One would have thought all was well one Sunday evening with most people at that time either at home after visiting places of worship, feeding their minds, renewing their faith and just getting another dose of hope for life. Some were also on their way home or to various destinations, a medical doctor included and while most would have reunited with their loved ones, Dr Allwell Orji had other plans. He stopped his car on the Third Mainland Bridge in Lagos, alighted and then ended his life by jumping off the bridge into the lagoon below, leaving his driver and the generality of Nigerians shocked at what happened.
And it’s easy to see why; Nigerians do all they can to avoid death. Why then would someone take his own life? Simply put, suicide is not ‘our thing’.
A lot of questions were asked as to what could be wrong with the doctor to make him take the extreme measure of ending his own life. As expected, quite a number of reasons were put forward as factors responsible, one of the most popular bordering on spirituality and superstition.
And this line of thinking is easy to understand as it is the lens through which the Nigerian society – and by extension, Africans – views issues such as suicide and mental illness. Very few people even gave it serious thought until the late doctor’s colleague alluded to depression, highlighting the poor working conditions of doctors in the country, including extreme stress due to long working hours and very little sleep or rest. The attempted suicide of a woman a few days later in the same location, with her reasons being depression due to huge unpaid loans, fanned the embers of the already burning issue.
Prior to this, depression and other mental illnesses are by and large, rarely discussed among Nigerians. Regardless of how difficult living conditions might be, with the prevalence of poverty, unemployment, and stressful work conditions, particularly in cosmopolitan areas like Lagos, such a topic is considered taboo. Depression is seen as a white man’s disease so people suffering from depression are likely to keep quiet about it due to the stigma tied to mental disorders. Such people on broaching the topic are likelier to be seen as suffering from witchcraft due to deeply rooted cultural beliefs and associations between mental disorders and evil spirits than to be given the required care.
The facts however state the contrary, depression is the leading cause of disability throughout the world and is especially prevalent among poor African countries, where 75 percent of the people who suffer from mental illness do not have easy access to the mental health care they need. In a survey by psychiatrists at the University of Ibadan, the prevalence of schizophrenia, characterized by hallucinations and delusions, was put at 0.5 to 2.5 percent, roughly the same as the global figure – in numbers, that is at least a million people in Nigeria. Unfortunately, due to the aforementioned traditional beliefs about supernatural causes and remedies, most patients will end up either abandoned to roam the streets or chained in religious houses rather than with trained psychiatrists. And when these people see that rather than get the required help, they are stigmatised, they either keep quiet and get worse or commit suicide.
Particularly saddening is that these traditional beliefs are held all the way to the top government channels, creating a problem when it comes to creating or improving the framework for the provision of appropriate mental health care services for the needy. For some government officials, incarceration appears to be a more viable solution to ostensibly prevent the mentally ill from either being seen, injuring themselves and also protect the public. This was the case in 1999, when homeless people with mental disabilities were cleared off the streets in Port Harcourt in a ‘clean up’ carried out in anticipation of the FIFA World Youth Soccer Championship hosted by Nigeria. Hence, policy-makers are also (often) of the opinion that mental illness is largely incurable or at best, unresponsive to ‘western’ medicine. To them, you can only cure what you can see.
This is seen in how countries like Nigeria and other sub-Saharan countries in Africa allocate an average of 0.5 percent of their health expenditures to mental health, compared to more than 5 percent for more developed countries. This sorely affects mental health care providers as they lack the money to expand, buy needed medications, and to train sufficient caregivers. The ripple effect on this on the economy, while not anticipated or considered, is a cause for concern as expenses related to treating mental disorders and lost worker productivity are currently estimated to cost low- and middle-income nations $870 billion a year (and is projected to soar to $2.1 trillion by 2030).
However, all was not lost in Dr Orji’s suicide. If anything, his tragic demise got everyone talking more about depression and other mental illnesses, and while a good number of people are still wont to cling to previously held beliefs, it’s a more open discussion now. Many Nigerians, including health professionals now understand that until issues like this become openly discussed, many more people will be more inclined to taking their own lives rather than speaking out and getting help.
At this point, it is imperative that alongside increased attention and funding to mental health institutions, the education of the public should also be a priority. This can further aid the development of mental health policies in Nigeria as many aspects of mental health care require the active collaboration of people in the community. A good example of this can be seen in the circulation of suicide-prevention helplines in the aftermath of Dr Orji’s death.
Before now, the earlier question was: how do you cure what you cannot see? Today, the answer resides in the demystification of mental illness and in widespread awareness which can only be achieved through honest conversations on the issue. Families will be more open as a result and this is important because they are usually the first line of care for patients with mental disorders. If the discussion progresses, we can begin to move towards community understanding and rehabilitation of the mentally ill as communities are crucial to the elimination of the stigma and discrimination.