 45 primary health centres across the state. Over 12,000 clients have now accessed these services. Also, 17 user-led self-help groups now meet on a monthly basis. 774 service users and their carers have been enrolled in these groups. In order to promote economic empowerment, CCMHP has provided 10 of these groups with economic integration grants, which are used to establish revolving loan funds for members. So far, a total of 129 people have benefitted from these loans. Currently, CCMHP is also helping 21 service users develop vocational skills, and has so far provided 6 of them with seed grants to establish their own businesses.
What impact does the work of CCMHP have on the lives of people with psychosocial disabilities?
I’d say there are three main areas of impact:
- Sustained improvements in health outcomes: Beneficiaries of this programme have witnessed tremendous improvements in their health. Generally, their level of functioning improves, and they find they can be useful to themselves and society.
- Advocacy: Self-help groups give beneficiaries a collective voice to conduct advocacy among opinion leaders and in communities, to raise awareness about mental health and promote their rights in society.
- Economic empowerment: Through the introduction of the economic integration program, service users and their families who previously had little or no resources with which to care for themselves have boosted their incomes and are able to fend for themselves.
What more do you think needs to be done for people living with psychosocial disabilities?
People living with psychosocial disabilities need to be given the opportunity to lead their own cause. That way, they can hold decision-makers accountable for their protection, given that they are not recognized as a vulnerable group by government or other development partners. Also worrying is the growing sexual abuse of women and girls with psychosocial disabilities—yet no action has been taken to address these issues.
A great majority of people living with psychosocial disabilities still lack access to financial resources and are depending (even as adults) on family members and other people to meet their needs. They should be engaged in income-generating activities—for themselves and for their households—so that they can meet basic needs, like shelter.
People living with psychosocial disabilities also need to be included in schools. In general, schools in Nigeria are not adequately resourced to accommodate children with intellectual disabilities, so they’re not sent to school. The educational system needs to be developed in order to meet the needs of people living with psychosocial disabilities.
For more on CCMHP's work in Benue State, visit their Innovation Page.