A Consultant Psychiatrist, Dr Shehu Sale, has commended Federal Government effort at integrating mental health into Primary Health Care (PHC) system to improve mental health coverage and services in the country.

Sale told the News Agency of Nigeria (NAN) on Tuesday in Sokoto that the Federal Ministry of Health has adopted Mental Health as the ninth component of PHC in 1989, which will improve services at the grassroots.

Sale, an Associate Professor and Master Trainer with the United Nations Office of Drugs and Crime (UNODC) and Medical Director, Federal Neuro-Psychiatric Hospital (FNPH) Kware, Sokoto State, described the effort as a landmark achievement.

He said the National Mental Health Policy of Nigeria, which was promulgated in 1991, took cognisance of this reality and advocated for the integration of Mental Health into PHC as the viable policy option to ensure improved coverage to the Nigerian populace.

According him, integration approach was also recommended by the World Health Organisation (WHO) through the principle of tasks shifting; which entails the transfer of essential skills to non-specialists in order to improve access to much needed services.

“WHO launched the Mental Health Gap (mhGAP) programme and its accompanying manual as a generic template for the scaling up of services for Mental, Neurological and Substance use (MNS) conditions globally.

“In Nigeria, the WHO has supported government as well as the European Union to adapt the mhGAP manual for the Nigerian context and this has already been successfully piloted in some states,” Sale said.

He further commended the efforts of National Primary Health Care Development Agency (NPHCDA), a government parastatal tasked with the implementation of National Health Policies, especially at the PHC level.

Sale said the agency has good track record of excellent collaboration and successful implementation of landmark projects like the Global Fund Health System Strengthening Programme and the Midwives Service Scheme, among others.

“NPHCDA has also partnered with experienced psychiatrists who possessed credible track record of involvement in the adaptation and contextualisation of the WHO mhGAP manual for Nigeria.

“This partnership with psychiatrists served as good avenue for NPHCDA to obtain good services, thereby providing technical expertise for the successful development and implementation of this programme.

“The proposal aimed at developing a national training schedule that will ensure the successful integration of mental health into PHC, both in the short term and in the long term,” Sale said.

According to him, the effort will actualise in the short term via regional training of the Teachers of PHC workers, who will subsequently train selected PHC workers from all the local government areas in each state.

He said such training partnership would ensure quick uptake of skills transfer, which would translate into improved coverage for mental health services.

He suggested for adequate monitoring and quality assurance platform to be provided at all levels during the training by the Mental Health Specialist aided by National Master Trainers/Supervisors.

“In the long term, the mhGAP manual will be incorporated into the curriculum for training PHC workers, to ensure that subsequent generations of PHC staff are routinely competent to recognise and offer interventions for the priority mental health conditions across the country,” Sale added.

He explained that this would address steady rise of mental health care disorders, demands and facilitate necessary strategic intervention measures to cater for growing population in need of mental health services.

Sale stressed that growing need, if not controlled properly, would contribute to the global burden of illnesses which also reduce the overall quality of life of the people.

He described PHCs as providers of essential healthcare which is universally accessible to individuals and families in the community as near as possible to where people live and work.

“It also refers to care which is based on the needs of the population. Ideally, PHC services are decentralised, with active participation of the communities and family members.

“Based on the needs of the population, PHC forms an integral part Nigeria’s health system, and should be the main focus, in order to boost the overall social and economic development of communities,” he said.

He said mental health burden is likely to be under estimated because of inadequate appreciation of the connectedness between mental illness and other health conditions.

He explained that mental illness increases the risk of both communicable and non-communicable diseases and vice versa as it also increases the likelihood of living in poverty, perhaps because of their influence on functionality and ability to get or sustain employment, conversely, poverty, substance abuse and depression increases the likelihood of developing mental disorders.

The psychiatrist said stigma and discrimination against people living with mental disorders affects their education, employment and access to care, and hampers their capacity to contribute to society.

“Mentally ill patients, especially if chronic, have poor health related quality of life and poor global adjustment of functioning.

“Unfortunately, the majority of developmental and poverty alleviation programmes do not reach persons with mental or psychosocial disabilities,’’ said the expert.

He attributed the prevalence of mental health cases to absence of synergy between institutional organs in the formal sector and traditional or religious healers.

He said everyone was vulnerable to mental illness as research indicated that one out of every four persons would have one form of mental disorder in their lifetime.

Sale said most psychiatric cases are often taken to non-formal places as the first point of call before later reported to qualified facility, adding the integrating mental health into PHC system will offer great succour in addressing such problems.

He appealed for allocating significant funding resources to mental health as obtained in control of malaria, tuberculosis and HIV/AIDS, and the promotion of maternal and child health.

NAN reports that the Permanent Secretary, Federal Ministry of Health, Alhaji Abdulaziz Abdullahi, at a mental health action committee and stakeholders’ workshop in Abuja, disclosed that about 40 million Nigerians are estimated to have mental disorders.

Abdullahi attributed the country’s high burden of mental disorders to inadequate attention paid to mental illnesses, misconceptions and lack of awareness on the part of the Nigerian public which promoted stakeholders action plans.

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