Neil, I read this posting avidly. Thank you for sharing it.
Mental Health care in Nigeria has faced, and continues to face, many challenges for a very long time even though it was an illustrious son of Nigeria who literally in 1961 'invented' the Community Mental Health Service idea: Late Professor T Adeoye Lambo. He established the Aro Community Mental Centre in Abeokuta, Nigeria. There is a community mental health centre in Cambden, North London named after him. He rose to serve as Deputy Director General of the World Health Organisation in Geneva for 15 years. Today, in most HICs the idea of removing stigma and ignorance about mental illness and caring for the non emergency patients in settings similar to the Lambo Centre in North London where patients can be attended to as out patients. With proper control the patients remain stable to pursue activities that benefit them and society. Even though the Aro centre in Nigeria is still open (even though I notice it is now called a hospital) the idea of community mental health service for appropriate mental health cases, supported by community mental health nurses cadre, and accepted by their family (not ostracised as happens now) has not taken root.
In 2004 as part of a complete overhaul of the Cross River State Health service in Nigeria we attempted to establish a community mental health service anchored on a new cadre of community health nurses, including constructing a centre where patients who are stable after stabilising their acute state, by receiving their long term medication regularly would be taught various trades and vocational skills that would enable them engage in useful activities beneficial to them and society and be able to go back to their local communities and families eventually. The programme started and was very effective in removing vagrant psychotics from the streets of Calabar and other urban towns in the state, and managing them by both medical and other health practitioners with expertise in psychiatry. The rehabilitation centre was still under construction when we left office and was never completed. (BOOK- 'Whole System Repair of Failing health system’. 2009. ISBN: 978-978-49487 -0- 8). More tragically the service idea was aborted.
The greatest challenge to functional and integrated mental health service in Nigeria is the lack of progress on the Mental Health Bill that has stalled in the National Assembly since about 2004. Until that bill is passed and it becomes Law after Presidential assent, efforts like the one in this article will suffer the damage of being aborted along the line. We wish the HAPPINESS project team success in their endeavour because Nigerians need a modern, caring and responsive mental health service which must be community based for all the obvious advantages.
When the Imo state 'pilot' succeeds may it be scaled up across Nigeria with its 36 states and Federal Capital Territory. The team must begin now to work out how the success can be sustained even if a new government is formed after the upcoming elections. Change from one government to the next has killed many a project like this one in Nigeria because of the 'start-stop-start' again method of governance by the politicians, even when a new government is from the same political party as their predecessors.
HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: www.hriwestafrica.com Joseph is a member of the HIFA Steering Group: http://www.hifa.org/people/steering-group
jneana AT yahoo.co.uk