Mental Health Services at the Primary Health Care Level in Three States in Northern Nigeria

Mental Health Services at the Primary Health Care Level in Three States in Northern Nigeria

Abstract:

Mental health disorders represent over 14% of global disease burden, and accountfor more than 30% of all years lived with disability (DALYs).Most of these disorders can be prevented or managed at the primary level of health care. Despite this, mental health services (MHS) at the Primary Health Care (PHC)level are grossly neglected in many communities. The level of MHS in States in northern Nigeria is not known. Thisstudy therefore examined the current state of MHS at the PHC level in three States in northern Nigeria, with particular reference to theavailability and acceptability of these services, as well as factors affecting these. This is with a view to suggesting a model for providing these services in the study areas. This exploratory, cross-sectional study adopted the Donabedian Model of Health System analysis (as a variant of Structural-functionalist approach) to explore MHSin Gombe, Kaduna and BenueStates. Two sets of questionnaires and in-depth interviews, focus group discussions, Medical Records, Observations of PHC centres and content analysis of PHC Training Curricula were used to collect data from 794 participants. These werePHC service providers, PHC service users, and community members in 45 PHC centres and their hosting communities,as well as health administrators in the State PHC Agencies,and mental health specialists (such as psychiatrists, psychiatric nurses, and traditional healers in the three States. The data collected were analysed descriptively,using Statistical Package for the Social Sciences(SPSS) Version 20.0, and thematically, for the qualitative data. These were then triangulated to meet the research objectives. Findings revealed thatvirtually all the PHC centres studiedlacked any government-organised MHS.Even mental health information services in form of posters or handbill are absent except in two PHC centres in one of the three States; withPHC service providers being ignorant of the existence of such posters. Two-way referral services of suspected mental disorders are also poor. Despite these scarce MHS in the study areas, there are identified cases of mental health challenges in the study areas, which could be classified as (1) Substance abuse and related disorders; (2) antenatal psychological problems among pregnant women; (3)Suicidal attempts, and (4) ―Imported madmen.‖ (This is a situation in which relatives of mentally sick people take the sick to places where neither the sick nor the relatives are known and abandoned at the motor parks at night; thereafter the mentally sick person becomes a vagrant in the community.) The communities strongly desire MHSbut many obstacles to the provision of MHS at the PHC level were identified. These include policy gaps and lack of political will, which reflected as inadequate and poorly trained PHC staff, lack of mental health specialists or general duty doctor and service area for MHS, lack of funds,and weak data base for mental health disorders. There are also prospective socio-cultural barriers such as negative attitudes towards and incorrect perceptions of mental illness and people living with mental illness (PLWMI) by both health workers and community members. It is concluded that MHS in study areas are very scarce, due largely to government poor policy arrangement and other foreseeable social barriers in form of negative attitudes and stereotypes. However,enormous mental health challenges and high demand for MHS by community members are evident in the communities. Stimulating the government at all levels, and their partners, to initiate or activate policies in favour of MHS to address the burden of mental health problems prevalent in the areas andreorienting and training PHC workers to enable them kick-start MHS in their centres are suggested. A model activating the needed interplay between the three levels of health care, and a functional collaboration between the formal sectors and communities, will provide a template for effective and efficient community-based MHS delivery in the present era of de-institutionalisation.

Mental Health Services at the Primary Health Care Level in Three States in Northern Nigeria

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