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Nigeria is continuously expanding in population and so also are persons with mental health and psychosocial challenges which extends to persons with substance and alcohol problems.

Typically, Nigerian healthcare authorities have always relied heavily on Neuropsychiatric hospitals across the nation to care for the chronically mentally ill, most often using a medication style or intervention form of psychiatry.

It is estimated that in our population of roughly 170 million people that we have 64 million Nigerians who suffer from some form of mental disorder. Outpatient and inpatient treatments and other related services mostly take place in the very few Neuropsychiatric hospitals around the country, many of whom came into existence in the early and middle 1900s. To some extent mental health services can also take place in the few available teaching hospitals, federal medical centers and specialist hospitals.

A case in point is in Lagos State where the federal Neuropsychiatric hospital reportedly receives between 15 and 20 new cases every day and receives from 150 to 200 patients on a clinic day which means in a single day, one doctor may have to see over 50 clients.

An unknown number of mentally ill persons generally manage their conditions with the aid of traditional or native doctors due to the belief that a mental disorder is a result of mystical, spiritual or supernatural powers.

There is no attempt here to dismiss the contributions of traditional practitioners, who have a role to play in regards to the reality of the support they can sometimes provide to ailing persons. Among many ailing persons there is high acceptability and accessibility to these traditional care services which, when viewed from a positive angle, could add value to psychosocial programs within the communities.

The Nigerian government and the people need to understand that the management of mentally ill persons and the support of their families could occur also through a new way of thinking about mental healthcare

It is important to understand that people with mental illness can live properly within the community as long as we build up a process that includes the involvement of the right mental health service providers.

The Community Mental Health Center (CMHC) is a multidimensional system in terms of caregiving being executed collectively, including services such as social work, child and adolescent, psychological, psychiatric, medical, drug abuse, advocacy and other related services.  Historically, community mental health centers are usually non-profit agencies serving those with severe disorders, such as schizophrenia, bipolar disorder, disabilities, and chronic depression.

Funding comes to them from the federal government in the form of grants which are then disbursed by the state governments to the local community mental health centers. Community mental health centers with a good programmatic format provide services such as individualized case management, including a comprehensive assessment of each client's needs, care planning, arrangements of home and community services, referrals to other community resources, and continuous follow-ups.

Every community mental health center should be a part of a comprehensive community care program to allow it to be an integral part of general health services, specifically at the primary health care level since improvement in physical health often complements improvement in the treatment of the mental problems.

There are fewer stigmas when mental health service users are managed alongside those with physical health problems in community-based clinics.

In a community-based mental health center, training is given to family caregivers in order to enhance their coping and resource skills within the community. Also a communal style of treatment could be particularly helpful as it reduces the burden and distress on families, as it is well known in many Nigerian cultures that families have been directly or indirectly blamed for causing their relatives' ailments.

A CMHC allows for a culturally-sensitive treatment where persons are provided assistance, including individuals and families who live with symptoms and stressors of mental illness, and can receive extended home-based services without interfering with daily functioning.

A CMHC's objective is always to assist clients to make positive changes and gain personal growth leading to healthy living.

A CMHC also provides an in-home counseling program that targets high-risk children, frail elders and other family members. It can also provide respite care assistance through certified home health aides, caregiver counseling, and consumable medical supplies and disposable undergarments.

In a CMHC format, elders could be set up in programs with a wide variety of fitness classes, intergenerational events, nutritional assistance, social and cultural activities, and counseling services. Also, a CMHC could provide congregate meals, home-delivered meals, transportation services, recreation and health support services, volunteers and companionship services which could give assistance to elders at their homes.

Alongside the CHMCs are the necessary supporting various types of mental health systems, such as independent agencies, single providers, primary care providers and private practice therapists who usually deliver most of the mental health care needed by people with non-severe mental disorders.

As in America, where the concept of community mental health programs began in 1963 under the late President John Kennedy, the NigerianParliament or National Assembly should enact a Community Mental Health Act to help create community mental health centers across targeted towns and cities throughout the nation.

Focus should be on providing treatment to persons with long-term and disabling illnesses, those being released from prisons and jails (when we establish them), including taking in those being released through deinstitutionalization of this population. A CMHC could also extend help to long-term patients in group/nursing homes (when we establish adequate ones).

For future CMHCs to be effective, it is necessary that there must be an evidence-based practice in line with African-centered studies and results as it relates to mental health science and medicine.

A CMHC concerns itself with caring for people in the community who are in need of treatment integration, continuity of services, appropriate and supportive housing, substance abuse and dependence treatment, victimization assistance, violence prevention classes, employment skills, poverty reduction skills and full psychiatric rehabilitation.

Nigeria, like all right thinking nations, should follow the current trends in mental health in terms of approaching mental health issues from the perspective of prodromal stages—that is, before the onset of psychosis,—on the basis of initial clinical symptoms, family history, and environment changes and stressors in social functioning. A strong focus should be on the practice of preventive mental health services in order to reduce severe mental health illnesses and decrease the costs for the care and management of community mental health centers.

***Dr. John Egbeazien Oshodi is a Florida based Forensic/Clinical Psychologist, a specialist in Police/Prison/Community mental health matters and a former Secretary-General of the Nigeria Psychological Association.

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