Author name: Noetic Minders Health Services

Mental Health

Men and Boys Do Cry! Engaging With Men’s Mental Health, By Margaret Uddin-Ojeahere.

Prioritising men’s mental health is not only essential, considering the relationship between mental health, physical health, relationships, and productivity, but vital for building healthier societies. … it is high time we discard the archaic slogan and replace it with, “men and boys do cry,” and begin to push narratives that support this. It is also important to acknowledge that boys and men experience emotional and physical pain, often in ways that go largely unnoticed or unacknowledged. Therefore, societies should know, in order to recognise and address disparities in responses to trauma, regardless of gender. After all, justice and health care cannot afford to be selective, neither should empathy be conditional. June is considered men’s mental health awareness month in some parts of the world. A simple interpretation of this is that there ought to be increasing awareness of men’s mental health on all days or most days in June. The questions now are: Is there a need for conversations around men’s mental health and should it be limited to a particular time of the year? After all, men have long been expected to endure in silence, shaped by social norms that equate emotional suppression with strength. As a result, men appear to do a good job of masking whatever turmoils they struggle with. However, the reality is that mental health conditions affect men just as profoundly as they do others, and neglecting these discussions can have dire consequences. Men’s mental health, which is seldom discussed, can suggest that there is sufficient awareness of the topic or that men do not have mental health problems of substantial dimensions in Nigeria. Reinforced by societal expectations that men must be physically dominant and emotionally resilient, discouraging them from expressing vulnerability and forcing them to internalise their pains. While this erroneous concept undermines men’s mental health, it is hardly surprising that countless men suffer in silence, breaking down after years of maintaining a facade. An example is the story of James, a 38-year-old father of two, who had been struggling to provide for his family after losing his job. As financial stress mounted, he felt increasingly overwhelmed, insecure, and anxious about the future. His sleepless nights and diminished libido strained his relationship with his wife and his children noticed his growing irritability, lack of focus, and disinterest in their usual fun activities. About the same time, James withdrew from his friends, avoiding conversations about his emotions, convinced that expressing vulnerability was a sign of weakness. Over time, he developed persistent headaches, chest tightness and fatigue, symptoms that he attributed to stress. A trusted friend encouraged him to seek professional help, but James hesitated, fearing judgment and the stigma of being perceived as weak. James’ experience highlights how many men mask their struggles, fearing judgment or dismissal. His turning point came when he finally acknowledged his pain and sought help. Unfortunately, not all men will embrace their vulnerabilities, or be able to access appropriate mental health care, for reasons that span stigma, socioeconomic hardships, to social status and beyond. Recently, Brigette Macron was caught on camera giving her husband, the president of France, an allegedly playful slap; an incident that left the world wondering if it was domestic violence or just lovers’ banter. Media was awash with memes and questions that tried to ascertain whether it was an affective or aggressive gesture. Unsurprisingly, it was short lived, as most sensational news are, but it was quite disappointing to see the scarce presence of social justice groups advocating for the rights of men. Not that I am recommending random groups creating chaos, but the whole shebang left me pondering what would have happened if the roles were reversed. Quite ironical, in a world that champions gender equality, the stark contrast in responses to violence against men and women is painfully conspicuous. Perhaps, because we have normalised women as victims and men as perpetrators. A stance that perpetuates inequalities and exacerbates mental health stressors, permeating everyday life even in vocabulary, with terms such as “man up”, “real men don’t have mental health problems” and “men don’t cry”. Apparently, reactions to physical altercations often differ on the basis of gender. A man being slapped by a woman is frequently dismissed as insignificant, with shades of amusement, while the reverse scenario sparks outrage and demands for accountability. This phrase by a colleague – “he gets hit and the world looked away, but if she is hit then we call for his head” – encapsulates a troubling reality; that society often reacts differently to trauma, depending on gender. Quite ironical, in a world that champions gender equality, the stark contrast in responses to violence against men and women is painfully conspicuous. Perhaps, because we have normalised women as victims and men as perpetrators. A stance that perpetuates inequalities and exacerbates mental health stressors, permeating everyday life even in vocabulary, with terms such as “man up”, “real men don’t have mental health problems” and “men don’t cry”. Newsflash! Crying is a normal human physiological activity, so men do cry, and it is therapeutic too. In fact, it is high time we discard the archaic slogan and replace it with, “men and boys do cry,” and begin to push narratives that support this. It is also important to acknowledge that boys and men experience emotional and physical pain, often in ways that go largely unnoticed or unacknowledged. Therefore, societies should know, in order to recognise and address disparities in responses to trauma, regardless of gender. After all, justice and health care cannot afford to be selective, neither should empathy be conditional. However, it raises several concerns about double standards in violence, forms of abuse men face, their reactions, accessible care and the consequent mental health implications on men. In pushing the narrative that “men and boys do cry”, then one should be ready to challenge the traditional masculinity notion that men should mask their emotions. Incontrovertibly, normalising open conversations about men’s mental health through tangible and digital platforms is crucial in

Mental Health

Noetic Minders Health Services Brain and Art Initiative organised the Sip and Paint Wellness Break.

Noetic Minders Health Services Brain and Art Initiative organised the Sip and Paint Wellness Break A program designed to promote mental health wellness through creative expressions, stress reduction, and social connection. The event provides a relaxing and artistic outlet, one that supports emotional wellbeing and resilience, and allows participants to unwind, connect, and explore creative self care. The maiden edition saw a rich gathering of people who embraced the importance of wellness and mental through music, creative arts (painting, drumming circles, and dancing) in an idyllic and luxuriant setting.P.S – Did I mention that the food was so amazingly sumptuous that the suggestions were that it should have been a “Munch & Paint” and the the Jazz was ethereal.

Mental Health

Adopting a mentally healthier 2024 and the “no gree for anybody” mantra, By Margaret Isioma Ojeahere.

Enjoy a healthy 2024 as we “no gree”for harmful mental health practice. It is important to state that I do not equate “no gree for anybody” with aggression/irritability or anger in all instances. However, I think it is important that in resisting people riding us roughshod and demanding better conditions, we should be mindful of boundaries, people’s idiosyncrasies, and our mental and physical health as well as that of others. Perhaps we can re-channel the “no gree for anybody” and adopt the “no gree for unhealthy mental health” mantra. A few days ago, the air was filled with cheer: Resounding with echoes of “happy new year” and the characteristic exchange of pleasantries to usher in the new year. Goals were set. New year resolutions were made and perhaps broken almost immediately too. And not a few people had high aspirations for a better year. If I am to go by what I have seen and heard, health and wellbeing appear to be strong considerations for the new year. In prepping for a better and healthier 2024, a substantial number of people have cited mental health as topping their priority lists and plan to be deliberate about safeguarding their mental health. In no small measure, the increasing attention given to mental health, albeit inappropriately, is welcome. Afterall, we cannot aim for a healthier society without healthy mental states. However, I cannot help but muse over the new mantra “no gree for anybody” and its many variations that allegedly came into public space towards the twilight of the preceding year as a slogan for 2024 among Nigerian youths — but which now appears to have been adopted across age groups. It can be described as upholding one’s rights, defending one’s turf, or being more decisive. Certain people have argued that the mantra speaks to a positive move for a better country by its youths’ resisting acquiescence, which is presumed to be part of the sundry problems that have plagued Nigeria, insisting that it is high time to demand for improved conditions. In other words, the desire for change for a better Nigeria. Anyway, like every ideology there are bound to be outliers who will distort the underlying good intentions and there is the possibility of it being misrepresented or understood. Little wonder the spokesperson of the Nigeria Police Force described it as a nidus for rebellion and expressed concerns about the trending mantra and its revolutionary tendencies. Although, such innuendoes can be unsettling and appear as threatened infringement of one’s human rights, it is appropriate to remind the citizenry to act within the confines of the law. Contrary to the seemingly austere warning from the Nigeria Police Force, the endorsement of the mantra with regards to security issues by the representative of the Nigeria Defence Headquarters was a more charitable action. Now, the question is: What is the relationship between the “no gree for anybody” mantra and the angst of a psychiatrist? Or simply put, what has this mantra got to do with mental health? As a psychiatrist, I prefer to interpret the “no gree for anybody” mantra as one that motivates individuals to be more assertive, confident, and resilient. One that spurs individuals to aspire for actualisation and these seem to be the case in some situations. Intriguingly, information from social media suggests that some individuals in their pursuit of wider social media visibility and “likes” use this “no gree for anybody” mantra to showcase aggression, bullying, intimidation, and egomania. Quite disconcerting is the interpretation and display of “no gree for anyone” as aggression, irritability, or anger in its subtle or profound forms. Usually, there exists a bidirectional relationship between the subject and the target. Anger can be a normal reaction to untoward events, information, thoughts, and/or actions directed at a person or thing. It can be a positive and valuable emotion, if properly harnessed. Certain others who perceive forms of disenfranchisement have adopted the mantra as an opportunity to project distress emotions, such as aggression or unusual anger. Although, these actions can be argued to be part of the process of evolution from subservience to boldness, a phase of change from learned helplessness to emancipation in a population that has been largely marginalised, I have concerns about the significance of these on the mental health of all involved. Quite disconcerting is the interpretation and display of “no gree for anyone” as aggression, irritability, or anger in its subtle or profound forms. Usually, there exists a bidirectional relationship between the subject and the target. Anger can be a normal reaction to untoward events, information, thoughts, and/or actions directed at a person or thing. It can be a positive and valuable emotion, if properly harnessed. Conversely, it can be a symptom of ill-health, or reaction to the threat or experience of an illness, its course, management, or the outcome of the illness. Studies have linked mental health conditions such as depression, anxiety, self-harm, and some physical health conditions such as elevated blood pressure, headaches, and migraines with anger. Biological, psychological, socioeconomic factors including the changing climate have been identified as causes of aggression/anger. Unsurprisingly, current conditions in Nigeria present a good medium for varying levels of aggression vis-à-vis health concerns. Therefore, in asserting our posture, we should be mindful of our actions and words, how we use them and who we use them on. Targets of hostile actions such as bullying, intimidation or aggression may experience mental health conditions such as anxiety, post-traumatic stress disorders (PTSD), depression and in some cases, have recourse to suicide. A great number of Nigerians are experiencing forms of emotional distress. Some people are like the Indian rubber ball that bounces back while some are at their wits’ end. Some people may see the “no gree for anybody” as a call to claim their rights and some for better governance, while for the person on the receiving end, whose struggle you may never know, it may just be the last straw that will crush his/her resolve

Mental Health

Broadcast Media and Mental Health. By Margaret Uddin-Ojeahere.

Appropriate resources and regular training on proper dissemination of information on mental health should be offered to journalists, media enthusiasts, script writers and content creators, taking into consideration the sensitivities of people with lived experiences and their caregivers. Media establishments, the entertainment industry, health care providers and regulatory bodies are indispensable to mental health information. Appropriate resources and regular training on proper dissemination of information on mental health should be offered to journalists, media enthusiasts, script writers and content creators, taking into consideration the sensitivities of people with lived experiences and their caregivers. I had put off writing in the media for a while. At some point, concerned persons had reached out to ask if I had also “japa-ed” (a Yoruba word that has become an euphemism for emigration). I must admit that to jump ship has been a tempting recourse in the past triennium, considering that one is constantly confronted by the ills of our society: the insecurity, worsening inflation, a decrepit health sector, successive draconian decisions, and the policies of Nigerian lawmakers which continue to fuel widespread system collapse. Nevertheless, I am aware that there are numerous doctors in Nigeria who still hang on to the tendrils of hope for a better tomorrow and have put “checking out” or “japa-ing” on hold. Recently, on my way to work, these themes ran violently into each other. I was tuned into a radio programme, where I had to endure the ordeal of listening to some “expert” from a different field from mental health lecture listeners on mental disorders and treatments. The horror I experienced listening to this individual, who felt qualified enough to brazenly misinform the public, was profound. It did not help that the call-ins during the programme spurred further misinformation. What was remarkable though was the confidence and eloquence of the “expert’s” delivery. It was almost incidental that he was also endangering uninformed listeners. I shuddered and cringed through the broadcast. But I could not phone in. The phone lines to the studio were ringing off the hook, and bear in mind that I was driving. I also reckoned that taking up arms against a speaker on radio would not have been the best approach and may have further fuelled animosity and misconceptions about mental health professionals. Again, it would have been unimaginable to insinuate that the speaker, who was highly recommended by a popular radio presenter, was spewing misinformation and worsening the stigmatisation of people living with mental disorders. As I listened, I pondered the increasing number of these “neo-psychiatrists” who appear suave, voguish, and knowledgeable. Traits that interestingly appeal to unsuspecting individuals, yet predispose them to exploitation. It was instructive how these traits are rarely found amongst qualified specialists who aim to ensure optimal health and are less bothered about how their appearances or speech patterns come across. On the flip side, there are the lower classes, barely able to afford transportation costs for the next hospital visit, who struggle to procure medications and often skip doses so that purchases last longer. Several of this latter cohort will with gusto seize upon the offer of a purportedly cheaper alternative for an ailment that they still struggle to accept is not wholly supernatural. A little dose of misinformation by these snake oil vendors may be all they need to revert to “questionable unorthodox” care. Afterall, the nostrum on offer is similar to cultural practices and beliefs they can easily relate with. Professionals cannot continue to adopt the practices of old to tackle the challenges of the new. It is no longer tenable to stay within the confines of treatment facilities and allow charlatans to take over the mental health space, misinform people and in the wake of this, have qualified professionals left to deal with the complications of their ill-guided actions. I am not saying that unorthodox care is all bad. But in several instances, people with mental disorders have been exploited by quacks under the guise of cheaper care. There are reported cases of the administration on unsuspecting persons of unregulated doses of antipsychotics and psychoactive drugs included in herbal concoctions. Some of the recipients of these interventions have been physically and sexually abused, culminating in worsened states and complications that warrant medical interventions. A number of these incidents present as would be storylines off Nollywood movies, but the damage they lead to are as real as their occurrence in our clinics. A slight drift to Nollywood: an institution that for too long has stigmatised people with mental disorders and lags in its portrayal of mental disorders – depicting them as ailments without treatment and without hope of returning to normal functioning. But again, aren’t some Hollywood movies guilty of this too? I did not get to muse for long though, as I had arrived at my destination and was jolted back to my reality. The reality of most doctors who have stayed back in Nigeria. A long waiting line of people who require medical consultation, mentees to be trained, and other administrative matters to be addressed. Any issue I had with the radio programme was repressed and archived for a later date. However, this time around, rather than stay in the archives, the experience reignited the need to contribute to the dissemination of accurate information on mental health and appropriate treatment channels. Enough of wishing things were done differently, whispering, or exclaiming at what has and had not been done. I have long realised that while wishes may work in fairy tales, they do not work in today’s world. The time for one to play one’s part in realising the desired change in basic assumptions is here. Professionals cannot continue to adopt the practices of old to tackle the challenges of the new. It is no longer tenable to stay within the confines of treatment facilities and allow charlatans to take over the mental health space, misinform people and in the wake of this, have qualified professionals left to deal with the complications of

Mental Health

Why digital technology could worsen mental health conditions – Margaret Uddin-Ojeahere.

Consultant Psychiatrist and a Fellow of the West African College of Physicians, Dr. Margaret Uddin-Ojeahere, says digital technology has helped in the management of mental health practice and helped to create awareness about improving how people accept mental health conditions. But there is still much more that technology and awareness creation can do to manage the entire spectrum of mental healthcare including emotional well-being, cognitive functioning, social connections, and overall psychological resilience. The challenges of tech on mental health are on the rise as digital enablement becomes a way of life for millions of people. For instance, ‘infobesity,’ an overload of information and systematic inability to filter info-consumption online in order to maintain mental balance is increasingly becoming a norm of digital existence. Uddin-Ojeahere, a mental health advocate, works at the Jos University Teaching Hospital (JUTH). She shared insights with Tracy Yekaghe of IT Edge News.Africa. Could you share your own perspective on the impact of technology on mental health? Looking at it broadly, technology in our present day and age is something we have to embrace. Increasingly, our world revolves around technology making it impossible to exclude the demands of our daily living from this reality. Nevertheless, it can have both adverse and positive effects on one’s mental health. It is no longer news that increasing engagement on the different social media platforms and prolonged screen time can lead to negative consequences on people’s mental health in diverse ways such as sleep disturbances, exposure to cyber bullying, viewing people’s glamorous lives on certain apps, especially considering the fact that most people share admirable events or parts of their lives and rarely post the negatives. These can result in feelings of inadequacies, low self-esteem and rejection to mention a few and may lead to mental health conditions such as anxiety, depression, addictions, substance use disorders, and suicide at the extreme. There is also the risk of “infobesity which has a lot to do with excessive consumption and overload of information in today’s digital age that can lead to the mental breakdown of that individual particularly if the person has traits of being easily overwhelmed and anxious. So it is important that people are deliberate in filtering and regulating what they consume or are exposed to. On the flip side, technology has helped mental health practice in advocacy, creating awareness about mental health conditions, improving how people accept mental health conditions. Before now, mental conditions were considered a punishment for misdemeanours, curses from gods or having supernatural aetiology. Not forgetting, how stigmatized people with mental health conditions were in our society and in some instances ostracized. But with advancing technology, there is a paradigm shift and better acceptance. Technology has also improved the delivery of mental health care from screening, identifying, diagnosing, and management of people with mental health conditions. One area which technology is playing a vital role is tele psychiatry which is increasingly being accepted as an important means of delivering mental health care especially during and in the aftermath of COVID19. It has helped in the treatment of hard to reach patients and has yielded good results. There are other useful apps that can help users de-stress and some that can guide users to appropriate helplines/centres. In addition, technology has aided the dissemination of information, monitoring and evaluation, training, education and research in the field of mental health. Do you have a word of caution as regards technology and its impact on mental health? There are a number of things that we can use technology for. But in my opinion, I think an important word of caution is that of moderation and regulation, especially in the development and usage of apps and technological devices. It is important to have in mind the consequences (on mental health and other spheres of life) during the creation process so we do not develop what would eventually destroy us. There is also the risk of “infobesity which has a lot to do with excessive consumption and overload of information in today’s digital age that can lead to the mental breakdown of that individual. Could you share some recommendations in line with how the negative impact of technology can be reduced to the barest minimum? I think it is for us to be informed and educated about these things. Let’s know more about it. An example is cutting down on screen time for instance; not everyone might be aware that blue light from their electronic devices can affect their sleep to the extent of disturbing their sleep cycle and may lead to sleep disorders or forms of mental health conditions. Hence, there is a need for awareness to help more people stay guided on best usage practices. We also need to understand and be informed about the age limits attached to the usage of certain gadgets which would require the need for supervision and promotion of usage by critical stakeholders such as parents, schools and others where applicable. What would be your counsel to those who mostly leverage technology for necessities or gainful activities such as work and businesses? I must state that technology is indeed necessary and something we need to embrace, we cannot throw away the baby and the bathwater. No! It is something that is beneficial for our daily livelihood. However, we just need to understand our weaknesses and our strengths so we are aware of those times we might need to either pause or have some timeout or step back in order to maintain or improve not just our mental health but our overall health and wellbeing. Tele psychiatry … is increasingly being accepted as an important means of delivering mental health care especially during and in the aftermath of COVID19. It has helped in the treatment of hard to reach patients and has yielded good results. Would you encourage the usage of latest technological tools to drastically reduce human efforts used to get work done for the sake of sustaining mental health? Absolutely! I am not against technology as it has made life very

Mental Health

Mental Health, Protests and Social Upheavals In Nigeria. By Margaret Uddin-Ojeahere.

Several risk factors associated with poor mental health following protests were identified among youths. …if we are to avoid a mental health crisis in the country, then the time to act is now. It is necessary for mental health practitioners in Nigeria to be vigilant to the psychological aftermath of collective actions, particularly as some symptoms may be covert and manifest long after the event. Researchers should engage in more studies to determine the magnitude of protests and riots on the mental health of people. “Where ignorance is bliss tis folly to be wise” – Thomas Gray Collective actions, be it in the form of riots or peaceful protests, have long been a part of human history. Increasingly, much of the world is witnessing large scale protests and riots against systems of leadership, with the aim of achieving specific goals occurring in their different parts. Ultimately, such actions can either lead to a definite alteration in the existing system of governance or stimulate a domino-like effect, which may lead to the loss of lives and properties. Nigeria presents a good example, with a history of collective actions predating the country’s independence. One’s mind easily flashes to the Aba Riot by women in the Eastern Region of colonial Nigeria between 1929 and 1930. A historical event which has been described as one of the earliest protests documented in Nigeria.  Some scholars have argued that the women’s riot signaled the emergence of the feminist movement in Nigeria. Others posit that it was a cultural protest resulting from the defects in their government at the time. While this remains debatable, what is commonly known about the women’s riot was the collective efforts to oppose socioeconomic, and political injustice by the existing leadership. Several other protests and riots are intertwined in Nigeria’s history and aimed at changing extant systems, unfavourable policies, and living conditions. One protest that Nigerians will not forget in a hurry is #EndSARS, which occurred at a time when Nigerians were only beginning to bounce back from the turmoil of the COVID-19 pandemic and its adverse consequences. The #EndSARS street protest commenced on October 8, 2020 and was spearheaded by Nigerian celebrities, activists, and other young professionals. It held across several states in Nigeria and gathered support internationally. Demonstrators comprised mostly Nigerian youths who discounted perceived social class, ethnic and religious divisions to protest the perennial police brutality, and unrestrained activities of the special anti-robbery squad (SARS) – a unit of the Nigeria Police Force composed to handle violent crimes. The protest raised the awareness of the terror and psychological distress that Nigerians face as a result of the SARS unit and called for its dissolution and reform of the police force. Certainly, there’s no gainsaying the diverse adverse effects that protests and riots have on the emotional and psychological state of individuals. Unfortunately, the focus of attention has revolved around the economic import, and physical and social components of health. Although this appeared as the main theme for the protest, several other issues were brought to the fore. Common grievances were police brutality, the deteriorating health and educational sectors of the country, the worsening socioeconomic state of Nigeria, increasing corruption, and bad governance. The protest represented different things to different people, but to a large proportion of Nigerians, it kindled the hope for the desired change, regardless of whether they were on the streets protesting or not. However, the hope for favourable change was short-lived, as some other groups of youths saw opportunities in the street protest to unleash mayhem, loot and vandalise properties. This was further compounded by the involvement of the military and the use of ammunition on unarmed protesters on the twelfth day of the protest at the Lekki toll gate, referred to as the ground zero of the “#EndSARS” protests. This left a trail of wanton vandalisation, and carnage across states in Nigeria in its wake. The knotty question then is why I have decided to write on the #EndSARS protest several months after its occurrence. After all, it is presumed that the worst is over and Nigerians are “back to business as usual”. However, the sequence of events and the obvious disregard by certain significant authorities for the psychological consequences of such actions on Nigerians  piqued my interest. Certainly, there’s no gainsaying the diverse adverse effects that protests and riots have on the emotional and psychological state of individuals. Unfortunately, the focus of attention has revolved around the economic import, and physical and social components of health. Nonetheless, if we are to attain the appearance of a balanced society, then strategies that support mental health must be adopted. It will be quixotic to expect people who witnessed traumatic events, such as gruesome killings and mayhem, to remain mentally unscathed. However, there is usually an interplay of factors following a traumatic event before psychological conditions manifest. A few include the personality of the individual, the nature and duration of the traumatic event, existing support systems, underlying health conditions and the presence of other stressful events or previous exposure to traumatic events. … it is likely that the aftermath of the #EndSARS protest had differing effects on the mental health of people, generally, regardless of whether they were directly or indirectly witnessed. The increase in distress calls to organisations which provided psychosocial support during the days to weeks following the shooting and carnage suggested this. One event that has and is still taking a toll on people’s mental state is the COVID-19 pandemic. It has heightened mental health conditions and depression has been reported to increase by six to ten times amongst Nigerians. Existing evidence shows that protests and riots, whether violent or otherwise, may adversely affect mental health. The unbridled dissemination of the gruesome images of the mayhem and carnage on social media platforms ensured people across the country and beyond were indirectly exposed. Therefore, it is likely that the aftermath of the #EndSARS protest had differing effects on the mental health of people, generally, regardless of whether they were directly or indirectly witnessed. The increase in distress calls to organisations which provided psychosocial support during the days to weeks following the shooting and carnage suggested this. Similarly, several risk factors associated with poor mental health following protests were identified among Nigerian youths who accessed available helplines.  Consequently, if we are to avoid a mental health crisis in the country, then the time to act is now. It is necessary for mental health practitioners in Nigeria to be vigilant to the psychological aftermath of collective actions, particularly as some symptoms may be covert and manifest long after the event. Researchers should engage in more studies to determine the magnitude of protests and riots on the mental health of people. More importantly, though, is the implementation of concerted actions at addressing the mental health consequences, rather than the usual “talk” and barrage of paperwork. Therefore, it becomes pertinent to establish structures for rapid assessments, psychological first aid, and appropriate referrals following protests. This will require commitment and funding for the provision of available, yet effective treatment, adequately equipped facilities, and motivated manpower. An all-hands-on deck approach should be adopted, right from the individual seeking change on the street to the highest level of government expected to provide a certain minimum degree of good governance to its citizenry. Possibly, what the people need may just be better governance and then the frequency of collective actions will drastically reduce. Perhaps, the time is yet. In the interim, we continue to carry on with “it’s business as usual”. Margaret Uddin-Ojeahere, is a psychiatrist and Fellow of the West African College of Physicians. Also Published on Premium Times Newspaper – https://www.premiumtimesng.com/opinion/450514-mental-health-protests-and-social-upheavals-in-nigeria-by-margaret-uddin-ojeahere.html?tztc=1

Advocacy, Mental Health

COVID-19 Lockdown: Are We Compromising the Emotional Status of Children? By Margaret Uddin-Ojeahere.

Recently, there has been an upsurge of fear, apprehension, anxiety disorders and worsening states of pre-existing mental illness documented in adults. What then happens to children in the COVID-19 pandemic period? Should we be concerned about their emotions? When the news of the coronavirus broke in January, little did the world realise the larger consequences of what the outbreak portends. Not many Nigerians considered the full implications of an imminent lockdown as a way of mitigating and flattening the disease’s curve. The reality of these consequences is dawning on us in varying degrees across Nigeria – as well as impacting all spheres of life across the globe. There has been an increasing strain on the economic, educational, social and health sectors. However, as a psychiatrist, the mental health component is my present area of concern. Particularly the emotional and psychological impact on children. Children, a vulnerable yet significant population of any society, are still mostly seen and not heard, especially in Africa. A considerable number of them still lack the attention and care they deserve or are entitled to. It had been assumed in some quarters that children were somewhat immune to the COVID-19 infection – as implied by early reports, suggesting that children have some degree of immunity to the virus. However, more recent findings show that children are susceptible to the virus and tend to be asymptomatic carriers. A virus with such a complex nature poses challenges and each research supports either an enlightening or confounding information. However, we remain optimistic that we are closer to breakthroughs and the end of the pandemic. The role of precautionary measures in mitigating the spread of COVID-19, leading up to the dissemination of information, have resulted in the media being awash with regular updates, whether appropriate or otherwise. And regardless of the mental health implications on individuals. Not everyone has the mental capacity to handle such information and really for how much longer? Considering that these consequences can be short, intermediate and long term. Recently, there has been an upsurge of fear, apprehension, anxiety disorders and worsening states of pre-existing mental illness documented in adults. What then happens to children in the COVID-19 pandemic period? Should we be concerned about their emotions? Children constantly bear the brunt of major life events and upheavals, yet are unfortunately side-lined in some situations. They are at a stage where they learn by observation and imitation. They look to their parents and carers for answers, support and tend to feed on the emotions of adults around them, modelling their behaviour patterns after them. The current disruption in schooling, their normal routine and deprivation of social support systems consequent on the lockdown, may predispose children to some form of psychological distress, if not properly managed. It therefore become imperative for parents and carers to provide the predictability needed to ensure mentally healthy children in the short and long terms. This may require periods of learning and play. Also, a good time to acquire other skills such as art and craft, learning to play an instrument, learning sign or a new language. With significant life events, adults tend to be embroiled in their own concerns and there is the tendency to neglect the emotional needs of their children or assume their wards are not affected by these events. Children, on the other hand, communicate their distress in several ways and their reactions differ across ages, cognition, personalities, experiences and support systems. Some may manifest vague symptoms or mimic symptoms of an observed disorder. Whereas, others with prior adverse experiences or some form of psychological challenges may exhibit more obvious symptoms. Some common symptoms include some becoming more clinging, irritable, or throwing tantrums. Some may have night terrors or nightmares, start to bed-wet or a child who had previously stopped, begins to bed-wet anew or develop changes in their eating patterns. The older children may excessively engage in playing video games, using the internet or bingeing on television. It is important to place a premium on the emotions of children. To respond and explain with honest, age appropriate answers, putting in perspective their individual traits and uniqueness. There is a need to be more caring, establish an environment that radiates love and warmth. It is important to reassure them regularly and keep optimism high. Children need to have predictability, such as a regular routine to mitigate their fears and concerns. A need to maintain some level of social connection, despite the apparent chaos. It therefore become imperative for parents and carers to provide the predictability needed to ensure mentally healthy children in the short and long terms. This may require periods of learning and play. Also, a good time to acquire other skills such as art and craft, learning to play an instrument, learning sign or a new language. Fortunately, there are several online platforms where they can access these. Noteworthy is the importance of monitoring and regulating the extent of information on the pandemic they are exposed to. It may be necessary to have specific times of the day when they view their phones and other digital platforms. All these are however dependent on the parents’ ability to procure data, materials for fun activities in a period of limited resources or access to electricity. However, not all anxiety-lessening activities require much funds. Exercising and performing house-chores as a family or team helps to reduce anxiety and increases bonding. Not forgetting the importance of eating healthy and getting adequate sleep, which enhance their immunity and promote sound health. There is a need to keep faith as a family, believe in God, find strength and assurance from the Holy book. Research has repeatedly shown that belief in an entity greater than the self or humanity gives hope, enables coping with untoward events and minimises catastrophe. How can children who dwell in a part of Nigeria where electricity is a mirage appreciate the relentless efforts of agencies and information on COVID-19? Or youngsters who have been deprived of basic

Advocacy

The Rarity Of Elder Abuse In Nigeria: A Misconception Or Reality? By Margaret Uddin-Ojeahere.

…abusers of the elderly include the relative or caregiver who denies access to regular food, hospital visits, drugs and general care, the in-law who constantly belittles and taunts the older adult living in her/his child’s home, to the government official who is in charge of disbursing fund for that aged pensioner. Old age is a phase in life associated with changes in social roles and capabilities. Lax muscles, memory loss and other aging processes set in, not forgetting the elderly’s predisposition to health challenges. Nevertheless, everyone hopes for long life in good health. Plans for this golden age differ from person to person, but generally most people just hope for a peaceful retirement or aging process. While this may occur in other climes, it remains largely aspirational in these parts. However, elder abuse, is one unspoken blight of the aging process. How much of our transition from a people with a culture of strong social support systems to an increasingly individualistic society contributes to the gradual neglect and abuse of a vulnerable section of our population? The context for this question was recently provided by reports on social media of a young man who flogged his grandmother, whose witchcraft he believed was responsible for his perceived misfortune. As bizarre as the recent case may appear, it is not an isolated occurrence. Over the years, there have been cases of the elderly being accused of witchcraft and in dire cases lynched. Europe’s witch hunts of the 16th and 17th centuries easily come to mind. Mental illness has been implicated by researchers in the latter period as cause for the gruesome execution of tens of thousands of people, following claims and suspicions of witchcraft. One might argue that these events occurred when mental illness was poorly understood and insist that such actions no longer occur in societies. It is deeply disturbing when acts that remind us of man’s inhumanity to man still occur in the 21st century. Prevailing levels of ignorance of the needs of and disregard for the elderly, makes it necessary to shed some light on elder abuse. Perhaps, it is important to be reminded that they are at a phase in life when their health deteriorates, cognition declines and common mental health conditions, such as depression or dementia, may manifests. Dementia is a mental illness characterised by progressive, usually irreversible affectation of memory, intellect, personality and behaviour. The individual experiences worsening forgetfulness, usually of recent information. As the condition progresses, memories of older things and events are forgotten and sufferers often appear confused. They struggle to remember names of familiar people, things or landmarks, and wandering tendencies may ensue. Sufferers may experience situations where they erupt violently from the frustrations of not being able to carry out their previously routine activities, such as dressing up or feeding. As the illness worsens, defecating and urinating on self become the norm. All these may manifest as bizarre and worrisome behavioural patterns perceived by caregivers as being deliberately stubborn, mischievous and inconsiderate. Thus, providing the platform for abuse of the elderly. It is not uncommon to see a depressed, elderly woman confess to events which she knows nothing about. However, before we get machetes and sticks out, excited over catching another witch who has been exposed, it helps to consider that such “confessions” might be the effect of feelings of guilt or delusional beliefs arising from depression… Depression is another condition which the elderly struggle with and has been described as common in this age group, considering that this stage is fraught with losses (loss of loved ones, social roles, certain body functions) and major upheavals. Interestingly, depression in the elderly does not usually present itself with sad moods, as seen in younger adults. It is usually characterised by vague body pains and aches. Some researchers have postulated that the recurrent complaints suggestive of arthritis might just be symptoms of depression. Memory problems, changes in sleep and appetite, social isolation, increased dependency and thoughts of death are a few of the symptoms associated with depression. It is not uncommon to see a depressed, elderly woman confess to events which she knows nothing about. However, before we get machetes and sticks out, excited over catching another witch who has been exposed, it helps to consider that such “confessions” might be the effect of feelings of guilt or delusional beliefs arising from depression and its consequent cognitive distortions. Certainly, the snippets of a confused, dementing aged woman confessing to atrocities must portray a fascinating view. But may we continue to choose to disregard the reality of someone suffering from impairment of brain functions resulting in the gradual inability to carry out major, yet presumed simple routine activities? Perhaps, if all these were viewed from the perspective of the brain being erased gradually, one will empathise better and begin to push for better treatment of the elderly. These symptoms are however not comprehensive symptoms of dementia or depression but only give a glimpse of the helplessness of the elderly when coping with mental health challenges in our society. Now, back to the young man’s action, I daresay that anyone who flogs a vulnerable, helpless elderly woman, regardless of blood ties reveals a great deal of the individual’s personality traits or the possibility of an underlying disorder in the abuser. However, before I get on my high horse and begin to castigate the young man who might actually need an evaluation beyond legal justice for assault, let us attempt to understand the phenomenon referred to as “elder abuse”. Noteworthy is that neglect of the elderly, whether deliberate or accidental, has been identified as a form of elder abuse. Can I then assume that types of neglect include: failure to regularly check on my aged ones in the village or countryside as it is now referred to; not calling regularly… Going by the WHO’s definition, elder abuse can be a single or repeated act or lack of appropriate action, occurring within a relationship, where there is

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