Train  non-psychiatrists to boost mental health care in Nigeria – Aliche

…Cautions against dehumanisation of people with mental illness

From Boniface Okoro, Umuahia

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Dr. Azubike Aliche

A mental health expert, Dr Azubike Aliche, has advocated massive training of non-psychiatrists, including social workers and community health workers,  to boost mental health care delivery system in Nigeria.

Dr. Aliche, a licensed Clinical Social Worker in the United States of America (USA) where he is a mental health practitioner, told a news conference in Umuahia, Abia State capital, that Nigeria, apart from the lacking infrastructure for mental health care, has only about 250 psychiatrists which was grossly inadequate for proper mental health care delivery. 

He also called for an end to stigmatisation and dehumanisation of people with mental illness.

According to him, social workers are licensed to practice mental health care in the United States, adding that they are trained to identify mental cases and then refer such cases to psychiatrists who now prescribe drugs.

Dr. Aliche, who is the President of Nigeria Mental Health Practitioners – USA Incorporated  was speaking at a pre-launch news conference of the Nigeria-American Institute for Mental Health in Nigeria in Enugu on April 13, 2024.

The twin event of the launch scheduled for Godfrey Okoye University, Enugu, is a mental health conference with the theme: “Towards Primary Mental Health Care in Nigeria.”

Dr Aliche explained that Nigerian Mental Health Practioners – USA Incorporated (NMHP-USA Inc.) want to use the Nigeria-American Institute for Mental Health, which is a Non-Governmental Organisation (NGO), as the vehicle to intervene in the mental health sector of Nigeria which, he said, was not receiving adequate attention.

He said the institute would focus more on creating awareness and training.

“On April 13, we are going to launch this new organisation and our interest in 

establishing the institute and the trying to intervene reflects  our observation that mental health care in Nigeria is not getting adequate attention and has never even really  been given adequate attention, at least, not at par with the medical or physical health care. 

“So what we are trying to do is to share our experience as practitioners out there in the US, we want to see what is going on here and how we can help,” he said.

According to the Sociologist, much of the primary health care system in Nigeria was more of physical or medical, and not mental health which was the reason why more needed to be done as the infrastructure for mental health care was equally lacking.

He said the institute would try to “see if there can be some kind of integration  between the physical health and mental health” using existing structures.

He attributed the inadequate attention being given to mental health care to poor funding and politicians not making it a campaign issue.

“Government, over the years, has spent little money on mental health care. In fact, my understanding was that, I think in 2022, health care itself, was like just  three percent of the budget. 

“So you can imagine what percentage mental health care is; perhaps, because it’s not a vote-getter. When politicians campaign for elections, they hardly make mental health an issue,” he noted.

“So, in many ways, there are areas to intervene, there are areas that things need to be done differently.

“The institute is going to intervene more at the level of creating awareness and training, that is the area that we think we can begin to make impact. Training in the sense that most estimates I have seen, show that there are less than 250 psychiatrists in Nigeria. That is basically not enough and a mental health care system doesn’t have to be built around psychiatrists. “As a matter of fact, they are leaders in the mental health care system, there’s no doubt about that. But there should be many others who are able to identify, treat or manage basic mental health issues.

“I am a licensed Clinical Social Worker, so, I am not a psychiatrist. When you come to the US, the licensed Clinical  Social Workers provide more mental health care than psychiatrists, and even more than pschologists. The have the greatest number of people who can diagnose and treat mental health issues.

“So, we need those kinds of people in Nigeria. I am not again saying that there has to be a transfer of the US model to Nigeria, but it is good to have a model that you are looking at and say what can we do in Nigeria that is. sustainable here,” he submitted.

The mental health practitioner also lamented that there were factors militating against access to mental health care in Nigeria, including culture and the people’s belief system.

“What I have seen in the research is that just about 10 percent of people in Nigeria who have mental health issues get access to mental health care.

“The World Health Organisation (WHO) says that up to 20 percent of the population, some 40 million people, suffer some kinds of mental health issues and just about 10 percent of that number get treatment. So, there is issue with access.

“Given that background, we thought we could help because our association is made up mental health providers: some are psychologists, some are psychiatrists, some are licensed Clinical Social Workers; we also have  nurses who are our members.

“In fact, what we are thinking about doing would require using people who are trained as Community Health Workers. So, we want to be able to involve them,” he said.

“Part of the problem with access to mental health care is  from our own belief system, our own culture, the way. we understand mental health care, the origins. Many times, we think of it as originating from evil spirits or man-made illnesses. Those are places to start with education,” he added.

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Dr Aliche cautioned against discriminating against or dehumanising people with mental illness.

“People with mental illness here are  locked up, they are  not getting enough respect as they desire.

“When somebody has a mental issue, it shouldn’t be a basis for discrimination or denying them their freedom. Nobody should be left on the streets because he has mental problem. They should not be abused or dehumanised,” he counselled.

He called for an end to stigmatising people with mental illness because of our belief system. “That should change,” he advised.

He commended Umuada Igbo in Nigeria and in Diaspora, for partnering with his organisation in floating the institute, adding that group was open to welcoming more partners.

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