PERCEPTIONS AND ATTITUDE TOWARDS MENTAL ILLNESS AMONG RURAL AND URBAN SECONDARY SCHOOL STUDENTS IN ENUGU METROPOLIS

CHAPTER ONE

INTRODUCTION

Background to the Study

Mental health is a basic component of health and it contributes to living a happy and fulfilled life. Mental health is defined by the WHO. (2011) as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community. On the other hand, mental illness refers to conditions that affect cognition, emotion, and thus, the everyday life of the person who suffers it (American Psychological Association, 2015). Mental illness is an important public health issue worldwide (Vijayalakshmi, Reddy, Math & Thimmaiah, 2013). Increasing health and socio-economic burden of mental illnesses and disorders have become a major concern in both developed and developing countries. Globally, it is estimated that more than 450 million people suffer from mental or behavioural disorders and one in four families has at least one member with a mental disorder (Fiasorgbor & Aniah, 2015). According to World Health Organisation (2012), mentally ill people often lack access to education, healthcare and opportunities to earn a decent living, which limit their chances of economic development and deprive them of social protection and recognition within the community. This burden of mental disorders is maximal in young adults, the most productive section of the population, and with the onset notably at adolescence; it issues a serious concern to the economy of any nation (Fiasorgbor and Aniah, 2015).

In Nigeria, as in other parts of the world, the prevalence of mental illness is quite high. It was reported by WHO (2007) that 20 percent of Nigerians are suffering mental illness. With a population of 160 million, this translates to the fact that more than 30 million Nigerians are suffering from one form of mental disorder or another (National Census, 2006). Most surveys on perceptions of mental illness have been largely conducted in western countries, with few studies in developing country contexts. In the course of this present study, it became evident that the major reason for the dearth of resources on public perceptions of mental health and mental illness in Nigeria is the absence of political will to develop a mental health service based on a comprehensive legal and policy framework that encourages research interest on the subject (Iheanacho, 2013). The law covering Mental Health Act in Nigeria is so grossly inadequate that Nigeria is still operating on the Mental Health Policy of 1996 (Godiya, Bala, Bala, Ogbonna, Osumanyi & Ahmed et al., 2013). This is in contrast to what is obtainable in Western countries and even neighboring African countries such as Ghana where a new mental health Act was recently passed (Fiasordor et. al., 2015). 

The belief system of people has been known to influence their attitudes and perception of a lot of subjects; mental illness inclusive. A recent Nigerian survey found that urban dwelling, higher educational status, and familiarity with mental illness correlated with belief in biological and psychosocial causation, while rural dwelling correlated with belief in supernatural causes. This identifies culture as likely to influence the experience, expression, and determinants of peoples’ perceptions (Adewuya & Makanjuola, 2008). These beliefs undoubtedly affect how the mentally ill is treated in the society. This was confirmed in a study conducted in South-western Nigeria where it was found that people were unwilling to have social interactions with those with mental illness. Most of the respondents reported that they would be afraid to have a conversation, would be upset or disturbed about working on the same job, would not share a room, and would feel ashamed if people knew that someone in their family had been diagnosed with a mental illness. Only very few reported that they could maintain a friendship with a person with a mental illness (Gureje, Lasebikan, Ephraim-Oluwanuga, Olley, & Kola, 2005).

Conversely, studies from western societies have shown that biological factors (diseases of the brain and genetic factors) and eventual factors (trauma and stress) are more likely to be considered causal while in Africa, supernatural causes are widely considered (Sadik, Bradley, Al-Hasoon and Jenkins, 2010). A study in India of community beliefs about causes and risks for mental disorders, found that the most commonly acknowledged causes were a range of socio-economic factors, while neither supernatural causes nor biological explanation were widely endorsed. In this case the main predictors of the variable of social distance from people with mental illness was perceiving the person as dangerous, while the main predictors of reduced social distance was being a volunteer health worker, and seeing the problem as a personal weakness. For depression, believing the cause to be family tension reduced social distance. For psychosis, labelling the illness as a mind/ brain problem, a genetic problem or a lack of control over life increased social distance. (Kermode , Bowen , Arole , Joag & Jorm, 2009)

Adolescence is the phase of development in which the individual is making the most effort to seek independent identity and control over his/her life, which includes the desire to start making more of his/her own decisions. Erroneously adolescents are generally perceived as the healthy age group but the irony of it remains that mental illness usually strike individuals in the prime of their lives, often during adolescence and young adulthood. In the United States alone, more than ten percent of children and adolescents suffer from mental disorders severe enough to cause some level of impairment more common than diabetes, cancer, or heart disease could (American Psychiatric Association, 2011). Studies in Nigeria have shown that as many as one in ten of Nigerian adolescents aged between ten and twenty four has a clinically recognizable mental health problem (Kabir, Zubair, Isa & Muktar, 2004). This high susceptibility in adolescents and young adults to developing a mental disorder correlates with their incessant compulsion to indulge in mental health risk behaviors such as taking psycho-active drugs and unhealthy sexual relationship among others (Rickwood, 2007)

As a result of all these circumstances surrounding a typical adolescent, understanding the perceptions and beliefs of the youths towards mental illness and people with mental illness has proven to be a very important step in addressing the negative public attitude reported so very often in mental health studies (Vijayalakashmi & Thimmaiah, 2013). The qualitative study by Tolulope, Olayinka, Nisha and Yetunde (2011), on the perceptions of mental illness among rural and urban adolescents in Southwestern Nigeria clearly shows that adolescents indeed are strongly opinionated on the subject of the nature, causes, characteristics and treatment of mental illness. Their study succeeded in exposing the gaps in the respondents’ knowledge which had varying degrees of cultural and religious inclinations. To further demonstrate the importance of young peoples’ view of mental illness, a study in Athens Greece by Sakerelli (2014) to explore perceptions of mental health and mental illness as well as the perceptions towards people with mental illness among adolescents, found that young people had a lot of negative attitude towards mental illness and the mentally ill. His study further showed that following a period of enlightening educational sessions, a marked improvement was evident in their attitude especially regarding the importance of social care and social integration of the mentally ill.

In determining the factors that shape the adolescents’ attitude and perceptions of mental illness, Said (20011) revealed that socialization and mass media play major roles. The community in which the adolescent finds himself being the socialization agent has been found to interfere with help-seeking behavior among adolescents suffering from some form of mental illness. Specifically, a reluctance to acknowledge mental health problems, social stigma, a culture of self-reliance, and a view that equates mental illness with “insanity” have been identified as the main factors influencing the help seeking behavior (and ultimately mental illness in general) of people suffering from mental illnesses who were residing in rural and remote communities (Adewuola and Makanjuola, 2009, Gulliver, Griffiths and Christensen, 2010). The reasons are not far fetched, because many of the perceptions of mental illness were formed from the basic childhood socialization (The mad woman at the village square, the frightening mental institutions, the mentally ill relative in the family closet et cetra –all these are part of the many experiences that form an individual’s perceptions of mental illness) transferred by parents and the society which eventually translates to the belief systems of the youth who then becomes an adult, and the cycle continues..

Therefore having validated the role of the community in the prevention and care of the mentally ill has now been widely acknowledged and is regarded as the most appropriate basis for the development of mental health programmes. Several studies have shown that knowledge of public perception (the youths inclusive) of mental illness and its treatment is a vitally important prerequisite to the realization of successful community-based programmes (Kabir et al., 2004; Fiasorgbor & Aniah, 2015).  This is due to the fact that the recognition of mental disorders first and foremost depends on a careful evaluation of the norms, beliefs and customs within the individual’s cultural environment. Unarguably therefore, adolescents’ perceptions of mental illness which includes beliefs, ignorance and stigma, play significant roles in determining help-seeking behavior, successful treatment of the mentally ill and eventually, the mental health status of the nation.

Statement of Problem