The Publisher caught up with renowned Consultant Psychiatrist, Dr. Femi Olugbile and a conversation ensued between them.
Below are the excerpts:
Publisher: Can we get to meet you sir?
Dr Olugbile: My name is Femi Olugbile. I am a Psychiatrist and a retired Permanent Secretary. I currently write Literature and run a firm of Psychological Health Consultants.
Publisher: What informed your choice of psychiatry?
Dr Olugbile: I have always been fascinated by the human mind. My two great inspirations as a growing adult were Sigmund Freud and Professor Adeoye Lambo.
Publisher: Do you think that psychiatrists have as much respect as other medical doctor specialists in Nigeria?
Dr Olugbile: I don’t know about respect; I think that depends on the individual. Perhaps Psychiatrists are not as visible and as vocal in the public space, in terms of affecting people’s lives and the policies of government, as they ought to be, and as they are in some other countries and cultures. However, that is changing rapidly, and Mental Health is receiving more focus and awareness here. The professionals are getting more recognition than they did in the past.
Publisher: Why is there still a myth around mental illness in Nigeria in the 21st century? Why is it still seen as a spiritual attack?
Dr Olugbile: It is because, more than any other category of illness, Psychological Illness is subject to cultural perception and interpretation, both on the part of the person experiencing the illness and the people around who are observing his symptoms. The understanding of Mental Illness depends substantially on the World View of a society. I once wrote a paper titled ‘Yoruba World View and the Nature of Psychotic Illness’ which generated a lot of discussion because it spoke to an ever-present reality in all cultures. That cultural colouring is more florid in some cultures than others. For example, you will hardly find a Yoruba Nollywood film that does not carry a depiction of mental illness of the psychotic variety. The causation and management are almost invariably tied up with ‘spiritual’ explanations that are generally at variance with the modern-day understanding of that group of illnesses.
Publisher: Do psychiatrists also suffer stigmatization from the members of the public?
Dr Olugbile: There are jokes about psychiatrists tending to behave like their patients, but that is mostly harmless dark humour and does not qualify as stigma. It is true that it has been challenging to attract young doctors to commit themselves to a career in the specialty. Some of that has to do with income, since specialties such as Obstetrics and Gynaecology are perceived as being more lucrative that Mental Health Care. That perception too is gradually undergoing change as people get more aware of Mental Health issues and the need to patronize the services.
Publisher: How can the stigmatization against the Nigerian mentally challenged end?
Dr Olugbile: Stigma is a problem all over the world, and Nigeria is not necessarily worse than any other nation. It is important for professionals and interested others to continually carry out advocacy to enlighten the public and change their attitudes. Laws and regulations are also necessary to eliminate discriminatory employment practices and the widespread habit of using a person’s mental health history against them socially, politically and in other spheres. It is an area of engagement that is likely to continue for many years to come.
Publisher: Most patients in Nigeria are placed on medication for the rest of their lives; why don’t some get weaned off the medications as is common in the West?
Dr Olugbile: That assumption is not correct. Anyone who is on medication for a mental health problem should be subject to periodic expert review to determine the continued necessity for such medication. And not all psychological illnesses require medication for protracted periods. Some, in fact, do not necessarily require medication at all, as there are other equally effective interventions, depending on the nature of the illness.
Publisher: HIV Drugs have been free in Nigeria since 2006; why can’t anti psychotics be free as well?
Dr Olugbile: This is a sentimental argument. HIV Drugs are ‘free’ because they are sponsored, meaning somebody else or some agency, whether government or NGO, is paying for them. There is a need to have good healthcare finance in Nigeria, and a need for Mental Healthcare to have a special place in funding. These are givens. However, for access to any healthcare to be sustainably financed in Nigeria, removing the need for out of pocket payment on the part of service users, we need to have compulsory Health Insurance. That is the way forward for everybody.
Publisher: You were the first psychiatrist to start a column on mental health issues in the defunct Concord Newspapers in 1983; 39 years later, not much has changed in the country with regards to psychiatry. Do you feel betrayed?
Dr Olugbile: Advocacy and public enlightenment are continuous engagements and there are no time limits. Awareness of mental health issues and provision of services are improving in Nigeria, but the pace is slow, and not keeping pace with increased demand. It is work in progress and is best approached with a positive spirit.
Publisher: Foreign embassies and sometimes universities ask prospective students if they have a mental health challenge, do you perceive the question as discriminatory? Why for instance won’t they ask if they have got cancer or diabetes?
Dr Olugbile: Again that is a sentimental question. The truth is that psychological illnesses are a special category of illness that may affect judgement and function, in ways that other illnesses would generally not do. The question to ask is what these bodies do with the information they gather about people’s mental health histories. If they use such information to exclude people, that would be wrong. If they use it to evaluate the quality of present function and steps being taken to prevent relapse, it may be difficult to fault. Unfortunately, many organisations, including employers of labour, find it easier to use the information for exclusion. That is wrong, and it is a stark result of Stigma. But there is a place for correct use of information.
Publisher: Psychologists and social workers seem relegated to the background in Nigeria especially in the public hospitals; how can this practice change?
Dr Olugbile: It is true that Mental Health services, especially in government facilities, have tended to be doctor-centred in the past, with insufficient accommodation for and respect for the roles of the other members of the mental health team. This is partly because there used to be a paucity in the numbers of these other categories. But that is changing gradually, the numbers are improving, and people are seeing the need to build more balanced teams where there is a role for every member. An increasing proportion of mental health care is being done in private facilities, where the constitution of the team is generally more balanced.
Publisher: Do you think that Nigerian mental health advocates are doing enough to be the voice of the voiceless Nigerian mentally challenged?
Dr Olugbile: More and more citizens are seeing to need to participate in the drive to sensitize the public on mental health issues. The increasing readiness of Service Users themselves to come out into the open to advocate has been a welcome development. The advent of the COVID19 and the widespread mental health issues induced by the prolonged lock-down all over the world has had the salutary effect of making more people aware of the actuality or possibility of illness in themselves and those close to them. It has also increased the readiness of people to seek help. We need to build on all these. It is also important for advocates to themselves have an understanding of the spread and variety of mental health issues. There has been an inordinate focus of psychotic illnesses such as Schizophrenia and Bipolar Affective Disorder in the minds and postures of anti-Stigma activists. The overwhelming majority of people with mental health issues suffer from Anxiety and Depression and may not look or act differently from other people in society, despite their internal distress. In a society where stigma prevents such people from seeking help, you have a huge army of ‘walking wounded’ who underachieve and underperform at work and in their various roles. That is the true burden of unrecognized and untreated mental illness in society that needs to be addressed and minimized through advocacy.
Publisher: The National Assembly recently passed the mental health bill and we are waiting for President Buhari to give it presidential assent. What would be the gains of the bill to the mental health patient on the street?
Dr Olugbile: I believe the bill is still with the National Assembly. When it eventually gets signed into law, which I hope will be soon, it will standardize the approach of society to mental illness and its management, and protect the rights of those living with a vulnerability to mental illness, including their entitlement to treatment and to a life of fulfillment and gainful employment. It will bring Nigeria into modernity from the dark ages, as far as mental health is concerned.
Publisher: How can we get more international donor agencies to do more in the Nigerian mental health care sector in the best interest of Nigerians?
Dr Olugbile: The mental health care of the nation is the responsibility of the nation itself, and not of outside agencies. Society must accept that responsibility and devote more structure and resources to carrying it out. Outside agencies can only assist on the periphery. They do not own the problem and are not responsible for its solution.
Publisher: What is your view on telemedicine in mental health? Do you think mental health app companies can really thrive in Nigeria as they are thriving in the west?
Dr Olugbile: My answer is Yes. One of the unintended gains of the COVID19 pandemic and the associated lockdown was to open the eyes of professionals and the public at large to the vast possibilities the internet represents in delivering an array of psychological interventions directly to a large number of people, cutting out logistic barriers. The gains have been preserved beyond the peak of the pandemic and are constantly being expanded. It has expanded the reach of Psychiatrists and also increased the readiness to seek help.
Publisher: Thank you for your time Sir.
Dr Olugbile: You are most welcome.