Nigerians ought to embrace humour to deal with hardship – Prof of psychiatry

A professor of psychiatry at the University of Jos, Plateau State, and President of the Association of Psychiatrists in Nigeria, Taiwo Obindo, speaks to VICTORIA EDEME on the effects of economic hardship and insecurity on people’s mental health

What are your thoughts on the current economic hardship being faced by Nigerians today?

It is a known fact that things have largely fallen apart concerning the economy. The indices are there. Inflation is hitting almost 29 per cent and the cost of living is skyrocketing. The standard of living is plummeting and people are losing their jobs. The costs of transportation and taxation have been high. For insecurity, there is banditry, kidnapping, and armed robbery. When we look at all these indices, it is obvious that Nigerians are going through a harrowing experience that they were unprepared for. The economic hardship is a result of the removal of fuel subsidy and the deregulation of the naira. These challenges go beyond the regular stresses that people are meant to go through and would surely impact people’s mental health. It’s a stressful experience for virtually every Nigerian irrespective of their status.

What are the effects of economic hardship on mental health?

The World Health Organisation defines mental health as a state of the well-being of every individual, in which case the individual can realise or attain their potential, face normal stresses of life, work productively, and contribute to society. Looking at the hardship in the country, with the increased cost of school fees, how many Nigerians can achieve their goals of attaining their full potential? What Nigerians face are not what can be described as common stresses or general stresses that everyone is used to. Banditry, kidnapping, farmer-herder clashes, and armed robbery are more rampant these days. So Nigerians are going through more-than-usual stresses of life. It’s not only those who face insecurity that are affected by these stresses.

A lot of people are not able to travel due to high transport fares and some are even afraid to travel on the road. There is an increasing number of people whose mental health is being impacted by all these challenges. When one’s monthly pay is insufficient to sustain the family, one can become over-worried and over-disturbed. A lot of people are in distress. Distressed people do not have mental health conditions but they are under some pressure and can show symptoms of insomnia, restlessness, lack of concentration, difficulty in feeding, and weight loss, which are symptoms of mental health conditions.

So there are likely to be more new cases of mental health conditions. Some are already ill and are planning to receive care only to find out that their money may not afford their hospital care. They may develop mental health issues as they are not able to access care. People are sitting on a ticking time bomb. Some youths are going into substance abuse and this also impacts on the mental health of the young Nigerian population.

What mental health disorders could be caused by economic hardship and insecurity?

Any mental health condition can arise based on the challenges we’re facing. People may have a genetic predisposition to developing mental health conditions, so the environment must be conducive. The commonest among them are anxiety disorders, which include post-traumatic stress disorders. A lot of people may find it difficult to go out. By 3 pm or 4 pm, everyone is rushing home because, in Abuja, people are reported to be at high risk of kidnapping or entering one-chance buses once it’s late in the evening. So people are afraid and living under tension. In 2022, I had people coming into my house and taking me away. But I thank God that the Operation Safe Haven troops of the Nigerian Army were able to rescue me. My wife and daughter were there when it happened and it took us all a long while to settle down. When we hear noises or dogs barking, we are afraid that they may attack again.

People who have been kidnapped live under such tension as they re-enact the situation and become tense. They may also have recurring thoughts. Depression is also one of the mental health conditions associated with hardship as people become unhappy, lose interest, are easily fatigued, unable to concentrate, have difficulty sleeping or eating, and see or hear things that others can’t see or hear. Also, there may be increased incidences of people taking their lives, cases of suicide, or attempted suicide. That is also a major challenge.

A lot of people have difficulty coping with what they are going through and may embrace psychoactive substances. They embrace alcohol and marijuana just to feel some sense of relief. No matter how much you drink, it will not change your situation, so people should not go that route at all. Increased incidence of substance use disorder may also occur because people are finding a way to cope with what they are going through and it could affect them. Schizophrenia and other disorders can happen. Adjustment disorder could happen when people lose their jobs and they have difficulty adjusting to their new realities, especially for those who just lost their jobs.

What coping mechanisms can Nigerians adopt during this economic hardship and insecurity?

The major one is to resort to hope. People should be hopeful that this tide will change and things will turn around. People may need to exercise to get rid of some kind of energy that may be caused by thinking. You should avoid the use of substances. You need someone to discuss with and express yourself to. This helps to relieve you. They may not offer you a solution but because they have a listening ear to what you are going through, it can also be helpful. We should also see the funny side of things. We can use humour to handle some things. Don’t take things to heart; laugh it off.

There are some chemicals in the body that are released when you laugh. Nigerians should embrace humour because it’s one of the good ways to handle stressful situations. Laugh things off and look at the positive side of things so you do not allow situations to overwhelm you. That helps a lot. Your faith must also be strong in whatever you believe in, that God can change situations. Your spiritual inclination can help in coping. Never resort to the use of substances no matter what the situation is. It has never helped and it will not help.

At what point should one visit a psychiatrist during a mental breakdown?

You have to visit a psychiatrist once you notice that things are getting out of hand. Let’s take the mood, for example, you may find out that each time you wake up, you’re not happy. You find yourself even crying because of the challenges but instead of finding solutions, you are always weak. You can walk into the doctor’s office and say you are ill because you’ve not been happy and have been crying. It doesn’t mean that the diagnosis must be a mental health condition; because that’s the fear of most people. When you come in for medical help, you may just need psychotherapy, counselling, or motivational help. Medications can be administered. If you notice that you’re becoming too anxious and your pulse rate is continually increasing, your blood pressure is going high despite using your medication, or there is no adequate control of sugar if you are diabetic, then you definitely must see the doctor.

Behind virtually all illnesses, there must be an emotional part to it, and when the emotional part is not attended to, there can be challenges. Somebody who hears the voices of people he cannot see or even people he can see but neighbours around cannot see, such a person will need to seek the services of a psychiatrist. If you’re not able to sleep for one or two days, do not resort to buying drugs that could cause cancer because of lack of sleep. When people use sleeping tablets, they become dependent on such drugs. So in addition to whatever diagnosis they have, they have a dependence on sleeping tablets as a second diagnosis, which will make the matter worse. So at this point, they should seek the right help.

How can people prevent the adverse effects of economic hardship on their mental health?

The adverse effects of mental health can be prevented by the individuals, those around them, and the government. We need to realise that there is nothing new in the world. Nigerians should believe that these hardships will surely end one day. We should have hope that sooner or later, there will be a solution, answer, or reversal of the situation. When one loses hope, the chances of mental health conditions are higher. If there are symptoms that you notice that are disturbing, you need to seek help as individuals. When you start hearing voices, experience a lack of sleep for a while, or eat but lose weight, you need to seek help from professionals.

You can discuss with the right set of people. They are psychiatrists, psychologists, and religious leaders who can help. You can discuss it with them. I’ll advise religious leaders that if the issue goes beyond what can be prayed for, they should refer them to professional help. As for other individuals, if you notice that your neighbour is under stress, is not eating, or having challenges, please try to extend a hand of help to them. We are all in this together. If somebody comes to you and shares their challenges with you, you should help such a person by referring them to the right place where they can get help.

What can the government do to mitigate the effects of hardship and insecurity on the mental health of citizens?

At the level of the government, we look at the hospital facilities and budgetary allocations. We have a Mental Health Law that has been passed, so policies must be put in place to mitigate the challenges that people are facing. People are leaving the country because of poor remuneration, insecurity, inability to fund themselves and their children, high transportation costs, etc. As the petrol subsidy was removed, cheaper transport means should be provided. Something should also be done for citizens to get better access to foodstuffs. The Mental Health Law was signed in January 2023 and till now, we’ve not heard anything concerning the implementation.

A department of mental health should be set up and there must be guidelines for setting up facilities. If there is a department that will accredit the establishment of mental facilities, such should be organised. Mental health needs more attention now than ever before. Mental health should be fully integrated into the primary healthcare system. Sixty to 65 per cent of Nigerians live in rural areas and for them to access mental health care, they may need to travel about 6,000 kilometres. There must also be a policy on medication and that’s where the National Health Insurance Scheme comes up. People do not have to pay out of their pockets. If people have to pay 10 per cent of the cost of care, then they should be able to afford treatment.

Therefore, more people need to be captured in the scheme. The cost of drugs must also be looked into. Most drugs are imported and their costs have tripled in the last six months. There must be a policy to subsidise the cost of drugs and assist the companies that distribute drugs to have a waiver or rebate to help push down the cost of drugs. Some can’t afford the drugs and the chances of relapses are high.

There’s currently a heat wave across the nation. What are the effects of heat waves on mental health?

Heat is a stressor and puts every individual under some form of stress. Being a stressor, it impacts the health of individuals. Stressors stimulate the release of some chemicals in your system, which can lead to mental health conditions. Heat waves can cause dehydration and when people get dehydrated, they also have some degree of stress in their system. Stress is the way the body wants to respond to the situation and at times, the body gets overwhelmed during its response. So heat waves can cause stress, and dehydration, which can make people fall ill.

Do you think Nigerians often misunderstand the issue of mental health?

What people call mental illness is a microcosm – a small portion of what mental health conditions are. There are so many mental health conditions and they vary. Most health conditions have an emotional and psychological part. For holistic management of such a condition, we have to look at mental health management. There are myths about mental health and all those myths shape the way people look at mental health conditions. People have a wrong notion about mental health that it is inflicted by drugs, a consequence of wrongdoing, or as a result of the use of substances. Another myth is that mental health conditions are a result of poison. These myths are not true. There is interplay between genetic disposition and the environment in which the individual lives. For example, let’s look at women who just put to bed. Some such women tend to have mental health conditions. They could have personal blues, postpartum depression, and postpartum psychotic disorders. Therefore, the understanding of such issues needs to be improved.

How can more awareness be created concerning mental health?

There must be increased awareness of what mental health conditions are, what services are available, and where they can be obtained. If treated, people with mental health conditions can do better. Some people have mental health conditions and have won Nobel prizes, and ruled nations. Even in the Bible, there were people with mental health conditions who did very well. So we need to change our notion about mental health conditions.