More banks and blue-chip companies are underwriting insurance policies that address mental health issues for their employees as awareness of mental wellbeing at the workplace gains traction.
But this, among other efforts from private organisations, is inadequate to tackle Nigeria’s mental health burden as government funding deficits remain huge, BusinessDay found.
Dr. Leke Oshuniyi, chairman of the Health and Managed Care Association of Nigeria (HMCAN), said funding of employee assiatance programme (EAP) by financial companies has increased in the last five years and there are hopes that more companies will jump on the trend in the next few years.
Workers are also embracing the adoption of what health insurance experts describe as an initiative designed to help people let out their personal or work-related challenges before they degenerate into untamable issues.
The EAP model is crafted around confidentiality and anticipation of issues using tools for prevention.
“We are beginning to see companies that practice EAP. It is generally an opportunity to discuss personal or work-related problems that can affect performance and well-being. The WHO definition of health is not merely the absence of infirmity. It is a state of physical, social, and mental well-being,” Oshuniyi, also the chief executive officer of AIICO Multishield Limited, said.
“Through EAP, a lot of which are anonymous, people can seek assistance. They can discuss with a counsellor and can be referred for a higher level of assistance.”
However, the burden of mental health challenges in the country is still huge despite these sorts of interventions. Nigeria’s profile on the World Health Organization (WHO) Mental Health Atlas 2020 shows that the total mental health expenditure per person is N89, based on the United Nations’ population estimate of roughly 201 million.
The government’s total expenditure on mental health is about four percent of total government health expenditure.
Most private interventions under insurance hardly cover more than consultation fees and low-cost medications.
Oyeyemi Afolabi, senior registrar, Department of Psychiatry, UCH Ibadan, said: “There are no major improvements. Some of the insurance that people bring in to cover mental health packages still do not cover many medications. So people still eventually have to pay out-of-pocket. It has not really made it so effective.
“It’s something but not enough to make a big mark or impact on the burden of the problem we have on the ground. I don’t think that there are any major landmarks or innovative measures at the moment.”
Mental health awareness has been on the rise. There are a few organisations that invest in picking people out of the streets and sponsoring their health bill through admission, to trace their roots and integrate them back into society.
But there is only so much they can bear in terms of financing without the government coming alive to its responsibility.
In addition to increasing funding at the national level, Afolabi charged the government to integrate mental health services at the level of primary health care in order to spread the reach to most Nigerians.
A 2019 survey by the Nigerian Health Watch found that most people are aware of mental health diseases, but they seem to connect with overt signs rather than covert signs.
It also found that drug abuse is the most common cause of mental health disorders in Nigeria while possession by evil spirits and sickness of the brain ranked as the second and third most common factors.
Most respondents indicated a preference for proper medical care in treating a person with a mental health disorder.
Also, an analysis featured on ScienceDirect, a digital medical journal, shows that the mental health budget mainly financed through the federal government health budget hangs between 3.3 and 4 percent, with over 90 percent going to the few neuropsychiatric hospitals available in Nigeria.
It recommended the integration of mental health into primary health care, legislative policies, human resource training and competencies, research and development, awareness and public education, and digital therapy as tools to combat the challenge.
Mental health issues require early intervention before things crystalise. For most professionals, there is a trend to be recognised and nipped in the bud, Oshuniyi explained.
While some other health issues may exhibit warning symptoms, mental health issues evolve in a peculiar way. It may start with absenteeism at work. It could present as untidy dressing, unusual behaviour, or change in mood or eating habits, among other signs.
Fisayo Adesokun, a consultant psychiatrist at the University of Port Harcourt, in an advocacy piece, said a major challenge in accessing mental healthcare is stigmatisation, noting that the subject should be seen as complementary to physical health rather than a taboo.
Oye Gureje, a professor of Psychiatry at the University of Ibadan, said that caregivers, formal and informal, provide the most intensive care, such that they are usually taxed physically, emotionally, and financially.
The Wellcome Trust, Mental Health Translation, in its study of putting science to work in workplace mental health, urges business leaders to draw on knowledge about supporting the mental health of their employees, including considering how to effectively implement these in practice.
Some specific examples from across the research projects include:
This can have significant positive effects on anxiety, stress and organisational factors such as job satisfaction, and moderate effects on depression and burnout.
Clear boundaries between work and non-work domains
This could decrease the chance of work-life conflicts, anxiety and depression, increasing the chance of achieving a healthy work-life balance. It was identified as being highly dependent on support from management.
This was shown to produce significant improvements in mental health awareness, stigma reduction, confidence in identifying mental health issues, and assisting and connecting co-workers, particularly in occupations at high risk for mental health concerns such as those in construction, healthcare, the military, and mining and energy industries.
Pensions and health insurance
The study found that pension and health insurance for agricultural workers led to a significant reduction in symptoms of depression and anxiety, particularly among older people. Other insurance interventions such as cash transfers also had positive impacts on mental health, but this was dependent on the specific context.
Paid maternity leave
This is associated with fewer symptoms of postpartum depression for working mothers, and some evidence suggests longer maternity leave is associated with fewer symptoms of postpartum depression. Negative work environments and having to negotiate specific conditions with employers were seen as factors that restricted access to adequate maternity leave.