‘Psychiatric illness is not something to be ashamed of’
Dr. Joseph Okegbe is the Medical Director of Neuro-Psychiatric Hospital, Calabar. In this interview, he speaks on people’s misunderstanding of psychiatric problems, funding psychiatric care, and assisting psychiatric patients among others. What is the general perception about psychiatric problems amongst Nigerians? The public perception of psychiatric health problems is not too encouraging because of the […]
Dr. Joseph Okegbe is the Medical Director of Neuro-Psychiatric Hospital, Calabar. In this interview, he speaks on people’s misunderstanding of psychiatric problems, funding psychiatric care, and assisting psychiatric patients among others.
What is the general perception about psychiatric problems amongst Nigerians?
The public perception of psychiatric health problems is not too encouraging because of the stigma that is associated with it. But gradually, from empirical studies as well as observation, a lot of people are now becoming aware that if you have a breakdown, let’s say psychosis for example, that it is no more a spiritual attack, that you can actually get help in the psychiatric hospital.
Psychiatric issues are many but they are mainly divided into psychosis and neurosis. The people who are suffering so much and are in the general population are those who have neurosis because they just believe maybe it’s a minor problem and they don’t seek medical help until, if by fate, they come across a psychiatrist or any doctor who has psychiatric knowledge.
The psychosis is a little bit strange, so you cannot blame Nigerians a lot when they say it’s a spiritual attack because no one can comprehend why a normal person will be sitting down, fully awake and be hearing voices, very clear voices, not whispering.
It is either the voice will be running commentaries on your activities, or it will be giving you command to do this or that or it will be gossiping you, that is, it will speak about you in the third person. Or somebody has very strange pains as if somebody is whipping you.
Is Nigeria getting it right in respect to psychiatric care?
Unfortunately, government at all levels is not doing enough. Prior to 1995, there were only three Neuro-psychiatric hospitals in the country owned by the Federal government. But by 1995, they took over five more, so we are just eight.
A place like Lagos for instance, that is heavily populated ought to have four or five neuro-psychiatric hospitals. But the good thing is that most of the Federal Medical Centers as well as the University Teaching Hospitals now have psychiatry as a department. It was during Prof. Onyebuchi Chukwu’s era as Minister of Health that psychiatry was really given a boost.
But in terms of the way forward, I don’t think we have because the facilities are not really there to enable some biological research. The trend these days is to look at the biological basis of those medical conditions and we don’t have the facilities like CT scan.
What is the extent of coverage of the psychiatric hospital, Calabar?
The scope of coverage of the hospital is very large. We cover Akwa Ibom and as far as to Rivers State, Benue State, Cameroun, and Equatorial Guinea, and we have a lot of patients coming in from Gabon. Apart from the patients, the School of Psychiatric Nursing is a post basic school so we just entered into collaboration with the government of Cameroun to be sending students for us to train. Last year, we were able to train three; then we decided to hold on because we are renovating the hostel.
Now, I have gone into a Memorandum of Understanding with Christian Methodist Network (CMN) Australia, an NGO primarily concerned with the provision of health services, especially in the Third World countries.
It is popular for mental health as well as ophthalmology to take care of the rehabilitation of those with mental health so that such people will not be abandoned. We started work very massively and there has been good funding.
Their mandate is to take psychiatry to the community level. We have identified three General Hospitals as base; that of Calabar, the one in Creek Town (Odukpani) as well as the one in Ugep. From that base, we now go to the Primary Health Care centers. We train community health workers and send them into the hinterland. So, they are there at the community level to handle minor issues but when it becomes serious, we take referral. The Federal Neuro-Psychiatric Hospital is first and foremost, a tertiary health institution.
What were the major problems you met when you assumed office?
They are lack of funding and uncompleted projects. But the biggest problem I had was the permanent site, Donald Duke’s administration gave us, about 22 hectares of land, which was revoked and my predecessor took the state government to court.
When I came on board, I saw that as a problem and myself and the immediate past chairman of our board of management, the late Brig. Gen. Bassey Asuquo in conjunction with Senator Bassey Otu and the Obong of Calabar, put pressure on the Cross River State government to return the land, which they did.
So at the moment, for me to secure the land, I am doing perimeter fencing. The other problem was that, there were so many junior staff, remember, we equally have the school of psychiatric nursing, so there were so many junior staff who were given permission to upgrade their certificates and they still remained junior workers.
Another problem was upgrading the facilities in the hospital so that we can continuously have accreditation from the West African College of Physicians and the National Post graduate Medical College of Nigeria to continue training specialists in the field of Psychiatry.
What strategies can individuals and families employ to achieve good psychiatric care?
Well, what they can do is to ask questions because I want to believe that all of us will know somebody who has a psychiatric condition, one way or the other. So, if they are able to identify any case, all they can do is to refer them and if they come, they will be given adequate attention.
Unfortunately, even the parents seem to be a little bit ashamed and they will say why should I go to the hospital and subject myself to ridicule. They should not think about that but rather have it at the back of their minds that psychiatric illness is just like any other illness.
What do you think accounts for the high rate of suicide and what can be done to stem the tide?
Suicide is a very big problem in psychiatry. In fact, suicide is one of the psychiatric emergencies. Our patients who are clinically depressed, especially those with mild or moderate severe depression, have negative thoughts. Most of the time, they feel worthless, they hear voices that tell them they are worthless, and so on and then the suicidal motive becomes very intense.
Suicidal ideation is a core symptom of psychiatric condition. Now, when you are interviewing a patient, it is incumbent on the doctor to always ask about suicide. Has the patient attempted suicide? Has he thought of killing himself? When you are able to establish that the ideas are very strong, you do what we call, suicide watch. You keep the patient in an open ward and any nurse on duty will have to monitor him.
In the process of treatment, all those suicidal thoughts would be wiped out. Now, apart from suicide, there is something else that we call Deliberate Self Harm (DSH), what people were used to as “attempted suicide.” The DSH is common with the youths and it is seeking attention.
What should government do to address numerous problems plaguing the health sector, especially ending persistent strikes and disharmony between doctors and other health workers?
What the federal government can do, in a nutshell, is to fund the hospitals. With proper funding, specialists would be recalled. Even the few psychiatrists will be able to complement the various departments of the teaching hospitals.
There is an aspect of specialization that we call Consultation Liaison Psychology. Some of the patients can even come in with paralysis. When the physician treats the patient and he’s not improving, you know there is psychological component to the case, so they will have to invite psychiatrists from teaching hospitals or federal medical center to come and attend to him.
If government funds the FMCs, teaching hospitals as well as the existing neuro-psychiatric hospitals, the health care delivery system in this country will be massively improved. What I can suggest to this government is that, the way they have managed to establish the Tertiary Education Trust Fund (TETFUND), where a certain percentage of tax is set aside to fund tertiary educational institutions, they should do the same to the health sector.