On World Health Day, let us talk about depression
On Sunday 18 March, Nigerians woke up to the very tragic news that a young man parked his SUV on the popular third mainland bridge in Lagos and jumped into the lagoon into the very cold hands of death. It became even more tragic when news filtered in that young man, Allwell Orji was a medical doctor. But then his death was later traced to depression according to reports in the media, an illness that is hardly discussed in Nigeria.
This year’s World Health Day has the theme ‘Let’s talk depression,’ highlighting the need to talk about the impact of a disease that afflicts over 300 million people every year.
The World Health Organisation (WHO) is embarking on a global campaign to have conversations around the stigma surrounding mental illness, including depression, which acts as a barrier to people seeking help throughout the world.
“Depression affects people of all ages, from all walks of life, in all countries. It causes mental anguish and impacts on people’s ability to carry out even the simplest everyday tasks, with sometimes devastating consequences for relationships with family and friends and the ability to earn a living,” says WHO.
When conversations about depression are had whether with a family member, friend, at the workplace, school or with a medical professional, it will help those battling depression to see the need to seek help.
According WHO, over 300 million people are now living with depression, which has become a leading cause of disability worldwide. It is also a major contributor to the overall global burden of disease.
Data from WHO indicates rates of depression have skyrocketed worldwide, rising by 18 per cent to 300 million between 2005 and 2015.
“Those are alarming numbers, as governments continue to invest little to no money in mental health programs,” says Margaret Chan, WHO Director General.
Stigmatisation
Shekhar Saxena, director of the department of mental health and substance abuse at WHO said one of the first steps in addressing depression is to deal with issues around prejudice and discrimination.
“The continuing stigma associated with mental illness was the reason why we decided to name our campaign Depression: let’s talk,”
“For someone living with depression, talking to a person they trust is often the first step towards treatment and recovery.”
Lack of support for people with mental disorders, coupled with a fear of stigma, prevent many from accessing the treatment they need to live healthy, productive lives.
WHO noted that at its worst, depression can lead to suicide and close to 800 000 people die due to suicide every year, which is the second leading cause of death in 15 to 29-year-olds.
The organisation finds that depression is the leading cause of ill health and disability worldwide, and has even become more prevalent than malaria, which only accounts for about 212 million cases each year.
According to a new study by researchers, Depression is the strongest predictor of death in the first decade following a diagnosis of coronary heart disease.
Heidi May, a cardiovascular epidemiologist at the Intermountain Medical Center Heart Institute in Salt Lake City, and the study’s lead author said, “Our study shows that it doesn’t matter if depression emerges in the short term or a few years down the road – it is a risk factor that continually needs to be assessed.”
Depression in Nigeria
Mental health experts say millions of Nigerians currently suffer from depression which has become a major form of mental illness and this includes even teenagers.
The recent case of Allwell Orji, a medical practitioner who jumped off third Mainland Bridge has become an obvious case of what depression can result in.
Adebayo Richard, a consultant psychiatric and clinical psychologist in the Federal neuropsychiatric hospital Yaba, Lagos, said, “Depression will affect not less than 20 per cent of any population in their life time. So that between 20 to 25 percent of the population will suffer depression at one stage or the other in their life.”
The mental health practitioner further averred that the notion that it is a leading cause of disability and one of the commonest forms of disorders is true because it impacts on people’s ability to carry out their everyday tasks with sometimes overwhelming consequences for relations with family and friends and the ability to earn a living.
Mental health is not only a matter of family or public concern but also it is a huge economic global burden.
Depression is very common in elderly, young and children, the presentation varies, it differs from the way children manifests to the way adults manifest and the rate of chronic mental disorder is about 40 percent among people suffering with chronic problems
“Yes, depression can be prevented and treated if more people understand what depression is, that will help reduce the stigma related with the condition, and lead to more people seeking help and getting support from family”
Experts say there is urgent need to review Nigeria’s mental health law. The current one was the one gotten from the colonial masters is said to be outdated and does not sufficiently protect the rights of patients involved in major crimes as a result of their disability.
“Hopefully, when it is passed, it will guaranty the rights of patients with mental disorder, but right now especially if a patient with a severe depression and psychosis and no longer in contact with reality and is dangerous to themselves and society and is forcefully brought to the hospital, a judge can rule that their rights have been bridged,” says Adebayo.
Owoeye Olugbenga, a consultant Psychologist and Clinical Psychologist at Federal Neuro-Psychiatric Hospital Yaba, Lagos said the criminalisation of suicide was predicated on the Lunacy Law made by colonial leaders.
“Our lawmakers should review the Mental Health Law in line with what obtains in other countries, especially developed nations. The bill is already with the Senate.”
“They should make provision for the treatment of those who attempt suicide rather than get them arrested. As the law is being repealed, the government should also fund the psychiatry hospitals. There are fewer than 500 psychiatrists nationwide to take care of 170 million people. We even have fewer clinical psychologists and psychiatrist nurses. These are not enough to take care of the psychiatry needs of the nation,” said Olughenga.
Urgent need for increased investment
The WHO has also advocated for increased investment in psychiatric healthcare in many countries as there is no, or very little, support available for people with mental health disorders.
Even in high-income countries, nearly 50 percent of people with depression do not get treatment. On average, just 3 percent of government health budget is invested in mental health, varying from less than one percent in low-income countries to 5 percent in high-income countries.
Investment in mental health makes economic sense. Every US$ 1 invested in scaling up treatment for depression and anxiety leads to a return of US$ 4 in better health and ability to work.
Treatment for mental disorders usually involves either a talking therapy or antidepressant medication or a combination of the two. Both approaches can be provided by non-specialist health-workers, following a short course of training, and using WHO’s mhGAP Intervention Guide.
More than 90 countries, of all income levels, have introduced or scaled-up programmes that provide treatment for depression and other mental disorders using this Intervention Guide.
Even this required more investments. According to a WHO-led study, which calculated treatment costs and health outcomes in 36 low-, middle- and high-income countries for the 15 years from 2016-2030, low levels of recognition and access to care for depression and another common mental disorder, anxiety, result in a global economic loss of a trillion US dollars every year.
The losses are incurred by households, employers and governments. Households lose out financially when people cannot work. Employers suffer when employees become less productive and are unable to work. Governments have to pay higher health and welfare expenditure.
A recent World Economic Forum report estimated the global economic burden of mental health at nearly $2.5 trillion (two-thirds in indirect costs) in 2010, with a projected increase to over $6 trillion by 2030.
“A better understanding of depression and how it can be treated, while essential, is just the beginning. What needs to follow is sustained scale-up of mental health services accessible to everyone, even the most remote populations in the world,” says Saxena.
Anthonia Obokoh