Dr Ojo Tunde Masseyferguson is a mental health specialist with over a decade cognate experience in mental health promotion, prevention and management of mental health conditions using evidence-based interventions including psychotherapy, counselling, and pharmacotherapy among others. He uses a multidisciplinary and biopsychosocial approach in the management of his clients which spans both the public and private sectors. He has a combined working experience both in Nigeria and abroad having worked for some time at the prestigious Maudsley Hospital in the UK.
He has publications in peer-reviewed journals and he is also a reviewer for journals. He is a recipient of many fellowship grants and awards among which are EMERALD (Emerging Mental Health system in Developing countries) studentship for his MSc, Lundbeck Neuroscience grant for early career psychiatrists and the World Psychiatric Association (WPA) early career psychiatrist fellowship award. He is also a member of the American Psychiatric Association (APA).
He is a passionate mental health advocate and uses various platforms to increase awareness and conversation around mental health. He founded Centre for Better Mental Health (CBMH) as a dedicated vehicle for mental health promotion, advocacy, community-based rehabilitation, empowerment and research. He runs a mental health advocacy programme on radio tagged Mental Health Matters.
He had his professional postgraduate qualification with the National Postgraduate Medical College of Nigeria (NPMCN). He holds a master degree in Global Mental Health from King’s College London and London School of Hygiene and Tropical Medicine and MBA in healthcare management. He is currently a consultant psychiatrist and Head of department of Mental Health at the University of Abuja Teaching Hospital where he serves as a clinician, researcher and clinical instructor in postgraduate training in the institution. He also serves on various committees (health research ethics, residency training and continuous medical education) within the institution.
We had a chat with him in commemoration of the 2020 World Mental Health Day, excerpts below-
NW: The theme for this year’s Mental Health Day is; Mental Health for All, Greater Investment – Greater Access, in terms of investments, how much have we invested in mental health awareness and advocacy in Nigeria?
Dr Ojo: There has been an increase in mental health awareness and advocacy in Nigeria in recent times especially with the surge in availability of electronic platforms and the social media. Most of the awareness and advocacy campaigns are largely driven by individuals and non-governmental organizations. There is need for government to play a leading role in mental health awareness and advocacy. This is important because misconceptions about mental health is what drives the high level of stigma and discrimination towards mental health conditions. This is what is in turn responsible for the large treatment gap for mental health problems as many affected people will not seek for the correct treatment due to the erroneous beliefs that mental health problems are spiritual problems resulting from bewitchment and spiritual attacks among others. It is therefore very important that government and other stakeholders need to increase investment in mental health and advocacy.
NW: Do we have sufficient access to mental healthcare for all Nigerians?
Dr Ojo: A quality mental healthcare must be patient-centered, evidence-based, accessible and affordable. We do have evidenced-based treatments and to an extent, I will say that our mental healthcare is affordable when compared to what is obtainable in other climes. However the major problem with our system is that majority of patients and relatives have to pay out of pocket because the coverage of mental health conditions under the health insurance is at best a not comprehensive and at its worst a mirage.
Access is about our biggest challenge in mental healthcare in Nigeria. Only about one in every ten persons that need treatment ever get to access it. The reason for this is the inadequacy of the resources needed. There is dire shortage of the need human resources for mental health care. For a country of over 200 million people there is only about 250 psychiatrists that makes it about one psychiatrists to almost one million people. There is also shortage of other mental health professionals like clinical psychologists, mental health nurses, social workers and occupational therapists among others.
Another big problem closely associated with this is the uneven distribution of the available scarce resources. Most of the human resources and mental health facilities are concentrated in few cities across the country whereas people that need the care most are in the rural areas. Many will have to travel hundreds of kilometers just to be able to access care.
NW: What is needed to enhance mental care delivery in the country?
Dr Ojo: Many things are needed to enhance mental health care service delivery in Nigeria. First, the right mental health policy need to be in place. Nigeria has had only two mental health policy since its existence. The last one was in 2013. Unfortunately, none of the policies was ever implemented. The policy is supposed to be reviewed every five years, so even the last one that was never implemented is long overdue for review. The policy must make integration of mental health into primary care one of its pillar. It must also put emphasis on multisectoral approach to tackling the issues of mental health involving all sectors including but not limited to housing, finance, poverty eradication and community development, education, and health.
Equally important is the role of legislation. Legislation is what gives legal backing to policy thereby making it enforceable. Many policies in Nigeria never get implemented because there is no law backing them. The mental health law operating in Nigeria is the Lunacy Act which is a very archaic law which has been in operation for over 60 years and doesn’t reflect the current global reality in the delivery of right-based quality mental health care. There has been previous unsuccessful efforts to address this. On a good note however, the current leadership of Association of Psychiatrists in Nigeria (APN) with other stakeholders in mental health has rally support to ensure the passage of the bill .It has passed its second reading. When both the policy and legislation are in place, many of the concerns in the delivery of quality mental health care would have been addressed.
NW: In the various cultures around Nigeria, mental health disorder is considered scary can you share with us what are the primary causes of mental health disorder?
Dr Ojo: There is no single cause of mental health disorders. The causes of mental health is multifactorial- an interplay of a lot of factors including biological, environmental, economic and psychosocial factors. Culture plays an important role in the explanation of mental health problems and the health seeking behaviour of the people. In Nigeria, as in other low and middle income countries, culture has not played positive role in mental health. Cultural beliefs have always attributed mental health problems to spiritual causes like attacks from household enemies, ancestral curses, bewitchment, demons and moral failures. This has led to stigma and discrimination towards people who are affected making it difficult for them to have access to care. Many people patronize faith and traditional healers with poor outcomes.
NW: Are there usually signs of a poor mental health and what are they?
Dr Ojo: Like any other medical condition, there are signs and symptoms that act as pointers to poor mental health. The signs differ based on the type of mental health problem. The common ones include: insomnia (poor sleep), decline in occupational functioning and maintaining interpersonal relationships, decline in personal hygiene, persistently low mood, loss of interest in usually pleasurable activities, feelings of hopelessness and helplessness. Others include having unusual experiences like hearing voices of unseen people and suspicion of other having malevolent intentions towards you.
NW: How can mental health disorder be addressed?
Dr Ojo: When people talk about mental health, what usually come to their mind is treatment. But the right approach to mental health is a holistic one which takes into consideration promotion, prevention and treatment of mental health conditions. Mental health problems are preventable conditions. If people are informed on how they can maintain optimal mental health, what they can do to maintain their mental wellbeing and what they can do to prevent mental health problems, it will go a long way in reducing the burden of mental health in our society. The approach that is used, we will be tackling the problem upstream rather than at the downstream when it would have already become a disease needing treatment.
NW: Are there activities that can improve one’s mental wellbeing?
Dr Ojo: There are a lot of activities than can contribute to our mental wellbeing. Some of these include: eating well, regular exercise, maintain a good sleeping habit, maintaining good interpersonal relationships with people, engaging in religious activities, keeping routine, paying attention to present moment(mindfulness), giving to others, volunteering and avoidance of use of recreational drugs.
NW: The world is just recovering from the dreaded COVID-19, what notable impact does it have on the mental wellbeing of people?
Dr Ojo: The COVID-19 pandemic has affected all areas of our life in every way and the mental health of people is one of those significantly affected. During the period of the pandemic, there was increase in the rate of mental disorders like insomnia, anxiety and depression. There was a lot of anticipatory fear of being infected which has negative impact on mental wellbeing of the general population. The high volume of fake news and reporting of mortality associated with the pandemic also impact negatively on the mental health of people. A lot of people that lost loved ones may have prolonged grief period. There was also a surge in post-traumatic stress disorder (PTSD) during and after the pandemic. The isolation and lockdown that were used in the control of the spread also affected the mental health of people causing loneliness and boredom. Associated with this is increased likelihood of eating disorder, psychoactive substance use and domestic violence. For people with existing mental disorders, the disruption in healthcare system and lockdown meant that many of them were not able to access usual care and disrupted logistics caused non-availability or increased cost of medications needed. So many patients had relapse episodes. The socio-economic implications of the pandemic also has negative impact on mental wellbeing. The healthcare workers are not immune against all this, in fact they are more susceptible as they are the ones on the frontline. The post-COVID-19 era is therefore a good opportunity for investment in mental health.
NW: Do we have enough mental health professionals in the country?
Dr Ojo: Mental health is very peculiar compared to other areas of healthcare delivery because of its emphasis on the biopsychosocial approach to treatment thus necessitating the use of multidisciplinary teams in management. This team include the psychiatrists, nurses, clinical psychologists, medical social workers, occupational therapists, community health extension workers among others. Sadly, we do not have enough mental health professionals in the country. For example, we have only 250 psychiatrists in Nigeria for a population of over 200 million where 1 in 4 people is estimated to have mental health problems in their lifetime. The scarcity of the human resources for mental health care is not just among the doctors but across all cadres of healthcare workers. Despite the inadequate human resources, the health workers working in this sector are leaving for greener pastures because of the poor condition of service here back at home, and the attractive packages overseas.
NW: What are the mental health services available in Nigeria? – How accessible are those services?
Dr Ojo: Most of the mental health services available in the country are mostly hospital based care. There are specialist psychiatry hospitals in each of the geopolitical zones, and department of mental health or psychiatry in each of the universities. Some state also run some mental health services either as stand-alone specialist hospital or integrated as part of routine service delivery in General Hospital. The very few facilities that are available are unevenly distributed and most, if not all of them, are located in cities thus making access extremely difficult for those who will need it but are far away from the facility.
NW: What do you think can be done to scale up mental healthcare in Nigeria?
Dr Ojo: The main thing that need to be done is for the government to develop the political will to make mental health a public health priority. Once this is done, scaling up will not be a problem. The political will translate greater investment in mental health. It will translate to development and implementation of mental health policy backed by appropriate mental health legislation.
In the delivery of mental health services, there is need for integration of mental health into primary health care as the current system of hospital based care can never adequately address the mental health treatment gap in the country. About 90% of people that needs treatment for mental health conditions in the country are not able to access care. Furthermore, in order to tackle the problem of inadequate human resources, there is the need for the adoption of task shifting as a strategy. Task shifting is the use of low to middle level health care workers to execute some tasks that ordinarily a specialist would have carried out.
NW: The issue of brain drain has seriously impacted on the medical profession in the country, what can be done to address this?
Dr Ojo: The government cannot totally stop the brain drain through migration. First because it is always a personal decision and there will always be push factors and pull factors. Government need to create better working condition for all healthcare workers and better payment package. Government should explore the possibility of a policy that will ensure the retention of healthcare workers within the healthcare system after graduation from schools. People can be given government grants while in school in exchange for retention in the system for a specific period of time. The government also need to value its healthcare workers.