Neuropsychiatric Hospital in Kogi State: Is there a need?

Ohunene, a lawyer in Okene, recently gave birth to her first child, a baby girl. She and her husband, a successful engineer, have been happily married for three years. Since the birth, however, she has often felt sad and exhausted, with little energy or motivation to get out of bed or manage household tasks despite being on maternity leave. Even bathing or caring for her baby sometimes feels overwhelming. She frequently cries, sometimes without an apparent reason. Her husband is supportive, but neither understands what she is experiencing nor knows how to handle the situation. During a visit from Abuja, her sister-in-law, Aunty Oiza, a senior nurse, was alarmed by her condition and urged her to see a psychiatrist for possible postpartum depression. The nearest options for psychiatric care were FMC Lokoja and FMC Owo, with Abuja or Ilorin as alternatives.

During his first year at Kogi State University, Omeiza became increasingly suspicious of others and heard voices saying that fellow students were watching him and planning to harm him. Afraid to leave his room, he began locking himself inside. His roommates heard him talking to himself and telling unseen people to leave him alone. They grew concerned when he stopped sleeping and caring for himself. His parents took him to National Hospital, Abuja, where he was diagnosed with acute psychosis and began treatment. Within weeks, he recovered: the voices stopped, and he was no longer suspicious of others. He soon resumed his studies, eventually graduated with first-class honors, and secured a job with NLNG.

Adamu was a hardworking mechanic who was very good with his craft, and his yard was always full of customers who trusted him to fix their cars. He was always jovial and friendly with everyone until his wife and son died in a motor accident on their way from Ankpa, where they had gone to attend a neighbour’s wedding. He was devastated, in shock, and felt totally lost. He also blamed himself and felt guilty for not going with them, as he would have driven more carefully. He gradually became severely depressed and a shadow of himself. Everyone understood and felt sorry for him, but when he started talking about having suicidal thoughts, his family decided that he urgently needed psychiatric treatment as he was getting worse as the months rolled by.

Facts about mental health

The World Health Organisation (WHO) defines health as a state of complete physical, mental, and social wellbeing and not just the absence of disease. This definition emphasises that health is not just physical health but also includes mental and social wellbeing as integral components. Unfortunately, mental health is often neglected in Nigeria, or ignorantly assumed to be due to spiritual factors. There is also a lot of shame and stigma associated with mental illness.

Mental disorders are common worldwide. WHO estimates that one in four people will experience a mental disorder during their lifetime. As the examples above illustrate, these conditions can arise unexpectedly and affect anyone at any time. They can also develop during pregnancy or after childbirth, including postpartum depression, as illustrated by Ohunene’s experience, or postpartum psychosis. Stressful life events can contribute to depression or suicidal thoughts, as Adamu’s story shows.

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Mental disorders can occur at any time throughout the lifespan: from childhood with conditions such as autism or ADHD; in adolescence through young adulthood, such as depression, psychosis, bipolar disorder, drug addiction, etc.; and into old age with conditions such as dementia with progressive forgetfulness and poor functioning as the brain becomes weaker with old age. Furthermore, many medical conditions can have associated mental consequences. For instance, someone with a diagnosis of cancer or stroke can become depressed about their situation. A couple struggling with infertility may become anxious or depressed. Young and responsible students may be lured by peer pressure into experimenting with drug use and become addicted. In all of these instances, it is imperative that professional care is readily available.

The case for a neuropsychiatric hospital

There is the argument for the integration of mental health into existing general medical services instead of establishing more standalone psychiatric facilities. However, the reality is that we still have grossly insufficient numbers of psychiatric beds for our population. Furthermore, a psychiatric facility will necessarily ensure the employment of mental health professionals (psychiatrists, clinical psychologists, psychiatric nurses, social workers, occupational therapists, etc.), which ensures quality expert care. Such hospitals can then serve as focal points for ensuring community integration of mental health care practices into primary and secondary care while serving as a referral hub for adjoining communities.

Conclusion

The move to establish a psychiatric hospital should not be viewed from the lens of shame and stigma toward the community but rather viewed as improved access to essential and critical mental health care services that is long overdue and urgently needed.