Ernst Josef Franzek is among the best mental health doctors in Europe. The German born professor of psychiatry and neurology spoke with Sunday Vanguard in the Netherlands during which he expressed worries over what he described as the neglect of mental health care in Nigeria. He attributed the high number of mental health patients in Nigeria to poverty and lack of care for mothers during birth. He also traced the bad leadership in Nigeria and the high crime rate to mental disorders suffered during birth. While calling on Nigerians to ensure their leaders pass mental test before being elected, he criticised the idea of taking mental health patients to the church and, in the process, subjecting them to torture. •Franzek BY SIMON EBEGBULEM, Netherlands Who is Professor Franzek? I am a psychiatric doctor. I have worked in the Netherlands for more than 40 years. I was born in Germany and educated in a German university. I was a lecturer at the university but, when I turned 50, I decided to do new things. In the summer, I go into research and now I am into another research and treatment of people who have psychiatric disorders like schizophrenia and people who also have problem with drugs: Psychiatric disorder and addiction. At the moment, I am the Project Director of the Organization of Mental Health Brabant, the Netherlands. The problem with mental health in Nigeria The problem is that mental health is almost completely neglected in Nigeria. One reason is that the population has no possibility to search for mental health care due to poverty. There are only nine psychiatric hospitals for about 200 million people in the country. And mental health care in Nigeria is mostly done through religious and traditional healers without medical background. This may help those whose cases are not severe. But in severe cases, mental disorders worsen. And stigmatization causes a lot of problems. The situation is that most people in Nigeria don’t have good mental and general health care and that is catastrophic for a nation like that. Mental disorders are twice as common in Nigeria as in other parts of the world. And it is sad that nobody cares about this. And this has to get into the consciousness of the people because those who suffer most are the poor people who don’t have jobs, who are starved of the basic needs of life such as food, water, no adequate houses. At the moment in Nigeria, the ratio is one psychiatric to one million people. In Holland, for example, the ratio is 40 psychiatric doctors to one hundred thousand people. You can imagine how big the treatment gap in Nigeria is, and the situation is getting worse because life circumstances don’t get better. Being poor, not having enough to eat, no education, this is one source of having mental illness later in life. To redress the situation, I intend to visit Nigeria through the Sunny Ofehe Foundation, together with the experts in the field of mental health care, in collaboration with the University of Benin Teaching Hospital, the World Health Organization and some pharmaceutical companies. We are going to focus on the need to treat mental health in Nigeria as an emergency. There are several anti-social behaviours in Nigeria including bad leadership at the top. Could this be attributed to mental problem? There is a whole body of research that when people grow up in an environment where people are poor, no healthy food, no job, once the mother and father live there, the offspring will have anti-social effects from the very beginning. Research showed that if the mother and the father suffered hunger at the time they made the baby such that, during pregnancy, they did not have enough food for the foetus, this can predispose the offspring to this personality trait. The conclusion can be that anti-social characteristics may be understood as a form of environmental adaptation so that exposure to malnutrition, to hunger during the formation of the baby can have impact on sex determination. This means that, in this situation, more boys are born than girls because the brain development predisposes these people to the so called-anti-social behaviours like, to have food, you have to kill or steal. Even terrorists around the world tend to come from poor countries just fight for their people. So, if you want to build a peaceful society, the atmosphere must be conducive. The real criminal or psychopath is not the terrorist; the real criminal is the guy who presides over a people and eats their common wealth without thinking about their welfare. And we have many criminals leading the people in many parts of the world today. They don’t care about the people. But these guys you call bad guys just want to improve their lives and those of their families. So, to build a peaceful society, basic human rights must be respected and government must give the people the basic needs of life. At the moment, there is a huge gap between the poor and the rich in Nigeria and, because of this, the poor always become poorer. What we need is the middle class where everybody has the possibility due to his own capabilities to walk up. My father was poor, we had nothing but I had the possibility to go to school and then to do it my own way. This is basic for a peaceful society. Everybody has to pursue his life. Let me tell you also, mental illness does not come from God and this is a problem in Nigeria. In Nigeria, those who have mental illness go to church for remedy because they think they have offended God, but that is not true. It is a problem of the society. And government plays a role. When you bring people with mental illness to the church, you don’t really help them; you make their situation even worse. We have good medication to treat acute forms of psychosis. The acute forms are in countries like Nigeria more often than in Europe. Religion and psychosis or mental illness do not go together. Religion cannot bring solution to mental health; it can only help the family, giving them encouragement but not healing the patient. Religion is like people coming together, praying together, eating together, this should remain; but it should not be used to cure sick people because it does not work. If you look at the civilized world, they care for patients with mental illness because it is not a punishment and, if you give them the basic things they need, they feel happy despite their illness. But when you see them punished, when their families feel ashamed of them, it is cruel and it is not good for them. Nobody is punished if he has cancer; so why are they punishing people with mental illness in Nigeria? They chain them and flog the hell out of them. Why Nigeria leaders loot The problem in Nigeria is that the rich people make money and they have no brains any more. The poor people have no voice; so there is no competition. This also has to do with growing up. If the leaders were given the best while growing up, their brains would have formed better and they will not have to steal. And for this to change, I think, before Nigerians elect their leaders, there should be public competitions among aspirants in which the people will participate and see the mental state of the aspiring leaders. During such competitions, there should be no written paper, so that when they talk, you will know whether they speak from their hearts or not. Nigeria is supposed to be practicing democracy, but it is not really a democratic nation because the rich use their wealth to acquire things and run for political positions and the common people have no choice. In fact, that is also where you can ascertain whether the person aspiring to be or President is fit to lead the nation or not because, when you don’t have a healthy President, it causes dislocation in the system. And that is the problem you people have in Nigeria. I want Nigeria to be united because that will make them greater tomorrow. Agitations come because you have no middle class, the rich are getting richer and the poor are fighting. Mortality rate Mortality rate in Nigeria is quite high, especially among children. Government must improve on women’s care during pregnancy because if the pregnancy is not good, child birth will be complicated. The food that the woman eats is also important. Nigeria is the fourth country with the highest mortality rate among 200 countries in the world. Nigeria is also in the leading position in death per hundred thousand people through fire and car accidents. Again it is not healthy for a woman to have more than three children but you find that, after war times, the number of children grows just to compensate for those who died. Now, Nigeria has about 200million people and, in about 30 years, even with the high mortality rate, it may end up with 500million to one billion people. It will now become one of the most populous countries in the world. It is not a problem but the basic needs of life must be put in place, otherwise it will be a catastrophe because the country will not be safe anymore. And Nigeria is a beautiful country; my future wife is from there and I want to come and live there; so I want the best for the country. The future of Nigeria and psychiatry Nigeria has a positive future; all you need is a highly motivated, educated people; people who will work for the people and not for money. The situation now in Nigeria is that highly skilled people like doctors, psychiatrics receive education there and then move to Europe or North America because they want to earn a lot of money. Government must make Nigeria attractive for these people to stay there so that they can develop community treatment. It does not help Nigeria if you build very expensive hospitals and no manpower. First of all, you have to develop a treatment centre that is close to the people and everybody can afford. This is the first step. Then in the area of mental care, you have to involve traditional doctors, those into voodoo; we look at them and take what is good from them. You must not go there to say ‘what you are doing is wrong’. We should avoid confrontations because this is a tradition that people are accustomed to and you don’t wish it away. Tradition keeps people together and the common interest should be to improve mental health care, good health. You have to communicate with these people and get the best out of them.