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Paper Number: ICHUSO-004
Proceedings of 14th International Conference on Humanities and Social Sciences 2018 (IC-HUSO 2018)
22nd-23rd November 2018, Faculty of Humanities and Social Sciences, Khon Kaen University, Thailand
Social Context of Mental Illness Disclosure in Kaduna, North West Nigeria
Suleiman, M.S.
Department of Sociology and Anthropology, Faculty of Humanities and Social Sciences,
Khon Kaen University, Khon Kaen, Thailand
E-mail: [email protected], [email protected],
Abstract
Mental illness is recognized as one of the huge contributors to the universal burden
disease, mentally ill patients receive little attention at global, regional and indigenous levels
compared to other illnesses. This paper examined the social context of mental disclosure in Kaduna,
North West Nigeria. The data for this research work was collected from Federal Neuro-Psychiatric
Hospital, Kaduna and were triangulated in order to enhance the data collected. This research used
observation, the daily activities of the hospital staff, the patients and their relations within the
hospital setting were observed. In addition, medical consultations and diagnostic conversations
between physicians and nurses as well as patients and their relatives were observed and recorded.
In-depth interviews were conducted with hospital staff and patients’ relatives as well as examining
the medical records and prescriptions for the patients. Among others, this study recommended that
moral values should be inculcated among citizens of Nigeria in order to reduce to the barest
minimum the incidence of mental disorders. It further recommends that there is need to promote
indigenous healthcare care for people with mental illness as well as the creation of policies that can
support the indigenous partnership with the mainstream psychotherapeutic hospitals and centres
for sustainable development.
Keywords: Disclosure, Mental Illness, Patients, Psychiatric, Social Context
6
Paper Number: ICHUSO-004
Proceedings of 14th International Conference on Humanities and Social Sciences 2018 (IC-HUSO 2018)
22nd-23rd November 2018, Faculty of Humanities and Social Sciences, Khon Kaen University, Thailand
Introduction
The World Health Organization (WHO, 2014) describes mental health as a state of
wellbeing in which individuals realize their own abilities, cope with the normal stress of life, work
productively and are able to make a contribution to their own communities. The estimate of WHO
indicates that psychiatric and neurological conditions accounts for 13 percent of the global disease
burden and likely going to 15 percent by the year 2020 and statistics furthermore, revealed that
globally, 59 million people suffer from bipolar disorder while 24 million suffer from schizophrenia
(WHO, 2011; WHO, 2014). Similarly, it can also be observed that from available WHO (2013)
data between 76% and 85% of individuals with mental illnesses receive no treatment for their
condition in low income and middle-income countries.
In a related development, previous studies also revealed that people affected by mental
illness face higher rates of disability and mortality, for instance, individuals with schizophrenia and
major depression have 40% to 60% increased chances of dying prematurely than the general
population and these premature deaths are frequently the result of other physical health illness such
as cardiovascular diseases, cancers, diabetes, HIV infections and suicide (Whiteford et. al., 2013).
Similarly, Eaton, Kakuwa, Wright and Minas (2014) in their view, put forward that mental illness
impact equally or more on life expectancy thus as smoking, diabetes and obesity, while they further
argued that people are challenged with human right violation like chaining and subjected to
treatment without consent, discrimination against and being denied to take part in political activities
and exclusion from social, family life and education.
It can be observed that understanding the mental illness in Nigeria is something that
has to be taken contextually and historically due to the fact that there are existing large
misconception as well as misinformation on the context of mental illness amongst Nigerians. The
social organization of this research is centred on the treatment of the psychiatric situation. This
research adopts a narrative approach that focuses on the lifestyle of the patients in the hospital and
upon treatment as a procedure that takes place over time. This study examines the various phases
involved in shaping the patient lifestyle and identifies the social factors crucial to that process in
Federal Neuro-Psychiatric Hospital, Kaduna, North West Nigeria.
Methods
The data used for this research work was collected from Federal Neuro-Psychiatric
Hospital, Kaduna. The methods of data collections were triangulated in order to enhance the data
collected. This research used observation, the daily activities of the hospital staff, the patients and
their relations within the hospital setting were observed. In addition, medical consultations and
diagnostic conversations between physicians and nurses as well as patients and their relatives were
observed and recorded. In-depth interviews were conducted with hospital staff and patients’
relatives as well as examining the medical records and prescriptions for the patients.
Federal Neuro-Psychiatric Hospital
Federal Neuro-Psychiatric Hospital (FNPH), Kaduna was established in 1995 along
four other new Federal Neuro-Psychiatric Hospitals in accordance with the National Mental Health
Policy of the Federal Government of Nigeria. Over the year Federal Neuro-Psychiatric Hospital,
Kaduna has witnessed the remarkable transformation that has since elevated it to international
standard such as providing quality service delivery, training of mental health professionals and
research in mental health and related fields (Jolly, 2018). Federal Neuro-Psychiatric Hospital
(FNPH), Kaduna is a 100-bed public regional psychiatric hospital with consultant psychiatrists,
general practitioners, nurses, administrative and other supporting personnel.
7
Paper Number: ICHUSO-004
Proceedings of 14th International Conference on Humanities and Social Sciences 2018 (IC-HUSO 2018)
22nd-23rd November 2018, Faculty of Humanities and Social Sciences, Khon Kaen University, Thailand
Symptomatic Identification of the Illness People with all kinds of psychiatric problems from simple to complex stage can be
identified by members of the society in different ways such as manifestations of strange behaviour
or communication patterns. It worth noting that through communication or interaction, individuals
with abnormal behaviours can be figured out.
Similarly, it is obvious that speech disorder is accepted as a manifestation of a mental
problem due to that fact it is generally believed that mental illness can be detected at the initial
stage through problems of speech mostly if the person’s speech is illogical and termed talkative or
when the person refused to talk and remain quiet. It is also worth noting that people with mental
illness can be identified with violence and aggressive behaviours as well as roaming or wondering
about as argued by Jegede (2005) and Nwokocha (2008) that mentally ill persons are mainly found
in the different parts of the cities, especially in the major roads or streets, motor parks and markets
among others with common features of roaming about, self-neglect, self-destruction as signs of
mental illness. Thus, it is worth noting that some of the symptomatic identifications of a person
with mental illness by the public may include wandering about, restlessness, looking dirty and
rough among others.
It is observed that people with mental illness may communicate verbally with people
in order to interact, although the communication sometimes could be illogical, meaningless as well
as incoherent, the person with mental illness sometimes could be taken to his or herself alone or
murmuring. For illustration, a relation of one of the patients narrated to the physician that she spent
days speaking to herself and later started shouting and naked herself, it was then they realized the
symptoms of psychiatric illness in her (Fieldwork, 2017). Similarly, another patient's relative
explained to the doctor that he used abusive words against people speciously and he became violent
by attacking people, he can through any object at people without caring if the object is harmful or
not. (Fieldwork, 2017). Thus, it can be observed that most of the dangerous and severe stage of
mental illness is when the mentally affected person becomes violent by maltreating, abusing as
well as beating people indiscriminately.
Admission into the Hospital and Case History
The patient and his or her relative report to the out-patients department on arrival and
they will be directed to register in the card room where patient’s bio-data is collected and at the
end, a referral card is issued to the patient and that of the diagnosis is kept in the hospital. Then, if
there is any referral letter you submit to the Senior Nursing Officer on duty and if not you explain
the conditions of the patient to the nurse who then takes the case history of the patient or likely
assign a nurse to do so. Similarly, the social welfare office can also make referral and patients are
encouraged to come along with relatives that can serve as a source of getting vital information of
about the patients in order to guide the medical personnel in providing a proper diagnosis. It is also
vital to mention that patients who are violent in nature are injected, isolated and physically
constrained in some cases.
Generally, admission into the hospital is expected to be formal and family members of
the patient play a vital role in the process of bringing and admitting the patient into the hospital.
An assessment of patient file records indicates the majority of the mentally affected persons were
brought to the hospital by their relatives but some of the patients were abandoned by their family
members along the line due to the financial challenges as well as stigma attached to mental illness
in the society. Andersson et.al (2013), Schierenbeck, Johansson, Andersson and Van Rooyen
(2013) and Topper, Van Rooyen, Grobler, Van Rooyen and Andersson (2015) assert that economic
challenges and stigma are parts of barriers to treatment as well as utilization of mental health care
8
Paper Number: ICHUSO-004
Proceedings of 14th International Conference on Humanities and Social Sciences 2018 (IC-HUSO 2018)
22nd-23rd November 2018, Faculty of Humanities and Social Sciences, Khon Kaen University, Thailand
services by persons with mental illness owing to the fact that they are mostly abandoned at the
various stages of their treatment by their family members and by implications worsening their
illness and making them rejected and vulnerable. Thus, it is important that people with mental
illness need to be given adequate care and support in order to improve their health conditions; they
should not be subjected to any form of stigma and discrimination.
In a related development to the case history of the patients, the case history of an
individual patient is taking by a nurse in the consultation room or office which the patient’s
relatives or persons who bring him or her to the hospitals are expected to equally participate and
provide vital information on the life history of the patient in order to get a clearer background
information and proper understanding of the patient’s mental health challenges since most of the
patients can hardly provide meaningful answers to the questions raised by the medical personnel.
However, it is noticed also as a challenge, that some of the relatives of the mentally ill persons find
it difficult to give adequate information about the patients due to some factors like they are not
living together, they don't understand the patient's lifestyle, and explained that the patient has
accessed any treatment elsewhere before bringing him or her to the hospital presently. It was
observed that most of the patients have received treatment from the native or religious healers in
the course of the illness. One of the patients’ family members revealed that:
They have to seek native healing process due to the fact that
they have belief in the influence of supernatural forces on
the causes of illness before coming to the hospital (Fieldwork, 2017).
Another relative of a patient also confirmed that:
They have to consult religious healers because they have a belief
in the healing process of the illness that was why they consulted
the religious healers first before seeking medical attention in the
the hospital now (Fieldwork, 2017).
Thus, it is worth noting that the society or family members of the patient’s belief in the
influence of supernatural forces in psychiatric illness are related to the first choice of healer.
Mental State Examination
Mental state examination of the patient is conducted after the completing the case
history as a mental assessment of the patient in order to validate and establish the information
provided by the family members regarding the condition as well as the behaviour of the patient.
The comparison is made between the patient’s case history and mental assessment which after then
a report on the patient is compiled and necessary recommendations are made to the consultant who
is expected to conduct the final diagnosis before the final decision to admit the patient or not is
taken. Thus, the recommendations put forward by the nurses help the psychiatrist in making a
decision despite there are other vital factors to be considered before concluding whether the patient
is to be admitted or not.
9
Paper Number: ICHUSO-004
Proceedings of 14th International Conference on Humanities and Social Sciences 2018 (IC-HUSO 2018)
22nd-23rd November 2018, Faculty of Humanities and Social Sciences, Khon Kaen University, Thailand
Factors that Influences In-patient Status
It is worth noting that there are many factors that influence the in-patient status of a
person with mental illness ranging from the availability of space for admission in the hospital and
willingness of the patient to cooperate with the hospital personnel. Previous research work indicates
that the global median number of facilities per 100,000 population to mental hospital is 0.04; there
are 7.04 psychiatric beds per 100,000 population in mental hospitals; and 1.4 psychiatric beds per
100,000 population in general hospitals and in Africa, the rate of psychiatrists per 100,000
population is 1(Fournier, 2011; WHO, 2011; Morris, Lora, Mcbain, Sexena, 2012).
In addition, Bird, Omar, Doku, Lund, Nsereko, and Mwanza, (2010) and Nwokocha
(2013) assert that indeed, the situation is more severe in low-income countries where insignificant
proportions of budgets are allocated to the health sector generally. Thus, the impact of poor funding
of the health sector cannot be overstated. It has been observed that most people with a mental, a
neurological and substance-use disorder in less developed countries were not receiving treatment
or care for their conditions and a condition that has remained largely unchanged in most places,
mental healthcare delivery is undermined by inadequate facilities, lopsidedness, and financial
constraint. Similarly, the proximity of the patient’s residence is sometimes taken into account
before admission due to difficulties some of the relatives from far places encountered due to socio-
economic factors of regular visits, provision of regular food, pocket money, drugs to the patient
among others.
Duties of the Hospital Social Welfare Unit The social welfare unit of the hospital plays a critical role in helping patients and their
family members address the impact of mental illness and treatment. Martin and Jo (1995) assert
that social workers in the hospitals necessarily work alongside other healthcare professionals and
the perspectives on social work held by doctors and senior nurses are relevant both to their
relationship with social workers and to the smooth running of the hospital. Thus, the social welfare
unit as part of the healthcare team provides assessment and appropriate interventions to aid the
patient in achieving optimum recovery, rehabilitation, and quality of life. Similarly, the social
welfare unit also renders service of admitting those patients who wander about on the streets or
public places especially the violent patients and those who resist coming to the hospital to seek
medical attention. Thus, the social welfare unit through its officers provides all the necessary care
and support for people with mental illness. Although, there is a decline in the services of the social
welfare unit in taking care of the people with mental illness wandering around the streets or public
places due to lack of adequate resources and the economic hardship the nation is facing.
The social workers reported that lack of adequate resources has turned them to be less
responsive and effective; it has incapacitated them and they find it very difficult to discharge their
responsibilities effectively and efficiently (Fieldwork, 2017). Hence, there is need to adequately
provide the social welfare unit with needed resources in order to make them more effective and
efficient in delivering their services to humanity that is cardinal to the sustainable development of
the nation. Mental illness remains one of the controversial illnesses with prejudice and stereotype.
People with mental illness are unnoticed by the policymakers due to the poor public health policies,
financial and human resources challenges making people with mental illness remain neglected and
marginalized strata of the society, therefore, their potential to contribute to the community remains
undermined and untapped.
10
Paper Number: ICHUSO-004
Proceedings of 14th International Conference on Humanities and Social Sciences 2018 (IC-HUSO 2018)
22nd-23rd November 2018, Faculty of Humanities and Social Sciences, Khon Kaen University, Thailand
Discussion
Most of the people with mental illness, their relatives as well as caregivers experience
the consequences of vulnerability on daily basis. While most of the people with mental illness are
poor and unable to receive the necessary treatment and care they require making them be a
marginalized group in the society. The above assertion is also observed by World Health
Organization from available data that between 76% and 85% of individuals with mental illnesses
receive no treatment for their condition in low income and middle-income countries (WHO, 2013).
One of the main perspectives of the symbolic interactionism is interaction, in this case,
the interaction between the medical personnel and patients as well as their family members in order
to provide understanding for a proper diagnosis as a social process while symptoms as social
objects. Mental illness is seen as a process that shaped in through social interaction. However, it
is imperative to note that diagnosing and symptomatic identification of mental illness as a social
construction is not in competition with any medical models but this study is sociological in nature.
Cockerham (1990) put forward a model of becoming mentally ill comprising seven separate
chronological phases in which a mentally ill patient passes through and acquires different
experiences of becoming mentally ill at each of the stages in the transition from normality to
madness.
Meanwhile, mental illness diagnosis is a socially constructed phenomenon as asserts
by Symbolic Interactionism which can be understood from the process of attending or admitting
the mentally ill patient into the hospital and it is vital to point out that illness is positioned within a
wider cultural and normative framework which has bearing on disclosure process. It is believe that
speech disorder is accepted as a manifestation of a mental problem due to that fact it is generally
believed that mental illness can be detected at the initial stage through problems of speech mostly
if the person’s speech is illogical and termed talkative or when the person refused to talk and remain
quiet and it can be noticed by any close family member or members for likely quick disclosure and
treatment.
Similarly, it is important to note that the family members play a significant role in the
social disclosure of mental illness, making recommendations and commencement of treatment
contact of a patient that is mentally ill; therefore, there understanding of mental illness is
imperative. Kabir, Iliyasu, Abubakar, and Aliyu (2004) pointed out that majority of the cohort of
community dwellers in North Nigeria attributed mental illness to supernatural factors, witches, and
evil spirits among others. In addition, mental illness is view as diverse and multifaceted and
includes knowledge and beliefs about mental disorders that emerge from prevalent culture induced
explanatory models such as attributing the causes of mental illness to cultural beliefs of
supernatural factors (Griffiths, Christensen, Jorm, 2004; Lauber, Nordt, Rossler, 2005).
Consequently, it is believed supernatural forces cause mental illness and this affects the disclosure
of mental illness and choice of healers by the family members of the mentally ill patient. In a related
development, Adewuya and Makanjuola (2008) posit that the beliefs of supernatural factors on the
etiology mental illness shape the attitudes and it has shown to have a huge impact on the acceptance
of the mentally ill among the people of Nigeria. Therefore, by implication, it is vital to point out
that the primary responsibility for the care of a person with mental illness lies with the family
members who disclose the illness and make decisions about treatment and care.
11
Paper Number: ICHUSO-004
Proceedings of 14th International Conference on Humanities and Social Sciences 2018 (IC-HUSO 2018)
22nd-23rd November 2018, Faculty of Humanities and Social Sciences, Khon Kaen University, Thailand
Conclusion
Mental illness disclosure and mental health help-seeking behaviour in Kaduna, North
West Nigeria is a household decision-making process, it is often influenced by the community
concept of mental illness. It is observed that the family members of the patients with mental illness
mostly decide on their behalf when and where to seek medical help. Similarly, the community’s
belief system about the causes of mental illness influences the families’ view about the possible
cause of mental illness experienced by a family member. It is also important to note that admission
into the hospital is not just merely on a patient being mentally ill but there must be a serious
commitment from the patient's family members in providing necessary care and support for the
patient as applicable.
Thus, the current moves by the global leadership inclusion of mental health in the
present United Nations Sustainable Development Goals (SDGs) is essential step to addressing the
barriers to availability of mental service in order to achieve positive impact on communities and
countries where people with mental illness can receive the needed help since Unattended or poorly
treated mental illness distance victims from self, family, and society. Hence, the chain of
psychosocial consequences arising from this situation is hostile to socioeconomic development.
Recommendations
This study recommends that moral values should be inculcated among citizens of
Nigeria in order to reduce to the barest minimum the incidence of mental disorders. There is a need
to promote indigenous healthcare care for people with mental illness as well as the creation of
policies that can support the indigenous partnership with the mainstream psychotherapeutic
hospitals and centres for sustainable development.
In addition, it is essential that more psychiatric hospitals and centres are created with
more facilities as well as upgrading the existing facilities in old psychiatric hospitals and centres.
There is the need for regular training of the psychiatric personnel in order to keep abreast with the
international best practices of the professional, while government should enact legislation to
discourage stigmatization and discrimination against mentally ill persons in Nigeria.
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Proceedings of 14th International Conference on Humanities and Social Sciences 2018 (IC-HUSO 2018)
22nd-23rd November 2018, Faculty of Humanities and Social Sciences, Khon Kaen University, Thailand
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Proceedings of 14th International Conference on Humanities and Social Sciences 2018 (IC-HUSO 2018)
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