On International Woman’s Day IFSW celebrates the power of women in creating choice for all people. From the women’s protests throughout the world claiming their rights and ability to make decisions over their lives, to Greta Thunberg leading change, to the political leaders in New Zealand, Finland, Ethiopia and elsewhere, women are advancing a world that is better for all.
Social Work and Suicide Prevention in Nigeria
Deputy Director Medical Social Services Department, Lagos University Teaching Hospital
Suicide is a word that carries so much stigma, that it affects how people view those who attempt to take their lives and how people seek help to prevent suicide.
What is Suicide?
Simply put suicide is the act of intentionally taking one’s life. It is important to note the word ‘intentionally’ because people can accidentally take their own lives, but intentionality means that the person has made a deliberate decision to take his or own life. This is a concept that seems alien to most people especially in Sub-Saharan African countries. The inability of the larger society to understand the meaning of suicide has created the basis for stigma against a group of people that are already vulnerable.
How serious is the issue of suicide?
According to the World Health Organisation (WHO), about 800,000 people die by suicide annually and for everyone who dies to suicide about 20-25 other people have attempted to take their lives but failed. In fact, the WHO says a suicide death occurs every 40 seconds. Suicide is the second leading cause of death amongst ages 15- 29-years and 79% of the global burden of suicide deaths occur in Low and Middle-income countries such as Nigeria. Based on officially recorded deaths by suicide, Nigeria ranks 15th in the world with a crude suicide rate of 9.9/100,000 people in 2016 which increased from 6.5 in 2012.
Going by the statistics provided, it shows that Nigeria with over 50% population being young people is vulnerable to increased rates of suicide if the issue isn’t addressed quickly. The WHO shows only 38 countries in the world have developed strategies to prevent suicide.
Risk vs Protective Factors
There is no single cause of suicide but there are well established data showing links between suicide and mental disorders. It is often stated that over 90% of individuals who die by suicide have mental disorders (Bertolote & Fleischmann 2002) and some particular mental disorders confer a higher risk for suicide than others. Studies have shown that disorders such as depression (2nd leading cause of disability in Africa), posttraumatic stress disorder, conduct disorder, drug and alcohol abuse/dependence (Nock et al. 2009) are closely linked to the risk of suicide.
Suicide has also been linked to various other psychosocial stressors such as financial problems, break up of relationships or chronic pain and illness, Family history of suicide or violence, cultural factors and societal pressures i.e. social media, etc.
All of the above listed factors individually or collectively can leave an individual vulnerable to suicide.
There are also protective factors, which are factors that lower suicide risk and they include: effective treatment for existing mental disorders, adequate social and family support, religious faith, strong therapeutic relationship with mental healthcare providers, building resilience and coping skills.
Signs to look for
People who are suicidal will sometimes share the fact that they are contemplating suicide while others will not share their ideations. It is important to be aware of the signs and symptoms to watch out for, they include:
- Changes in behaviour i.e. Decline in hygiene, Trouble concentrating, running away from home, etc.
- Social isolation and reduced interactions
- Talks or writes about suicide and death often
- Starts to hurry to settle quarrels, debts, etc.
- Giving away prized possessions
- Talks about preparations for taking his/her life
- Visits suicide websites
The role of stigma in Suicide
Stigma is a label that society places on someone. Stigma involves the hurtful attitudes and behaviours of society towards people with mental illness or people who have attempted suicide. People can also self stigmatize; the individual becomes accustomed to being stigmatised and discriminated against by society, that they start to believe what society says about them. Inadvertently what stigma leads to is
- Poor health seeking behaviours by people with mental health issues or people who are suicidal
- Absenteeism from work and school
- Social Isolation & exclusion
- Secrecy: Hides illness from people who may be able to provide support
All of the above and many more consequences of stigma become part of a vicious cycle of maintenance and reinforcement for the mental disorder and emotional distress.
Suicide Prevention: Is it possible?
Suicide is preventable but it cannot be carried out in isolation, it takes the collaborative efforts of the patient, family, healthcare providers and the community (education, health, religious, legal sectors etc.) at large to prevent suicide. The strategies include
- Really connecting with people by talking to them beyond the standard ubiquitous “how are you?”.
- Reducing easy access to the means of suicide (e.g. pesticides, certain medications, reinforce bridges etc.);
- The creation of a comprehensive, inclusive and modern mental health act that decriminalizes suicide in Nigeria
- School-based mental health interventions programs
- Provision of early identification, treatment and care services for people with mental and substance use disorders and people in emotional distress;
- Community follow-up and care for people who attempt suicide
- Address the chronic shortage of mental health personnel;
- Reduce stigma and discrimination against mental illness and suicide through continued education of communities
Roles of Social Workers in the management and Prevention of Suicide
Social Work is a profession that prides itself in its ability to provide help and support to people by mobilizing social resources (human or material) to help individuals achieve their full potentials and to address psychosocial stressors affecting them. As Medical Social Workers (MSW), we interact with a wide range of people from patients to their relatives during stressful periods in their lives.
MSW provides interventions that specifically focus on the prevention of suicidal intents which begins during the psychosocial assessments stage, whereby close attention needs to be paid to the patient (or significant other, relatives). Patients with mental disorders or life changing events maybe susceptible to suicidal ideation, the MSW should look out for risk factors then identify protective factors which can be used in carrying out interventions to help the patient.
In providing support to people who are suicidal or people seeking information about suicide, it is important that the MSW has tools and resources to turn to. The tools and resources are ideal in providing continued support where the MSW will not be able to provide the necessary help. The tools can include leaflets, websites and hotlines that can be easily accessible to the patient.
An example is the hotline for the Suicide Research and Prevention Initiative (SURPIN), which provides 24 hours hotline services for questions to be asked, on the spot counselling and referrals. They also provide face to face counselling, training, advocacy and research.
Additional resources include: –
Ahmedani B. K. (2011). Mental Health Stigma: Society, Individuals, and the Profession. Journal of social work values and ethics, 8(2), 41–416.
Bertolote, J. M., & Fleischmann, A. (2002). Suicide and psychiatric diagnosis: a worldwide perspective. World psychiatry : official journal of the World Psychiatric Association (WPA), 1(3), 181–185.
Houdmont, J., & Leka, S. (2010). Global perspectives on research and practice (Vol. 2). Malden, MA: Wiley.
Lawrence, D. and Kisely, S. (2010). Review: Inequalities in healthcare provision for people with severe mental illness. Journal of Psychopharmacology, 24(4_suppl), pp.61-68.
WHO, (2017) Preventing suicide: a resource for media professionals, update 2017. Geneva. (WHO/MSD/MER/17.5).
Canadian Association of Social Workers (2016) The Role of Social Work in Mental Health https://casw-acts.ca/en/role-social-work-mental-health
World Health Organization Fact sheet on Suicide: https://www.who.int/news-room/fact-sheets/detail/suicide
World Health Organization: Mental health and work: Impact, issues and good practices (2000) http://www.who.int/mental_health/media/en/712.pdf
Ms Titi-Tade is a Deputy Director Medical Social Services Department, Lagos University Teaching Hospital, Idi Araba and also a member of the Suicide Research and Prevention Initiative (SURPIN). +23480 3725 8323
Ogedengbe Kayode Anthony BSc, MSW; MSc
Deputy Director Medical Social Services Department,
University College Hospital, Ibadan
Diabetes is a group of metabolic diseases whereby a person has high blood sugar due to an inability to produce, or inability to metabolize, sufficient qualities of the hormone insulin. Type I diabetics (TID) is the second most common chronic illness in teenagers, trailing only asthma. The morbidity and premature mortality associated with diabetes is a major source of concern. Diabetes ranks among the most common, costly, and significant health problems worldwide. In 2015 diabetes affected more than 422 million adults globally. This resulted in 1.6 million deaths (World Health Organization, 2017). Diabetes complication may include stroke, renal disease, heart disease, blindness, peripheral neuropathy and lower extremity amputations. Reports from the National Stroke Association (2013) reported that people who have diabetes are about 2 or 4 times more like to have a stroke or heart-related disease at an early age compared with those without diabetes. Among individuals with Chronic Kidney Disease, diabetes is most common (National Institute of Diabetes and Digestive and Kidney Diseases, 2016), the reported showed that heart diseases resulting from diabetes were responsible for more than 65% of death among individuals residing in low and middle-income countries like Nigeria.
The cost of care for the most common diabetes (type 2 diabetes) is estimated to be $245 Billion a year, the disease condition demand financial commitment from both immediate family members and also the government. Physical complication associated with diabetes are also common and these grossly impact on individuals’ perception of self, social and professional relationship. (Sanndi, Satavi & Mahmodi, 2011). This disease demands long-term, intense, self-management and psychosocial support.
Along with health effect, diabetes has a major Socioeconomic impact on patient, family, health care providers and the society in general
- These patients are subjected to insulin replacement therapies throughout their lifetimes
- The disease involves a high risk of hospital admission due to severe hypoglycemia or ketoacidosis as well as diabetes-associated illness
- The time dedicated to the care of children with diabetes can be considerable. Hence the burden of and the cost of time spent on informed care can be high
- Families are also likely to spend extra resource (on drugs, private medical visits, monitoring systems, have education, sports activities and transportation) due to the disease
Medical Social Worker’s early intervention skills in Diabetes Management
After diagnosis, early intervention has been acknowledged as an important strategy to minimize the impact and burden of diabetes (Pntley, 2013). This is very important considering the complications that are associated with diabetes as they are connected with psychosocial problems and lack of access to community resources. These psychosocial factors are related to lack of finances, living conditions, social support glycemic problem, employment status and access to community services (Altfeld, 2013)
Social workers serve as liaisons between patients or clients in interdisciplinary teams in hospitals, other health care settings, and human service agencies. In health care settings, social workers often focus on identifying and facilitating clients’ psychological, psychosocial problems, and resource need. In providing early intervention, the goals are to facilitate adjustment to the impact and burden of the disease, reduce the risk of developing other significant health conditions, improve health and social functioning, and prevent progression of the condition, leading to death. Following a diabetes diagnosis, many individuals experience immediate and significant psychological distress, shock, anxiety, and fear (Rankin, 2014). These reactions often result from clients’ lack of understanding of the condition, worries about the cost of medical care, fear of concurrent complications, and concern about the intense daily and lifelong management responsibilities
The intervention of social workers include the following
- Provision of information and expertise that links patients and family members with vital resources
- They are trained to conduct comprehensive biopsychosocial assessments on individuals with a chronic illness that are incorporated into the client’s care plan (National Association of Social Workers, 2016)
- Social workers engage in active listening to clients, concern and provide emotional and psychological support to diabetes patients (Fabbre, 2011). Such services and support may assist the patient with diabetes to adjust to the impact of the disease on their health and social circumstances
- Medical social workers also facilitate meaningful medical, educational and psychosocial interventions in order to foster needed lifestyle changes thereby improve the overall wellbeing of clients (Ciporen, 2012)
- Medical social workers always assist patients with diabetes to obtain medications, ensure adherence, and help the patient to have access to health insurance
Many psychosocial issues pose a lot of barrier to the management and care of diabetes in adolescents and children. In order to achieve a successful intervention in term of management of diabetes, there is a need to recognize the psychosocial problems and help in reducing the damaging effects of this problem on patients.
Displacement of individuals remains a global humanitarian challenge which affects many countries including Nigeria. Country statistics indicated that there are about 3.3 million IDPs in 2014 scattered all over Nigeria in various camps and host communities. On a global scale, Nigeria is the third country with the highest number of IDPs after Syria with 6.5 million IDPs and Columbia with 5.7 million (Internal Displacement Monitoring Centre, 2014). Out of the 24 countries with the highest rates of displacement, 9 are from Africa and Nigeria has the highest internally displaced persons among these 9 African countries (Eweka & Olusegun, 2016). This means that about 2% of the Nigerian population has lost their homes, family life, means of livelihood and businesses (Oladeji, 2015). The plight of internally displaced persons has in recent years become a formidable problem of global significance and implications. It is pertinent to note that, the total number of internally displaced around the world is currently estimated at around fifty million, with the majority of these people located in Africa and Asia.
The issue is that there are no official displaced camps of long-lasting nature in the country like Nigeria. Temporary shelter is normally provided in army or police barracks, schools or hospitals, but they serve as IDPs camps only for a limited period. The vast majority of displaced people in Nigeria reportedly seek refuge with family, friends, or host communities in areas where their ethnic or religious group is in the majority. Many appear to return to their homes or resettle near their home areas soon after the violence which forced them to leave have subsided, but an unknown number also resettle in other areas of the country. The internally displaced persons (IDPs) are people who have fled their homes because of conflict and persecution based on religion, race, nationality, membership of a social group or political opinion but remain within their home countries’ borders. They are citizens of a country who are displaced within the territory of that country as a result of natural disasters such as erosion, desertification, flooding etc. People can also be displaced as a result of human-caused disasters such as civil wars, internal armed conflicts, terrorism etc. In this situation, people are left with no option but to flee their homes for safety.
Studies have consistently documented the impact of internal displacement of persons and individuals on mental health and physical wellbeing of individuals in IDP camps in Nigeria (Getanda, Papadopoulos, & Evans, 2015) and they have also experienced a lot of social misfortunes leading to poverty, illiteracy, and unemployment. Most people that are more vulnerable are women, children and older persons who are disproportionately represented in the IDP camp, with women and children alone accounting for over 70% of this population and are exposed to sexual and physical violence (Human Rights Watch, 2016).
Before the advent of insurgency in northern Nigeria, internal displacement in the country has been triggered by incessant torrential rainstorms, flash floods, ethno-religious violence, militancy, and state-sanctioned demolitions of “illegal” structures, cutting across Nigeria’s six geo-political zones. During these times, displacement occurred at a minimal level in terms of figures and groups hurt. However, following the thick of insurgency that began over a decade ago, displacement has happened on a humongous scale and have taken a devastating toll on vulnerable groups. In other words, the wave of insurgency in the country have continued to account for the upsurge in the numbers of IDPs in Nigeria, sparking a humanitarian crisis. Today, in response to such calls, many independent humanitarian organizations within and outside the shores of the country, have been active on the ground level in providing support services to IDPs. As an advantage in conducting various tasks, these organizations utilizes the services of helping professionals such as healthcare workers, psychiatrists, social workers, among others.
Social workers in the IDP camps are conveners of social justice and human rights with the sole aim of enhancing the social functioning of individuals, groups, and families while addressing the impact of environmental factors on the wellbeing of victims in the IDP camps. In keeping with this mandate, social workers have maintained a staunch commitment to displaced people, often bringing their experience and expertise to bear in addressing IDPs’ needs (Ramon & Maglajlic, 2015). Despite this, the literature on the nature of social work services to this population is very limited. An understanding of social work services is critical not only in enabling practitioners to provide effective services to IDPs but also, in improving the image of the profession especially in a context where social workers still contend with issues of non-professionalization.
According to the International Federation of Social Workers (2012), the roles of social workers in displaced population is regarded as that of an investigator of political and socio-cultural issues causing internal displacement of citizens, participating in the design and formulation of preventive, remedial and developmental policy programmes for improvement of wellbeing of victims of IDP camps, social workers are social managers of administrative functions in managing in project and programme which are within the framework which motivate participation in special groups, social workers analyse the social process which is related to power structures, conflict, co-existence, families and community dynamics. Social workers in IDP camps are specialist in addressing human and family problems which are caused by displacement by enhancing victims’ capacity to achieve their full potentials. Social workers also convey information about the rights of persons in displacement and harnessing services available to them while in displacement. These functions are significantly important in addressing the plight of internally displaced persons which showed the need for increased engagement of social workers in providing succour for the persons in IDPs without delay.
Alhaji Abubakar Alhassan Bichi
National President, Association of Medical Social Workers of Nigeria (AMSWON)
On behalf of myself, my family, NEC and all Medical Social Workers in Nigeria, I wish you Happy New Year. It has been very busy and productive in 2019 and we are proud to have made many advances in promoting and advocating for the Medical Social Work profession in Nigeria during the year. This shall continue in the Year 2020.
As we turn to Year 2020, our collective focus is on the New Year is achieving our Schemes of Service and most importantly promoting the Importance of Human Relationships. Like the previous themes, we have the occasion for shared learning, to expand our practice examples and to jointly advocating for changes in the care of patients in the Nigerian hospitals.
The opportunities before us are enormous and we have an excellent starting point: Medical Social Workers have in-depth experience in implementing innovative ways of improving the wellbeing of patients in Nigeria. When working with a family or community, a core role of the profession is facilitating agreements between conflicted people that balance the rights of all patients in Nigerian hospitals. The rights of the child, the parent, the family, the culture, the minority and the majority are frequently in conflict, and Medical Social Worker’s intervention and consensus understanding of the rights is often achieved.
Happy New Year and I look forward to facing the challenges with you in 2020
ALHAJI ABUBAKAR ALHASSAN BICHI
National President, Association of Medical Social Workers of Nigeria (AMSWON)