Psychiatric examination, another wrong-headed approach by the FRSC

BY OYE GUREJE

The Federal Road Safety Corps (FRSC) is reported to have just issued some guidelines that include compelling road traffic offenders to be subjected to what they term “psychiatric examination”. The offences that would lead to this mandatory examination include the use of phone while driving, route violation, traffic light violation, dangerous driving and overloading. The persons apprehended for any of these offences will be taken to what the FRSC describes as “recognized public medical facilities” and they would be made to “bear the cost of the examination”.

It is clear, even to the designers of these guidelines, that the purpose of this compulsory psychiatric examination is not to identify any psychiatric disorder but to use psychiatric consultation to shame the culprits. That is, what the FRSC hopes to achieve is not the identification and treatment of illness, which are the reasons why hospitals exist, but to use the threat of medical psychiatric consultation to control behavior. I say this because, as I hope it should be obvious even to the FRSC, someone using a phone while driving or driving an overloaded vehicle is no more likely to suffer from a mental illness than the average FRSC official conducting these checks on the road, not to talk of any other average Nigerian. The driver may be socially deviant, but that does not signify a disorder. Otherwise, every petty thief or an FRSC official demanding a bribe, not to talk of looters of millions, should be made to undergo psychiatric tests rather than face the law.

Nigeria is among the countries with the lowest ratio of mental health professionals to her population in the world, with about one psychiatrist to one million people and much fewer psychologists, social workers or occupational therapists.  South Africa has about 1 psychiatrist to one hundred thousand people and Brazil has about 10 psychiatrists to one hundred thousand. Both of these are “developing” countries. As can be imagined, developed countries fare much better than these few examples. What is true of human resource shortage in the country is also true in regard to material resources, including available beds for admission of persons in need.

Many studies examining the occurrence of mental disorders in the community, including the largest study of its kind ever, the World Mental Health Surveys, have shown that, as members of the human race, Nigerians are no less prone to mental illness than people of other nationalities. Indeed, given the serious social and security problems across different parts of the country, it is not difficult to see that we are in fact more vulnerable to developing mental illness, which of course is a common and natural consequence of severe stress for humans. These studies also show that only a small minority of persons who need treatment actually receive such in our country. Some of those with the more severe forms of mental illness end up in traditional and faith healing homes where they are shackled and given treatment many of us would not inflict on our dogs or they end up on the streets as vagrants. And here again, we are on the lowest rung among the nations of the world.

Among the many factors that impede access to good mental health care in our country, two stand out: pervasive stigma and the non-availability of both human and material resources to provide the required care. These are the two problems that the ill-conceived guidelines of the FRSC are going to make worse. By using mental health care as a weapon of social coercion or as punishment rather than as an intervention to alleviate suffering, FRSC has set its sight on reinforcing the stigmatization of mental illness and on engendering a sense of shame among those who may wish to seek psychiatric care when in need of such service. Why would I want to go to a facility that has been designated as a center for shaming perceived criminals?

Clearly, the few mental health professionals in the country will be stretched to their limit conducting these “psychiatric examinations” for traffic offenders. So, rather than devoting their time to providing service to those genuinely in need, they are being called upon to spend time conducting what in the end are useless examinations that will reveal nothing and lead to no treatment but are aimed at shaming. Because of the settings where many of the psychiatrists work, they may have no power to refuse to conduct these tests which demean their own professional training and skills and which, in many instances, can actually constitute professional misconduct and a gross violation of the rights of those being subjected to the tests. In a sense, this form of abuse of medicine is a throwback to the abuse of psychiatry by some authoritarian regimes that herded political opponents to psychiatric institutions. Indeed, a report quoted the Corps Public Education Officer as describing those to be tested as “non-conformists”, the same way those opponents were described by those regimes!

Granted that another statistics in which Nigeria stands out is road traffic accidents, with the country having one of the highest rates of deaths on the road in the world.  Even though good data is scarce, there is no doubt that one of the causes of the carnage on our roads is drink-driving. Even for this, a psychiatric examination would be a useless way of stemming the problem: by the time an apprehended drunken driver is taken to see a mental health specialist, the alcohol level in their blood has fallen and the evidence of their drunkenness has become tenuous if not completely absent. I expect the FRSC to see that two ways of substantially reducing this particular problem are so obvious as to constitute low-hanging fruits: the control of the sale of alcoholic beverages at motor parks and the conduct of random breath tests for alcohol. Both of these would do much more than any psychiatric examination, no matter how comprehensively conducted.

The FRSC needs to pursue meaningful strategies that would address the challenges of safety on our roads, rather than ill-thought out programs that do not address problems but rather create others. There is no challenge they are facing that other countries are not dealing with imagination. Indeed, the control of socially deviant behavior on the road is so well established across the world that the FRSC should not have a shortage of good practices to learn from, including from other African countries. Just a little imagination would reduce their proclivity for taking laughable and oftentimes counterproductive actions.

Gureje, a professor, is the director, WHO Collaborating Centre for Research and Training in Mental Health, Neuroscience and Substance Abuse, University of Ibadan