Today’s paper is ‘Developing Mental Health Services in Nigeria’ published in the Journal ‘Social Psychiatry and Psychiatric Epidemiology’ by Eaton and colleagues in 2008. The paper begins with a remarkable discussion of the psychiatric services set-up in Nigeria where there are only 100 psychiatrists in the entire country (with a population of over 100 million) and 4 psychiatric nurses per 1,000,000 of the population (there may have been a typo in the transcript, but there are 2 commas so I presume its a million). Recognition of mental illness is also not well developed in the Igbo people’s of south-east Nigeria where the family look after sick relatives.
The authors describe how mental illness in this culture can be viewed in the alternative terms of being a ‘spiritual attack’. This may then lead to treatment in prayer houses or by traditional healers who may use methods ranging from herbal medicines to chaining or fasting.
In Nigeria, there have been developments in the health services and now psychiatric care has been incorporated into primary care. The authors describe the work of a mental health awareness campaign that was funded by Comic Relief. Briefly the campaign provided training for staff as well as transport. Community Psychiatric nurses use motorbikes to travel to people’s homes where they prescribe some medications, as well as looking at other issues e.g. social issues. Volunteers within the community were chosen and trained to help with the awareness campaign.
In the study, the effectiveness of the campaign was measured by a change in the number of people attending a psychiatric clinic that had been running prior to the campaign. While there appeared to be a seasonal variation in number of clinic attendees, the researchers found a significant increase in the number of attendees in the months immediately following the campaign.
They used a linear model fit of the data. In this model it is assumed that if the model is correct the data should ideally fall along a straight line. They use some calculations to see how far away from the line the points actually lie and then draw conclusions about the relationship. They found that when looking at the entire year including the two months after the campaign the R2 value was 0.48 and was significant (p=0.01). When they looked at the first 10 months of the campaign the value of R2 was only 0.14. If this was a significant result it would have suggested almost no relationship between time and number of visits to clinic for the first 10 months. However the p value was 0.28 – and so they could only draw inferences about the whole year as outlined above.
This number dropped with time although it remained above the baseline measure suggesting a longer term benefit of this campaign. This was a neat study, looking at awareness through number of people attending clinic although it didn’t give an idea about any shifts in practice in the community.
This is a simple study which shows the benefits of raising awareness of mental illness in the community. The next stage would be to measure the effect on the mental health of the community
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