Growing Concern over Paediatric Mental Health

Tunde Alabi is a 10-year-old child. He is brilliant, intelligent and promising. He hails from the academic middle class family of the society which places strong emphasis on academics, upholding good moral and christian values. At the age of seven, he was faced with serious health challenges, which prevented him from performing well at school and living a normal life like his peers. The medical reports stated that Alabi was suffering from symptoms of mental disorders, which was caused by child and adolescent psychiatry.

Alabi is not the only child suffering from this health condition. Many other children are suffering in silence. The parents of some of these children lack the financial withal to give their wards the necessary medical attention. The health burden is a serious issue that the federal Ministry of Health should holistically address, if the nation aspires to achieve full improvement in healthcare delivery in Nigeria.

Paediatric mental health is the branch of psychiatry which deals with the treatment, prevention, diagnosis and prevention of psychopathological disorders of children, adolescents and families.

According to a research work titled ‘Audit of Child and Adolescent Psychiatry in a Teaching Hospital in Nigeria: Prevalence, Pattern and Implication for Improved Services’ by a Behavioural Sciences Consultant in the University of Ilorin Teaching Hospital, Dr. Tunde Ayinmode, child and adolescent psychiatry in civilised societies are characterised by a well-organised mix of service delivery facilities such as hospital, residential and day treatment units, run by a multidisciplinary complement of professionals including psychiatrists, psychologists, counsellors, and social workers.

Through routine or incidental observations and use of screening such as Child Behaviour Scale or Kiddie-SADs, this system ensures that majority of the children with psychiatrist disorders are brought into the net of service delivery.

Ayinmode in the work explained that in developing countries such as Nigeria, the situation is different due to poor services and attendance which implies that both the demands and supply ends of child psychiatric services are undeveloped.

He added that only few children are brought to health service centres because of mental problems, stressing that poverty was a major factor contributing to low attendance rate in clinics.

Another study explained that mental disorders in children are quite common and sometimes severe. About one-fourth of children and teenagers experience some type of mental disorder in any given year, one-third at some time in their lives.

The study further stressed that the most common kind of mental disorders are anxiety disorders, like over-anxiousness or separation anxiety disorder. Other common types of mental illnesses in childhood include behaviour disorders like attention deficit hyperactivity disorder (ADHD), mood disorders like depression, and substance-use disorders like alcohol use disorders.

A consultant in Child Adolescent Psychiatrist at Mcmaster University Onatario, Canada, Dr. Olabode Akintan, noted that 70 per cent of patients with mental illness have the first episodes or signs occurring in childhood, therefore early intervention is the key to a more favourable outcome, “the intervention should come through diagnosis and early treatment.”

He stated that the process of growth and development in any individual is unique, therefore there are some behaviours expected from children which are regarded as normal; but if there is a change in the pattern of behaviour of a child such as increased isolation, lack of interest in previously enjoyed activities, changes in sleep, appetite, energy levels or significant new behaviours which maybe negatively interfering with daily life, then those signs could be indicators of an illness in that child.

Akintan who explained that there are several factors that contribute to the development of mental illness in any individual, added that the genes individuals inherit from their parents and share with their siblings’ means that if a parent or a sibling has a mental illness, they are at increased risk of developing a similar or related illness.

“There are some social determinants of health such as socio-economic status, degree of community involvement as well as the personality of the individual that could contribute to the individual’s ability to either succumb to or protect from the development of mental illness. Our culture and strong religious affiliations for instance can be protective in some instance,” he stressed.

The Child Adolescent Psychiatrist remarked that the long term effects of untreated mental illness are profound, stressing that depression for instance is a leading cause of lost productivity in the workplace worldwide and mental illness is also associated with increased risk of suicide, “these are in addition to the negative effects untreated illness has on relationships with family, friends and peers. But the good news is that treatments exist and can change the course of life for many people.”

 The State of Mental Health in Nigeria

He explained that there have been reports on the state of the mental health system in Nigeria, and one of such reports was the WHO-AIMS report which was completed in 2006; stressing that though the report revealed quite disappointing news about the state of things, but the ability to generate such report was a first step in tackling paediatric mental health in the country.

“A lot more work needs to be done. There are people in the country who dedicate themselves to the care of people with mental illness who should be recognised and whose work should be afforded the same credibility and attention that childhood cancer or adult stroke treatment receives,” he urged.

Akintan further stressed that the psychological impact of mental illness is similar across cultures, noting that the language we use to express it may differ and the cultural differences can influence that but in general, there are more similarities than differences, there are some culture bound syndromes but these constitute a minority.

The consultant, who made a comparison of Canada and Nigeria, explained that Canada is a vast piece of land, with a lot of that area uninhabitable due to extreme weather; some indigenous people still live in these extreme situations since their ancestors have lived there. They find their livelihood there and are for the most part self-sufficient due to the logistic challenges of accessing these places.

He added: “Medical care in these areas is limited and in this regard there are some similarities to the situation in Nigeria. Creative means are being sought to provide good quality care in these areas and some include the availability of remotely available expertise via videoconferencing, so that doctors can see and engage with the patients without having to be physically present in the room.

“This is a growing model of care that I employ in my own practice. Besides this, I will say that any solution for Nigeria has to be home grown. There are unique circumstances in Nigeria that are quite advantageous to us and our solutions have to take these into account.”

He urged the federal government to recognise that public awareness of mental illness and its impact in our society is important; therefore government should invest in enlightenment campaigns.

The Canada-based Paediatrics called on the public to change their views about mental illness and the cost, stressing that the process would involve recruiting institutions already in existence such as churches, religious organisations and educating them on the nature of mental illness and the role they could potentially play to improve the overall health of their congregation.

He stated: “I would also suggest looking within for home grown experts, investing in their professional development by encouraging them to acquire skills from places in the world where this knowledge exists and then investing in the development of services guided by these local experts. These processes can occur in parallel. There are people within Nigeria who have given these issues a lot of thought.  I implore government officials to seek them out and listen to them.

“We are looking into how we can better identify diseases early and how we can define syndromes more accurately so that the issues of over diagnosis, under diagnosis or misdiagnosis are reduced. We are also looking into better and safer medications to help treat individuals with mental illness as well as developing new models of therapy that reduces the need for potentially harmful medications.”