My first draft was all about statistics – number of psychiatric hospitals, ratio of psychiatrists and psychologists to population… the usual numbers quoted whenever we deride the state of mental health clinical care in Nigeria. We all may not know the figures but there is a unanimous agreement that mental health is deeply neglected in Nigeria.
There are 8 psychiatric hospitals and about 24 hospitals with a psychiatric unit – and of course numerous private clinics – for a population of almost 200 million with very few professionals trained in the field. Such imbalance in demand and supply have ridden holes in the pockets of those who are bold enough to seek care. I say ‘bold enough’ because of the overwhelming stigma attached to mental illness which is fuelled by ignorance. We’d rather tend towards demonic possession than accept that our brains are under the weather and needs medical attention but let’s leave that sermon for another day.
Today, I want to give us some insight on the cost of accessing mental health care in Nigeria. Unfortunately, there are no statistics to throw about because there is no data…which is not surprising for this much ignored aspect of health care. When it comes to ‘how much?’ each person’s story is as different as their circumstances although there are common chords. I will tell you one of such stories which is similar to others I have heard.
‘It was my fourth hospital visit that month and the doctor is yet to figure out the underlying cause of my numerous aches and fevers. I had done a series of test with nothing to show for it. As usual, she prescribed some multivitamins but this time had included ‘Psychotherapy’. She knew I had a friend who was in specialized training in Psychiatry and encouraged me to talk to her. I did talk to my friend and she calmed my frightened nerves telling me to rest more and pray even harder although she gave me some diazepam to facilitate the ‘rest’. The pills helped but not for long. I went back to her (informally of course) a couple of times and was prescribed a different drug on each occasion; each more expensive than the former. After a couple of months with not much improvement in addition to side effects of the drug (which I wasn’t educated about), she sent me to see a ‘specialist’ for proper diagnosis and quality attention. I have never understood why she didn’t refer me to the psychiatric hospital she works in which- looking back- would have saved me some money. But then also, society attaches a stigma to psychiatric hospitals; only ‘crazy’ people go to psycha and that stigma follows you even after recovery making. Consequently, clients would prefer to be attended to outside the facility by the same government hospital doctors and these doctors are cashing in on it. Almost every psychiatrist has a private practice where he/she charges about 5 times what is charged at the facilities and in some cases sell the drugs as well. It is broad day robbery but some people would rather empty their pockets than let anyone know they access mental health care.
Special attention doesn’t come cheap; for starters I paid N10,000 for a card at a little private clinic where the Psychiatrist saw ‘special’ clients after her hours at the government facility. She was quick to give a proper diagnosis and in no short time, I was on my way to recovery but each session saw me part with more than I had paid for that card. And the drugs? Anyone who has ever been on Psychotropics know that those of good quality don’t come cheap. A few have cheaper alternatives but you buy at your own peril. Doctors will always advice that one sticks to top quality brands where 100 mg is indeed 100 mg, Otherwise, you might end up being pennywise, pound foolish. Moreover, who wants to play with their brain? Most psychiatrist double as psychologists or they partner with Pyschologists in the private practice business. I quit therapy after a short while as each visit left a hole in my paltry account and I still had to buy drugs. Unfortunately, most HMOs do not cover psychiatric care; everything is out of pocket payment. Moreover, how many people will be willing to let their organisation know that they are receiving psychiatric care? Stigma again.
With some Doctors it may not cost as much but it is still on the high side and the medicines as expensive as ever. There are psychologists who offer psychotherapy at a reasonable cost but you really have to search for them. I remember a friend of mine – a corps member- who was spending more than half of her money on drugs every 2 months. She couldn’t afford psychotherapy after diagnosis as all the professionals she was referred to were asking for too much. She resorted to faith-based therapy. I know of two cases where the psychiatrist/psychologists had asked for payment in ‘kind’ as the ladies could not afford his fees; I was weak.
Unfortunately, these services, albeit being expensive, are mostly available in the big cities, the moment you move to some out-of-town or rural area, that is usually the end of therapy unless you can afford to commute which incurs additional cost. In a few rural locations, one can find mental health programmes run by some charity/faith-based organisations but service users still have to pay for drugs and usually are not able to access regular and standard psychotherapy which is as important. Consequently, this gap further encourages unorthodox practices by traditional healers, witch doctors and churches who equate mental health therapy to exorcism and abuse fundamental human rights.
In other to avoid the danger of a single story, it is safe to say that some people have had it easier and have even been able to access wholesome psychiatric care at a reasonable price or even at government hospitals. The later definitely requires some bravery in Nigeria if you were not dragged there in the first case.
If you have had it this easier way, do write to us and tell us your story.