The public was recently informed by the Corps Marshal, of the Federal Road Safety Corps (FRSC), Dr. Boboye Oyeyemi that with effect from July 1st 2017, traffic offenders in Nigeria will be subjected to psychiatric tests. The offences on which ground individuals will be subjected to psychiatric tests include; use of the phone while driving, route violation, traffic light violation, dangerous driving and overloading .According to the Corps Marshall, “Offenders shall bear the full cost of the examination which would be conducted at recognized public medical facility”. The driver’s license of “offenders” shall be withdrawn pending the outcome of the psychiatric test. If the result of the psychiatric test reveals that the individual is fit, they will be made to pay a fine in addition they shall be sent for retraining programme. No information is given about the methodology and duration of the retraining programme. Furthermore no mention is made about the handling of those whose psychiatric test reveals that they are mentally unfit.
More worrisome is the apparent haste with which the FRSC intends to implement this policy without sufficient advocacy and multisectoral collaboration with other agencies. The Association of Psychiatrists in Nigeria (APN) speaking through its Publicity Secretary, Dr. Peter Ogunubi, has frowned at the modus operandi of the proposed Psychiatric test for traffic offenders. The Corps Education Officer, Bisi Kazeem, in an interview with a print medium in Nigeria, stated that “Psychologists would carry out both the medical and psychological evaluation of traffic offenders sent to them”. The Publicity Secretary of the APN avers that “the APN does not support the FRSC’s decision to attribute social misbehavior during driving to mental disorder because it would further stigmatise the mentally ill”. Some other commentators on this matter have wondered how the evidence of some of these traffic offences can be tendered in court as there is presently no functional real time Circuit Television Camera across the length and breadth of Nigerian roads. The Highway Code is not accessible to many Nigerians. A question whose answer is blowing in the winds is; would some offenders be exempted from the psychiatric test? Perceptive members of the public wonder how the FRSC officers who do not bear arms will be bold enough to apprehend arms bearing Military and Paramilitary offenders. How does FRSC plan to handle the risk posed by the convoy of prominent politicians to other road users? Will there be sacred cows?
With respect to some clinical issues, the World Health Organization(WHO) defines mental health 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 her or his community”. From the foregoing it is obvious that there can be no health without good mental health. The 1999 Nigerian Constitution as amended guarantees the right to health for its citizens. The World Health Organization Assessment for Mental Health Systems Report(WHO-AIMS Report) published in 2006 reveals that the Nigerian Mental Health Policy formulated in 1991 has not been subjected to any form of monitoring or evaluation that can lead to a review of some aspects of the policy .The Mental Health Policy was conceptualized for the purposes of advocacy, health promotion, prevention ,treatment and rehabilitation. The out of stock syndrome of essential psychotropic medications reported in the WHO-AIM Report is still prevalent to date. The report also laments the “absence of laws to regulate admission policies and patients rights coupled with the absence of a systematic method of gathering and collation of nationwide data on mental health”.
Statistics from several Federal Neuro-Psychiatric hospitals in Nigeria reveal that the prevalence of mental disorders is rising. The human and material resources of most of these health institutions have been stretched to the limit.
The WHO-AIMS Report reveal that about 3.3% of the health budget of the central(Federal) government goes to mental health, with over 90% of this going to mental hospitals(stand alone psychiatric health institutions).
There has been no appreciable improvement in the latter scenario from 2006 to date. One wonders if there are Psychiatrists and other Mental Health Professionals engaged as staff of the medical corps or unit of the FRSC.
Perhaps the FRSC did not think about the paucity of Psychiatrists in Nigeria before rolling out July 1st 2017 as implementation date for this policy. For the records the WHO-AIMS Report reveal that at least 25% of Psychiatrists in Nigeria migrate to other countries within five years of the completion of their training.
One also wonders if the legal unit of the FRSC is well funded to be able to cope with the deluge of litigations that may arise across the country as a result of the hasty implementation of this policy. In Nigeria Medical Doctors are the Heads of Health Institutions and as Chief Executive Officers they are to put on ground the required human and material resources for the implementation of the psychiatric tests for traffic offenders. The biopsychosocial approach is one of the models utilised in the diagnosis and management of mental disorders. The latter approach is executed by a multidisciplinary team led by the Psychiatrist. Furthermore in Nigeria the privilege of prescribing psychotropic medications for the mentally ill in government health institutions is strictly reserved for the Physician (Psychiatrist).
These issues must be given careful considerations before any hasty implementation of the new policy. As a one who has observed the behaviour of some motorists on Nigerian roads I dare to say that the new policy is not out of place. However all the stakeholders must be carried along especially the committee that oversight the FRSC in the National Assembly
An emerging challenge for those who are diagnosed of being mentally unfit is the rising costs of medication and cost of accessing treatment in mental health institutions in Nigeria. Payment for such services in Nigeria is still largely by direct out of pocket payment. Another unsavory phenomenon as earlier highlighted is the poor budgetary allocation to mental health care. WHO posits that low income countries like Nigeria invest less than 1%, of their health budget on mental health care. Majority of the institutions that provide professional mental health care services are located in the urban areas. Giving effect to the spirit and letter of Primary Health Care that incorporates mental health as its ninth component will improve access to mental health care for all and reduce the stigma associated with the illness.
In conclusion, the new policy should not be made to look like an avenue for revenue generation by the government. The time for the FRSC to retrace her step by doing the needful is now. This is the only way to effect behaviour change by motorists on Nigerian roads.
LAWANI AMBROSE, a Psychiatrist wrote in from Benin City Edo State
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