Impact statement

It is no news that mental health challenges and illnesses are on the rise in present times. The socioeconomic and political climate and other biopsychosocial factors have been implicated as factors contributing to the fast-rising burden of mental health. While other parts of the world are catching on to this realization and making an effort to match the demand for mental health care with the supply of caregivers and professionals, Africa and Nigeria in particular still have a long way to go. From trained psychiatrists and psychologists to paramedics and other personalities in mental health, there is a dire need to draw people into the field of mental health and psychiatry. Our paper aims to identify the challenges that plague the wide gap between the demand and supply of health care in Nigeria. From the exposure of medical students to psychiatry to issues like lack of adequate research and health coverage, we break down the factors that contribute to the deficiency of mental health care in Nigeria. We then go on to outline recommendations that can cause positive changes in this detrimental trend. One of our major recommendations is that from medical students and psychiatrists, it is important for students in other departments as well as members of the public to become involved in mental health. We emphasize why it is important for all young people in all facets, and works of life to become mental health advocates and direct or indirect collaborators in the delivery of mental health care in Nigeria.

Mental health challenges in Nigeria

Nigeria today confronts a state of emergency in mental health. Based on Ugochukwu et al. (Reference Ugochukwu, Mbaezue, Lawal, Azubogu, Sheikh and Vallières2020), patients with psychiatric care needs are often rendered to their household members since the available mental health workforce is apparently out of proportion, the majority of whom are centralized in urban areas, compounded by the lack of knowledge and capacity to cater mental disorders at the primary healthcare level (Ugochukwu et al., Reference Ugochukwu, Mbaezue, Lawal, Azubogu, Sheikh and Vallières2020). Statistics indicate that about 80% of people in Nigeria with severe mental health needs are unable to obtain care, which is primarily attributable to the country’s stigma and negative social attitudes toward mental health issues as well as a lack of facilities, resources and mental health professionals (Demyttenaere et al., Reference Demyttenaere, Bruffaerts, Posada-Villa, Gasquet, Kovess, Lepine, Angermeyer, Bernert, de Girolamo, Morosini, Polidori, Kikkawa, Kawakami, Ono, Takeshima, Uda, Karam, Fayyad and Karam2004). It is of utmost importance to recognize the unique socioeconomic and cultural barriers that can impede mental health outcomes in Nigeria and tailor interventions to meet the needs of local communities.

Factors hindering medical students’ interest in psychiatry in Nigeria

Several circumstances influence medical students’ career speciality decisions, which may be inferred early, during, or before their medical school training. These are divided into pre-, intra- and post-medical school factors, focusing on pre- and intra-medical school factors (Farooq et al., Reference Farooq, Lydall and Bhugra2013). Gender, exposure to mental illness, the social stigma associated with mental illness and perception of psychiatry are premedical school factors related to choosing psychiatry. At the medical school level, factors influencing career options include attitudes toward psychiatry, teaching methods, the quality and length of clinical exposure, electives and enrichment activities, personality factors and career guidance.

Students who pursue to become psychiatrists later in life have some premedical school factors in common. Gender is one of these factors, and there has been a beneficial association between the female gender and a positive attitude toward psychiatry (McParland et al., Reference McParland, Noble, Livingston and McManus2003). Prior knowledge of mental illness before entry to medical school, either personally or through having a family member or a friend become mentally ill, was associated with a positive attitude toward psychiatry and a choice in the specialty as a career in another study conducted by Kerebih et al. (Reference Kerebih, Salelew and Hailesilassie2019) among medical undergraduates in Ethiopia. This is supported by a survey conducted by Rajagopal et al. (Reference Rajagopal, Rehill and Godfrey2004), which suggests that it could be due to the student’s experience knowing or caring for a mentally ill person, which makes the student more comfortable with psychiatry and psychiatric patients. They also state that another possibility is that these students have firsthand knowledge of the flaws in psychiatric care service delivery and want to make a difference. Nevertheless, societal attitudes toward psychiatry and mental illness can influence students’ career choices.

Mental illness is often stigmatized in Nigeria, as it is in many other countries, and this stigma can discourage students from pursuing psychiatry as a career (Ighodaro et al., Reference Ighodaro, Stefanovics, Makanjuola and Rosenheck2015). This is especially concerning given that Nigeria already has a severe shortage of mental health professionals, with only one psychiatrist for every 800,000 people (Association of Psychiatrists of Nigeria, 2018). Furthermore, many medical students in Nigeria face financial constraints and may opt for specialities with higher pay or better job prospects (Aghukwa, Reference Aghukwa2010; Akpayak et al., Reference Akpayak, Okonta and Ekpe2014; Asani et al., Reference Asani, Gwarzo and Gambo2016). Psychiatry is often perceived as a less lucrative and less prestigious speciality when compared to other areas, such as surgery, which may discourage students from pursuing it (Asani et al., Reference Asani, Gwarzo and Gambo2016).

One of the most potent intra-medical school factors is quality exposure. In a 20-country cross-sectional study, Farooq et al. (Reference Farooq, Lydall, Malik, Ndetei, Bhugra, Alemu, Ohene, Mathai, Gakinya, Uwakwa, Olugbile, Hauli, Mugaza, Kilonzo, Musisi, Maling, Ravi, Fernandes, Nogueira-Martins and Pearson2014) found that quality exposure to psychiatry education is significantly associated with a career choice in psychiatry. It also highlighted the value of participation in simulation activities and exposure to clinical settings to improve medical undergraduates’ attitudes toward the field of psychiatry. In contrast, didactic teaching appeared to have the opposite effect on recruitment. Another study found that these active learning activities were more effective at reducing mental illness stigma among medical students worldwide (Corrigan et al., Reference Corrigan, Morris, Michaels, Rafacz and Rüsch2012) and in Nigeria (Ighodaro et al., Reference Ighodaro, Stefanovics, Makanjuola and Rosenheck2015).

Enrichment activities, such as research and special study modules, are typical activities that go beyond standard teaching and clinical placement. Enrichment activities like quality exposure to psychiatry education have also been shown in various studies to enhance medical students’ attitudes toward psychiatry (Halder et al., Reference Halder, Hadjidemetriou, Pearson, Farooq, Lydall, Malik and Bhugra2013; Lyons, Reference Lyons2013; Farooq et al., Reference Farooq, Lydall, Malik, Ndetei, Bhugra, Alemu, Ohene, Mathai, Gakinya, Uwakwa, Olugbile, Hauli, Mugaza, Kilonzo, Musisi, Maling, Ravi, Fernandes, Nogueira-Martins and Pearson2014). Multiple studies over the years have implicated personality factors. In a study conducted in Spain, high sensitivity and low (impulsive) self-control were found in choosing psychiatry as a career (Monleón Moscardó et al., Reference Monleón Moscardó, Rojo Moreno and García Merita2001). Another study discovered higher levels of neuroticism and openness among Australian medical students who went on to study psychiatry (Maron et al., Reference Maron, Fein, Maron, Hillel, Baghdadi and Rodenhauser2007). However, no specific study has been conducted in Nigeria to discover any relationship between personality and the choice of psychiatry. Moreover, mentorship and career guidance programs are other notable factors in Nigerian medical schools. According to a study conducted by Ossai et al. (Reference Ossai, Uwakwe, Anyanwagu, Ibiok, Azuogu and Ekeke2016) among medical schools in Southeastern Nigeria, there was no institutional career guidance for the students. This could also be the case at other medical schools in Nigeria, depriving medical students of the exposure and mentorship they need to make informed career decisions.

Recommendations

A holistic approach is crucial to encouraging enthusiasm and overcoming challenges that hinder undergraduate medical students, students from other fields, and others from entering mental health professions. This comprehensive strategy requires cross-disciplinary and stakeholder collaboration.

All medical and healthcare undergraduate programs should include robust mental health education to achieve this. While psychiatry directly addresses mental illness, primary care, nursing, social work and other disciplines also encounter mental health patients. Providing mental health education across various domains equips healthcare practitioners with a holistic perspective and the necessary skills to manage mental health issues effectively.

Furthermore, comprehensive community-based mental health awareness programs should extend beyond medical circles and engage the wider public, particularly the youth. These initiatives, including public seminars, workshops and informational campaigns, can educate citizens about the importance of mental health and the diverse career opportunities within the field.

Transdisciplinary teamwork plays a pivotal role in holistic mental health care. Collaboration among psychiatrists, psychologists, social workers, counselors and other mental health providers enhances the quality of patient treatment. Recognizing that mental health involves biological, psychological and social components underscores the need for collaborative efforts.

Enhancing support systems is critical for mental healthcare professionals to sustain their well-being throughout their careers. Addressing burnout and compassion fatigue, which are prevalent challenges, requires implementing measures that promote wellness, build resilience and prevent attrition, ultimately retaining talent in the field.

Structured mentorship programs can be highly beneficial, connecting prospective mental health professionals with experienced practitioners from various fields. Seasoned mental health professionals serving as role models inspire younger generations and illuminate the diverse career pathways within mental healthcare.

Additionally, establishing and actively promoting scholarships tailored for students pursuing careers in mental health professions, such as psychiatry, is imperative. These scholarships aim to make medical education more accessible and appealing to a broader range of students.

Prioritizing diversity and inclusion within mental health professions is essential. A diverse workforce representing various cultures, ethnicities and social groups enhances mental healthcare by fostering cultural competence and encouraging individuals from different backgrounds to pursue careers in this vital field.

National advocacy is pivotal for driving changes in mental healthcare and education policies. Collaborative efforts among policymakers can create incentives to attract students and professionals to mental health, potentially including financial incentive programs.

Finally, research and innovation are crucial in advancing mental health treatment. Engaging students, undergraduates and aspiring professionals from diverse backgrounds in research projects enhances their understanding of the field and ignites their passion for mental health.

By embracing this comprehensive set of recommendations, we can inspire students and citizens to pursue careers in mental health professions. This holistic strategy aims to cultivate a diversified, talented and compassionate workforce capable of seamlessly addressing Nigeria’s and the world’s pressing mental health challenges.