Mental Health: From Institutions To Community Care

As the global community marks this year’s World Mental Health Day on October 10, attention is increasingly shifting from long-stay psychiatric institutions towards community-based, person-centred mental healthcare.

With the theme, “Lived Experiences Heard: Real Voices, Real Change,” the World Health Organisation (WHO) is calling for greater recognition of the experiences and expertise of people living with mental health conditions.

The organisation has also warned that institutional care can be isolating and is too often associated with poor-quality services, coercion and violations of human rights.

This year’s campaign therefore places the voices of people with lived experience at the centre of discussions about mental health policies, services and community care.

This is a welcome approach, particularly in countries such as Nigeria where stigma, inadequate services and misconceptions continue to prevent many people from seeking help.

Globally, about one in eight people live with a mental health disorder, with anxiety and depression among the most common conditions.

In Africa, the burden is equally alarming.

The WHO Regional Director for Africa, Dr Mohamed Janabi, has stated that nearly 150 million people on the continent live with mental, neurological or substance-use conditions.

Nigeria is not exempt from this crisis.

Estimates suggest that tens of millions of Nigerians live with some form of mental health condition, ranging from anxiety and depression to severe disorders such as schizophrenia and bipolar disorder.

Depression alone is believed to affect millions of Nigerians.

This newspaper recognises that the pressures of daily life have further compounded the situation.

Economic hardship, rising inflation, unemployment, insecurity, displacement, kidnapping and other traumatic experiences have placed enormous psychological pressure on individuals and families.

Poverty is an important part of this picture.

The number of Nigerians living below the national poverty line has risen significantly in recent years, leaving millions struggling to meet basic needs.

In such circumstances, mental wellbeing can easily become an afterthought when families are preoccupied with food, shelter, education and security.

Yet mental health is an integral component of overall health and should be treated as such.

Nigeria has made some progress in this direction. The National Mental Health Act 2021 represented a significant step towards reforming the country’s mental healthcare system and replacing the outdated legal framework governing mental health.

More recently, the Federal Executive Council approved an amendment aimed at decriminalising attempted suicide.

However, legislation alone cannot transform the mental healthcare system. Implementation remains the critical challenge.

Although the Mental Health Act provides for the integration of mental health services into primary and secondary healthcare, access remains severely limited, particularly in rural communities.

Mental healthcare is still concentrated largely in specialist and tertiary institutions, while the primary healthcare system, which should serve as the first point of contact for millions of Nigerians, remains inadequately equipped to identify and manage mental health conditions.

The shortage of professionals makes the situation even more disturbing. Nigeria has only a few hundred psychiatrists serving a population of more than 200 million people. This leaves millions without reasonable access to specialist care.

The country has federal neuropsychiatric hospitals, psychiatric units in teaching hospitals, state facilities and private clinics.

But these services are predominantly located in urban centres. For people in remote communities, reaching a specialist facility can be prohibitively expensive or practically impossible.

Meanwhile, stigma continues to deepen the crisis.

It is distressing that Nigerians living with mental illness are still sometimes chained, secluded or subjected to degrading treatment in some traditional and religious healing centres.

Mental illness is often interpreted as spiritual affliction, possession or a character defect rather than a health condition requiring appropriate medical and psychosocial care.

This newspaper believes that Nigeria must urgently move from a predominantly institution-based model to one that brings mental healthcare closer to the people.

Community-based rehabilitation centres, supported by strong primary healthcare networks, should be established and adequately funded, particularly in underserved rural areas.

General practitioners, nurses, community health officers and other frontline health workers should receive appropriate training to recognise and manage common mental health conditions and refer complicated cases when necessary.

The WHO is right that deinstitutionalisation requires a carefully planned shift in funding, services and support so that people can live with dignity within their communities.

It must not simply mean closing institutions without creating viable alternatives.

Equally important is the need to involve people with lived experience in designing and evaluating mental health services. Their voices should not be invited merely for symbolic purposes; they should influence policies and decisions that directly affect their lives.

The different tiers of government must therefore move beyond rhetoric and make mental healthcare a genuine priority.

Funding must support community services, workforce development, medicines, rehabilitation and public education, while health insurance schemes must provide meaningful coverage for mental health treatment.

Mental healthcare should not remain an elite service available mainly in tertiary hospitals in major cities. It is a basic component of healthcare and a fundamental human right.

As Nigeria confronts poverty, insecurity, trauma and social pressures that increasingly threaten the mental wellbeing of its citizens, the country can no longer afford to treat mental health as a peripheral issue.

The time has come to take care beyond the walls of psychiatric institutions and into the communities where people live.

Most importantly, Nigeria must listen to those who live with mental health conditions and allow their real experiences to drive real change.