The stress, strain and side effects

Living with mental illness is a big challenge in Nigeria with the poor access to treatment and the discrimination often suffered by those affected. However, some mental health patients battling schizophrenia said it is tougher living with the health condition, noting that aside from dealing with stigmatisation, taking medication every day is hard. ANTHONY ADEMILUYI who was recently at the out-patient clinic of the Federal Neuropsychiatric Hospital, Yaba, Lagos, reports

George Okoye (not his real name to avoid stigmatisation) was well-dressed in a starched white shirt and black jeans trousers. He also had a conspicuously big Bible in his hands. For anyone just meeting him for the first time, he comes across as any jolly good fellow pursuing his life dreams. But, Mr. Okoye said life has been tough since he was diagnosed with schizophrenia.

Schizophrenia, according to experts, is a chronic, severe mental disorder that affects the way a person thinks, acts, expresses emotions, and perceives reality. While the cause of schizophrenia is not known, experts said, a combination of genetics and environmental factors and altered brain chemistry and structure may trigger it.

The condition is often characterised by thoughts or experiences that are out of touch with reality as concentration and memory are affected. Treatment for schizophrenia is usually lifelong and often involves a combination of psychotherapy, medications, and specialty care.

Sharing his story with PUNCH HealthWise during an outpatient visit to the Federal Neuropsychiatric Hospital, Yaba, Lagos, Mr. Okoye said his mental challenge began when he was an undergraduate at the University.

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He recalled that he had returned home during one of the Academic Staff Union of Universities strikes and was watching a popular sitcom with his siblings when the problem.

He said he was later told that he ran into the room and started screaming at the top of his voice and began to behave funny by removing his clothes when he returned to the sitting room, noting that he was restrained from going outside and making a public scene by his stronger siblings.

He disclosed that he was then rushed to a private psychiatric hospital because the public hospitals were also on strike during that period.

Speaking with our correspondent, he said, “Honestly, I don’t know why I have been afflicted with this incurable ailment as I have been told I have to be on medication for life. I have never used hard drugs before or even smoked a cigarette. I also don’t know how alcohol tastes as well. Sometimes I wonder whether God is punishing me for my sins or that of my ancestors. I suspect God is punishing me for the sins of my ancestors as a relative told me that one of my great grandfathers was a Chief during the slave trade era and that he colluded with the White Man to sell some of his brothers into slavery. I believe this illness which doctors have not been able to cure is karma for that sin.

“The sickness has cost me a lot. I was diagnosed with schizophrenia. I had an extra year in school even though by the Grace of God I eventually graduated with a Second Class Upper Degree. I have, however, been admitted many times to both public and private psychiatric hospitals. Many ladies I loved have rejected me when I opened up to them about the health condition I am living with. I left the United States and dropped out of my Master’s Degree programme after just six months because I couldn’t cope with the course and the environmental change as the sickness has made me live a rather sheltered life. I feel less of a man and deeply believe that my life would have been better if not for this condition.

“Another challenge is that of having to take medications twice daily. It is tough. These medications are anti-psychotics and they have huge side effects. I have not been able to work very well because the pills often make me sleepy during the day. Also, my hospital appointments often fall on Mondays which made it difficult to get permission from employers to see the doctor as the most important office meetings in all the places I have worked are usually held on that day. I recall how I relapsed in my immediate past place of work because I missed my medical appointments several times.”

Visibly fighting back tears as he talked, Mr. Okoye said he is still optimistic for the future but intends to relocate abroad to achieve his dreams of better management of his health condition and a good life.

He said, “I plan to migrate to Canada for my Master’s Degree. The reason is that healthcare costs in the United States are the most expensive in the world and I may not be able to cope there. Canada operates a welfare state and I would be able to better function there. I am studying project management which I discovered is in very high demand there which I will combine with my newfound love for mental health activism.

“I want to be a voice for the mentally challenged. I want to start my activism abroad as it caused a huge conflict at home when I told my parents I wanted to commence my activism from Nigeria. They are also worried about stigmatisation. The decision to do activism side-by-side with my day job in Canada was mutually agreed upon between my parents and me and I want to respect that”.

He also urged the government to be more proactive with policies that would help ensure patients living with mental health can work and contribute to the economy while managing their health conditions.

“The Nigerian government should factor in the interests of persons who have mental health challenges by making it possible for their hospital appointments to hold on weekends so that those who don’t work on those days can easily go for the necessary check-ups and thus not need to tell their employers all the time that they have hospital appointments for fear of stigmatisation.

“The mental health medications should also be made free like HIV drugs or at least highly subsidised. It breaks my heart to see many out-patients practically begging to pay for their drugs. I count myself lucky to have parents who finance the costs but it also makes me feel bad that I am still an economic burden to them at over 30 years.

“This is what is driving my desire to relocate to Canada so that I can stand on two feet as a man. I see hope for a brighter future but as much as I love Nigeria – the land of my birth, I have to move abroad to have a better future as my paramount health needs would be better met abroad,” he said.

Also speaking with PUNCH HealthWise during the clinic at the Federal Neuropsychiatric Hospital, another outpatient who, however, spoke on the condition of anonymity said it is tough dealing with schizophrenia.

Sharing his story, he said, “My parents were busy career people and I was practically raised by many housemaids. My mental health challenge started when I finished secondary school.

“My behaviour was rather bizarre despite my never taking hard drugs which made my absentee parents eventually take me to a public psychiatric hospital where I was diagnosed with schizophrenia. I have been in and out of the hospital since then. I almost didn’t finish my university education as I spent an extra three years. My NYSC was chaotic as I was posted to serve in the north but was redeployed back to Lagos on health grounds. I relapsed during my NYSC while teaching in a prestigious school which was an opportunity of a lifetime. I ended up spending half of my NYSC time in the hospital.

“Since I finished the service seven years ago, I have not been able to secure a job as most employers are reluctant to hire someone like me who is already close to 40 with no relevant work experience. The closest I got to working was an internship in a large firm but I just couldn’t cope and fit in since I lacked the basic skills to function in the workplace. I am really scared for my future as my parents are close to 70.

“I am hated by my siblings and family members who see me as a failure and a liability. It is also difficult to cope with taking my drugs, but it is compulsory to avoid relapse. One of my siblings even threatened to sell our family home and toss me into the streets when our parents die. Another one told me to my face that while he was more compassionate than the other one, he will confine me to an institution since I have refused to work and earn a decent living. They don’t realise that it is not as if I am lazy or hate work, the illness, and the medications that I take as well as monthly injections are standing in the way of my being able to effectively function in the world of work.”

When asked if he would love to consider entrepreneurship as an alternative, he said, “Yes, I would love to be an entrepreneur as the paid employment set-up has been rigged against me on account of my old age and health condition. The challenge though is I don’t have any unique problem-solving ideas though I have considered opening a provisions shop near my family house. However, it is a crowded market because there are more than five in my street alone. I really fear for my future and contemplated running away to Europe by road but the fear of a relapse which may get me maimed or even killed by those ignorant of the challenge made me hold back.”

Hidden pains of guardians

Also speaking with our correspondent, a guardian who brought her daughter who she said was in her 20s and had relapsed lamented the emotional and financial burden of caring for someone with mental illness in Nigeria.

She said, “This sickness is a lot of financial strain on the family. Her father is late and so I bear the burden alone and even borrow as well as use my pension funds to finance the treatment as she must take her drugs daily and also take a monthly injection. I also have to physically supervise it as she once relapsed when she confessed that she used to throw her drugs away and so acting on the doctor’s instructions, I now make sure that she takes the pills in my presence.

“She lacks time management skills and couldn’t finish her fashion designing course. She is very creative and good with her hands but needs emotional intelligence and discipline to focus squarely on what she wants to do. She can stand on her feet if she puts her mind to it and how I wish she can develop a mindset of service and stop being entitled as the painful reality of life is that nobody owes you anything.”

Another guardian, a woman who came to buy medications for her son who was on admission said he hoped the son can be gainfully employed to enable him to fend for himself.

She said, “My son is actually the most brilliant of all my five children and we fondly call him the accidental baby since he was born after I was 40 years old. His brilliance is wasting away because of this sickness. He had his first degree and a First Class in a Russell Group University in the United Kingdom then followed by a fully funded scholarship for his Doctorate in an American Ivy League University. His challenges started when he worked with a Big Tech Firm in the UK where he encountered brutal racism. He just couldn’t handle it and went off the rails and he hasn’t been able to hold down a job despite his extreme brilliance. He is the real definition of a living tragedy.

“I sincerely hope that he can at least go back to work so that I can take a well-deserved rest and play with my grandchildren. You wouldn’t believe that he even got a patent after just working for two years which is what came in handy for the funding of his treatment. His father nicknamed him Einstein. If he could get a patent after just two years, imagine what he would have achieved in his ten years of unproductivity. I have even gone as far as seeking spiritual help from some powerful Men of God but all to no avail. I believe in science and hope that one day he would be able to fend for himself.”

WHO’s position

In 2019, the World Health Organisation launched the WHO Special Initiative for Mental Health (2019 – 2023): Universal Health Coverage for Mental Health to ensure access to high-quality and affordable care for people living with mental health conditions in twelve selected countries that covered about 100 million people.

Mental health treatment in Nigeria

Nigeria is, however, yet to have universal health insurance coverage or even highly subsidised medications for people living with mental health challenges. Most patients with mental health issues have to still do out-of-pocket payments for their treatment with many depending on parents or loved ones not just for treatment but for other essential living needs.