The Editor-in-Chief conducted a no-holds-barred interview with renowned psychiatrist Prof. James Taiwo Obindo.
Below is the conversation:
What informed your decision to pursue a specialization in psychiatry after leaving OAU in 1995?
My decision actually predated my qualification from OAU, right from when we went for our postings. My first day at the psychiatric ward was full of apprehension, like anybody entering a mortuary or a cell or a prison out of nowhere, somebody jumped from my back and was hanging on me, shouting My husband, my husband. I was like asking the ground to open, and somehow I should enter, but somehow I was rescued from her. That wasn’t the major one. Within a week of that experience, she recovered, and she came over and apologised. And from my experience, people in internal medicine people in surgery know so much about their patients, but their patients die. But from this experience, I saw that I could actually make an impact. Yes, the discussion about cure may not be there, but we can recover; people can go back to their premorbid functioning. This fast was an interesting one.Â
Secondly, because of the ASUU strike, we had to do the posting twice, and in Ife, we spent three months, then in psychiatry for undergraduate posting. So we spent three months posting, but in this particular instance, because of the ASUU strike, I spent 6 months in psychiatry. And last but not least reason why I chose psychiatry was Professor Roger Makajuola who was our teacher who was our CMD, and subsequently provost and vice chancellor. His ethics for work, his readiness to help, his demeanour despite being a CMD, provost and the VC, he was down to earth and very friendly, those were the reasons why I decided to be in psychiatry.
What should be the appropriate ratio of psychiatrists to patients in Nigeria?
The recommended ratio is 1:10000. In some climes, you will equally have 1:8000, 1:7500. But in our own environment, with the population being in the region of well over 200 million, we would have one psychiatrist for close to a million, given the number of psychiatrists that we have. We have less than 300, and with the population of 250 million, or some people say 230 million, we would have close to one million people to one psychiatrist.
How can we end the stigmatization of the mentally challenged in Nigeria?
We need to educate, we need to advocate, we need to make people realise that mental health is everbody’s concern and everybody has mental health and everybody that has mental health which means has a brain is predisposed to developing a mental health condition and therefore we need to be conversant of this and what helps is educating people that people develop mental health conditions not because they sinned, not because they are cursed, not because they did anything out of the ordinary. It’s largely because they have a brain and they are predisposed to having mental health conditions, whereas those who don’t have mental health conditions do not have 2 heads. It’s just that by God’s grace, they have not developed it. If the environment is made conducive, everybody who has a brain will develop a mental health condition.
How can we tackle ignorance about mental illnesses, as most time it is attributed to spiritual attacks?
Ignorance is what actually promotes stigmatization and discrimination. the causes of mental illness is an interaction between the nature ie the genetic predisposition and the nurture ie the environment the person grew up in. if people are well educated, well informed via sensitization programmes, inclusion of mental health in the curriculum of primary, secondary and tertiary institutions and then making the religious leaders know what exactly constitutes mental health condition and how this comes about and how they can be treated people can then be helped knowing that it is not a spiritual attack, it is not something that comes as a result of curses and it is not because people use substances, yes some use substances that develop mental health condition we also must be able to let them know this so education, sensitizaton and information are the sure way of making sure that this ills are removed from the mindset of people.
Is it possible for psychiatric patients to get weaned off the medications?
Certainly, yes, it is taught in the past that ist episode of mental illness can result spontaneously with or without treatment, another third can be treated, and they recover with medication or psychotherapy, and the last third may have a chronic form of the illness, which means it can be there for a very long time. So, presenting early, those who have their first episode and present early can actually be managed and then treated well. For those who have a significant life event as a source of the illness, ie loss of relations, loss of a particular significant thing, can actually be treated, particularly when the precipitant can be handled can be resolved, people recover, and they function well and revert to their premorbid personalities, the premorbid way of life, premorbid functioning.
 How can the workplace better support psychiatric patients who need to go for medical appointments?
One of the items in the National Mental Health Act 2021 is the fact that employers are mandated to assist employees who develop a mental health condition. If the employers are not judgmental if they dont stigmatize, people will have the free environment to come out and then identify as those who have mental health conditons and therefore the office of the employer should encourage the person to seek the right help, secondly to go for their follow up visits, thirdly to also assist with some form of assistance with the medication whether subsidizing it or making sure that national health insurance act is available.
Are there dangers to the baby of pregnant psychiatric patients as a result of the antidepressants?
Generally, antidepressants do not affect the growing embryo, though teachings talk about avoiding the first trimester of pregnancy. Largely, most of the old generations like the tricyclic antidepressants do not really impact the growing embryo, but the newer generations, because they have not been studied for long, one would need to be cautious in their use.
How can patients better manage the side effects of the medications?
The best is to report to the prescriber that these are the side effects I am having, and the person who prescribed knows what the side effects are likely to be and therefore can help the individual manage the side effects if they occur.
About fourty million Nigerians suffer from mental health crisis, how can we better manage this glaring health challenge?
I would just list them.
a.) Implementation of the new Mental Health Act 2021 by establishing the mental health services department, setting up the screening committee and establishing the mental health fund.
b.) We need to look at the funding for mental health; largely, what we have now is limited, and the whole budget for health for now is about 6 per cent of the budget, and the recommendation for health is about 15 per cent, and if we increase the budget for health, it will trickle down to mental health also. We also need to look at the integration of mental health into primary health care, whereby, as most Nigerians live in rural areas, they can easily access the primary health care and one form of mental health treatment or the other and then can be referred if need be from that local place at the primary health care.Â
Also, we need to stem the tide of people japaing – leaving the country in droves so we can have more hands on the ground to attend to mental health conditions. If we do all this, we will definitely make a difference, and of course, improving the remuneration of those who are in the mental health field will also go a long way in encouraging them to remain and to stay.
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