World

Nigeria: Fact-Checked – Al Jazeera’s Claims About Nigeria’s ‘Mental Health Problem’

On World Mental Health Day on 10 October 2019, Qatar-headquartered news organisation Al Jazeera focused on Nigeria.

In an online report with the headline ‘Nigeria has a mental health problem’, the broadcaster made several claims. In July 2019, Al Jazeera also reported that Nigeria had a “mental health crisis“.

In an effort to improve the accuracy of public debate on mental health in Nigeria, often an under-reported topic, we checked the accuracy of a number of claims made in the most recent report.

Claim

One in four Nigerians are suffering from some sort of mental illness.

Verdict

unproven

Al Jazeera attributed this statistic to the World Health Organization, estimating the share at “some 50 million people”.

Africa Check contacted Al Jazeera for the source of the report’s claims, and were told that it was against Al Jazeera’s policy “to provide external organisations detailed breakdowns of its public and proprietary sources”.

“The information is factually correct, and you are welcome to independently verify it,” the report’s author said. We turned to the WHO, which also raises awareness on mental health internationally.

What is mental illness?

Mental illness, sometimes referred to as mental disorders, “comprise a broad range of problems, with different symptoms,” the WHO says. But they are generally characterised by some combination of abnormal thoughts, emotions, behaviour, and relationships with others.

Examples include depression, schizophrenia, intellectual disabilities, and disorders due to drug use. Most of these disorders can be treated, the international health agency says.

For data on Nigeria, Dr Mark van Ommeren, the mental health coordinator at the global health agency, referred us to the WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences & Drug & Alcohol Abuse at the University of Ibadan.

Prof Oye Gureje, who is the director of the centre, told Africa Check that the largest nationally representative study on mental health in Nigeria was published in 2004.

Titled Prevalence, Severity, and Unmet Need for Treatment of Mental Disorders in the World Health Organization World Mental Health Surveys, it was carried out in five of Nigeria’s six geopolitical zones in 2002.

In a sample of 6,667 people aged over 18, it was found that one in eight Nigerians had had a mental illness in their lifetime. The most common were depression and anxiety disorders.

There is no newer data from the WHO to show that one in four Nigerians have suffered from a mental illness.

Claim

There are only eight neuropsychiatric hospitals in Nigeria.

Verdict

incorrect

We were unsuccessful in finding an official definition of a neuropsychiatric hospital. Peter Ajiboye, professor of psychiatry at the University of Ilorin Teaching Hospital, told Africa Check that a neuropsychiatric hospital can manage both behavioural and some nervous disorders, such as epilepsy.

“More psychiatric hospitals are now using the name neuropsychiatric hospitals. This is a way of fighting the stigma that comes with the word psychiatric hospital,” he said.

There are eight federal neuropsychiatric hospitals in Nigeria, according to the health ministry. This number is accurate, Emeka Akpa, the administrative head of the Nigerian Medical Association, told Africa Check.

But there are three other state-run neuropsychiatric hospitals in Nigeria, Dr Joyce Omoaregba, a senior consultant at Edo state’s Federal Neuropsychiatric Hospital and secretary-general of the Association of Psychiatrists in Nigeria, told Africa Check.

These are in Port Harcourt, Ondo state and Anambra state.

Claim

Nigeria has Africa’s highest rate of depression.

Verdict

incorrect

Al Jazeera said this was according to the WHO. Country-level estimates on depression rates can be found in the health agency’s 2016 Global Health Estimates. The most recent data is from 2015, Allison Brunier, a WHO spokesperson, told Africa Check.

For depressive disorders, Nigeria does have the continent’s highest number of cases, at 7,079,815. But as a share of the population, at least 24 other countries in Africa have a higher rate of depression than Nigeria’s 3.9%.

The top five are Cape Verde (4.9%), Lesotho (4.8%), Botswana (4.7%), Ethiopia (4.7%) and South Africa (4.6%). Some 47 African countries are covered by the data.

Claim

Nigeria ranks fifth in the world in the frequency of suicide.

Verdict

incorrect

The frequency of suicide is the number of suicide cases in a year and is measured per 100,000 of the population, Dr Joyce Omoaregba, a senior consultant at Edo state’s Federal Neuropsychiatric Hospital told Africa Check.

The WHO has previously told Africa Check that for comparisons between countries, age-standardised rates are the most appropriate. (Note: The organisation does not release rankings and cautions against this partly due to concerns over data accuracy.) The health agency’s most recent data shows that Nigeria’s age-standardised suicide death rate was 17.3 suicides per 100,000 people in 2016. This places the country 15th in the world.

The South American country Guyana has the highest frequency of suicide in the world, at 30.2 suicides per 100,000 people.

Claim

There are less than 150 psychiatrists in this country of 200 million.

Verdict

incorrect

In a 2013 national policy document on mental health services, Nigeria’s health ministry also made this claim.

According to the Association of Psychiatrists in Nigeria, there are 250 psychiatrists registered to it, and 200 psychiatry trainees. All psychiatrists working in Nigeria must also be listed with the association, secretary-general Joyce Omoaregba told Africa Check. Despite some Nigerian psychiatrists moving to other countries, their estimate still holds, he said.

Mental health professionals in Nigeria face several challenges leading many to leave the country, according to Gabriel Onyeama, an associate professor of psychiatry at the University of Nigeria.

These include poor physical environments and weak conditions of service. In addition to improving these, the government should train more professionals, Onyeama said.

Claim

WHO estimates that fewer than 10% of mentally ill Nigerians have access to the care they need.

Verdict

correct

This estimate is from a WHO survey, Prof Oye Gureje told Africa Check. He is director of the WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences & Drug & Alcohol Abuse at the University of Ibadan.

It was from a study on mental health published in 2004. “It is a finding showing that those with severe forms of anxiety and depression and substance abuse rarely get any treatment for their conditions,” Gureje said.

“Other studies show that probably a higher proportion of those with psychosis get treatment, but mainly from traditional and faith healers – and that the treatment is often inappropriate and inhumane.”

In a November 2019 report international advocacy organisation Human Rights Watch highlighted the mistreatment of people with mental health conditions in Nigeria.

Claim

Yaba Psychiatric Hospital had a 2018 budget of N133 million (US$372,000) – but only N13 million ($36,000), or less than 10% of that amount, was released by the federal government.

Verdict

unproven

According to the 2018 appropriation bill released by the national assembly, Yaba Psychiatric Hospital in Lagos was allocated N3.3 billion, or $10.7 million at the official exchange rate. (Note: The hospital is also known as the Federal Neuropsychiatric Hospital.)

Another N134 million was set aside for ongoing construction and other projects.

There is however no detail in the 2018 budget implementation report from the national budget office on how much eventually reached the hospital. The hospital’s management also declined to share this information when contacted.

Claim

By 2018, Nigeria had allocated just 3.95% of its budget to funding its ministry of health.

Verdict

correct

In Nigeria’s approved 2018 budget of N9.12 trillion, some N356.45 billion was allocated to the health ministry.

This works out to 3.91% of the allocated budget, according to documents from the country’s budget office.

In previous years the budget share was higher. In 2015, the health share was 4.24% of the budget, in 2016 it was 4.1% and in 2017 4.17% – or N304 billion.

Claim

Every week, at least 12 doctors leave Nigeria to seek employment in the UK.

Verdict

incorrect

Drawing attention to the number of doctors from Nigeria leaving for other countries, Al Jazeera said the country was losing at least 12 doctors every week to the United Kingdom, citing data from the UK’s General Medical Council.

The General Medical Council is responsible for registering doctors and setting professional standards for all doctors working or training in the UK. Its registry does not make explicit whether doctors are from a country other than the UK or when they arrived in the UK, but does record the “place they were awarded their main medical degree”.

On 7 November 2019, there were 310,527 doctors in the register, a 10.9% increase from the 280,000 doctors listed when we last checked on 25 April 2018.