For three days, Emmanuel John waited anxiously in the psychiatric emergency unit of the Jos University Teaching Hospital (JUTH), hoping a bed would become available for his daughter.

She had been referred to the hospital after suffering a severe mental health episode, but every bed in the psychiatric ward was occupied. She remained in the emergency unit, where doctors and nurses monitored her condition while the family waited for a vacant bed.

“We spent three days there because there was no bed,” Mr John told PREMIUM TIMES.

When a bed eventually became available, the family’s relief was short-lived. According to Mr John, his daughter was discharged early to yield her bed space to patients in more critical condition.

“I was disappointed, but I didn’t blame the doctors,” he said. “They were doing everything they could. The real problem is that there are too many patients and too few beds.”

Mr John’s experience illustrates the growing strain on one of North-central Nigeria’s major referral centres for mental healthcare.

John’s experience is becoming increasingly common at JUTH. As more Nigerians seek treatment for mental illness, the hospital’s psychiatric department is struggling to cope with demand, leaving patients waiting for admission, stretching healthcare workers and exposing wider weaknesses in Nigeria’s mental healthcare system.

A PREMIUM TIMES investigation, based on interviews with patients’ relatives, healthcare workers, hospital management and mental health experts, found that rising demand for psychiatric services is stretching JUTH’s capacity, forcing clinicians to make difficult decisions about admissions and discharges.

Although JUTH has not publicly released annual psychiatric admission figures, hospital officials and mental health workers interviewed by PREMIUM TIMES said they have witnessed a steady increase in patients over recent years.

They attributed the trend largely to rising substance abuse, worsening economic hardship, insecurity and increased public awareness that has encouraged more people to seek treatment.

Families caught in crisis

Mr John’s family is not alone.

Patience Samuel recalled a similar ordeal after her son developed a severe mental health condition and was taken to JUTH for specialist care.

Following an assessment, the family was informed that no admission bed was available.

“They attended to him, but they couldn’t admit him because there was no bed,” she said.

With no alternative, the family sought treatment at a private hospital, where the cost of care placed a heavy financial burden on them.

“If there had been space at JUTH, we would have stayed because treatment there is more affordable,” she said.

Their experiences highlight the difficult choices confronting many Nigerian families who depend on public hospitals for mental healthcare.

An overstretched facility

During several visits to JUTH’s psychiatric department, this reporter observed anxious relatives waiting around the emergency unit as healthcare workers attended to patients awaiting admission.

Hospital management confirmed that the department currently operates only two inpatient wards, a 20-bed male ward and a 15-bed female ward. Once the wards reach capacity, newly referred patients remain in the emergency section until space becomes available.

Healthcare workers, who spoke on condition of anonymity because they were not authorised to comment publicly, described the shortage as a persistent challenge.

According to them, clinicians are frequently compelled to balance the needs of patients already on admission with those arriving in critical condition. As a result, patients whose conditions have stabilised may be discharged earlier than doctors would ordinarily prefer to create room for emergency cases.

For many families, the alternatives are limited: endure days of uncertainty while waiting for admission or seek treatment at private facilities where the cost of care is often beyond their means.

A national challenge

The pressure on JUTH mirrors a wider crisis confronting Nigeria’s mental healthcare system.

According to the Federal Ministry of Health, only about one in five Nigerians living with severe mental illness receives appropriate treatment, leaving an estimated treatment gap of about 80 per cent.

A shortage of specialists has further weakened access to care. Nigeria has fewer than 300 practising psychiatrists serving a population of more than 200 million people, with most concentrated in major urban centres.

Mental health advocates attribute the situation to years of inadequate funding, persistent stigma, limited community-based services and the migration of healthcare professionals.

These challenges have increased pressure on tertiary hospitals such as JUTH, which now receive referrals from neighbouring states, even as their resources remain limited.

The growing burden comes despite recent policy reforms aimed at improving mental healthcare. The National Mental Health Act replaced decades-old legislation and seeks to strengthen mental health services, promote community-based care and protect the rights of people living with mental illness.

However, experts say meaningful implementation will require sustained funding, improved infrastructure and the recruitment of more specialised personnel.

Against this backdrop, JUTH has become a critical lifeline for many families seeking affordable psychiatric care, making the pressure on its limited facilities increasingly difficult to manage.

Hospital management responds

The Chief Medical Director of Jos JUTH), Pokop Bupwatda, acknowledged that the psychiatric department is operating under immense pressure but said the hospital has begun taking steps to improve capacity and service delivery.

In an interview with PREMIUM TIMES, he linked much of the increase in psychiatric admissions to the growing abuse of psychoactive substances, particularly among young people.

“We have seen many cases related to substance abuse, especially among young people,” he said. “It is one of the biggest challenges confronting mental healthcare today.”

Mr Bupwatda said the problem extends beyond patients seeking treatment.

“We have even discovered some members of our staff abusing substances. Whenever such cases arise, we ensure they receive appropriate rehabilitation because our priority is to help them recover.”

He stressed that tackling substance abuse requires a coordinated response involving families, schools, religious institutions, communities and government, arguing that hospitals alone cannot reverse the trend.

His concerns are consistent with national findings.

According to the United Nations Office on Drugs and Crime (UNODC), an estimated 14.3 million Nigerians aged 15 to 64 used psychoactive substances in 2018, representing a prevalence rate of 14.4 per cent—more than twice the global average at the time.

The survey remains Nigeria’s most comprehensive national assessment of drug use and continues to inform policy discussions on substance abuse and mental health. Cannabis remains the most commonly used illicit drug, while the non-medical use of opioids such as tramadol and codeine continues to drive addiction and psychiatric disorders across the country.

Mental health specialists say prolonged drug abuse can trigger psychosis, worsen existing psychiatric illnesses and increase the likelihood of relapse, making treatment more difficult and recovery longer.

Mr Bupwatda said the Federal Government’s policy requiring drug tests for prospective employees of federal health institutions is one of several measures aimed at addressing the challenge.

“The objective is to identify those who need help before they enter the workforce,” he said. “Where necessary, rehabilitation is provided because the goal is not punishment but recovery.”

Shortage of specialists

Beyond inadequate bed space, the hospital is also struggling with a shortage of specialised personnel.

Mr Bupwatda admitted that the psychiatric department is overwhelmed, describing the challenge as part of a wider healthcare workforce crisis affecting Nigeria.

“Yes, they are overwhelmed,” he said. “But this reflects the broader shortage of healthcare workers across the country. It is not a challenge peculiar to psychiatry.”

He explained that psychiatric care requires specialised training, making recruitment considerably more difficult than in many other areas of medicine.

“It is not every doctor or nurse that can work in psychiatry,” he said. “We are training more psychiatric nurses to strengthen the department and improve service delivery.”

During visits to the psychiatric department, this reporter observed relatives sitting quietly outside the emergency unit while nurses moved between patients awaiting admission. Inside, clinicians attended to new referrals even though the inpatient wards were already full, highlighting the pressure facing the department.

Despite these constraints, relatives of patients praised the commitment of doctors and nurses, saying staff continued to provide compassionate care despite limited resources.

Security concerns

The investigation also uncovered concerns about security within parts of the psychiatric complex.

This reporter observed sections of the complex that were not fully enclosed. Some healthcare workers, who requested anonymity because they were not authorised to speak publicly, expressed concern that the layout could make it easier for patients to leave the premises without authorisation.

Others alleged that prohibited substances occasionally find their way into the facility through visitors, potentially undermining the rehabilitation of patients receiving treatment for drug-related mental health conditions.

Responding to the allegations, Mr Bupwatda said he was unaware of the concerns but promised to investigate them.

“I am hearing that for the first time,” he said. “I will discuss it with the Head of Department. If there are security lapses, we will address them because the safety of our patients remains our priority.”

He added that strengthening security forms part of the hospital’s broader expansion plans, which are expected to improve both patient safety and the quality of psychiatric care.

Expansion offers hope, but challenges remain

Mr Bupwatda said the ongoing expansion of JUTH’s psychiatric complex is expected to ease pressure on the department by increasing admission capacity and improving the treatment environment.

According to him, the complex was designed to be developed in phases, with the existing wards representing only the first stage of the project.

He disclosed that the second phase is between 90 and 95 per cent complete and will provide additional wards and treatment spaces once commissioned.

“Our goal is to ensure that more patients receive timely care in a safer and more conducive environment,” he said.

The CMD added that JUTH’s relatively affordable treatment costs, compared with many private hospitals, have also contributed to the growing number of referrals from Plateau and neighbouring states.

“For many families, this hospital remains the most affordable option,” he said. “That is why we must continue expanding our facilities to meet the increasing demand.”

Experts call for wider reforms

Mental health experts, however, say expanding one hospital will not be enough to address Nigeria’s widening mental healthcare gap.

A Jos-based mental health expert, Mary-Jane Samuel, described the experiences of patients and their families as evidence of years of underinvestment in mental health services.

“The burden of mental illness is increasing, but investment in mental healthcare has remained inadequate,” she told PREMIUM TIMES.

While welcoming JUTH’s expansion project, she said the country must also invest in human resources by recruiting more psychiatrists, psychologists, psychiatric nurses, occupational therapists and social workers.

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According to her, strengthening mental healthcare at primary and secondary health facilities would reduce unnecessary referrals to tertiary hospitals.

“Many patients should be able to access treatment closer to their communities instead of travelling long distances to referral hospitals,” she said. “Early diagnosis and treatment at lower levels of care will reduce the burden on facilities like JUTH.”

Mrs Samuel also advocated increased funding for psychiatric medicines, counselling services and rehabilitation programmes, stressing that effective mental healthcare extends beyond hospital admission.

Although the National Mental Health Act provides a legal framework for improving access to care, protecting patients’ rights and promoting community-based treatment, Mrs Samuel, however, cautioned that legislation alone will not transform services without increased funding.

She said that expanding psychiatric units, recruiting specialists and strengthening mental healthcare at primary and secondary facilities are essential if tertiary hospitals such as JUTH are to avoid becoming overwhelmed.

Waiting for change

For Emmanuel John, the debate over mental health funding is deeply personal.

He still remembers the anxiety of watching his daughter spend three days in JUTH’s emergency unit because no bed was available.

Although he commended the doctors and nurses for their professionalism, he believes no family should have to endure such an experience before receiving specialist care.

“I hope the government completes the new building quickly,” he said. “If there are more beds, other families will not have to go through what we experienced.”

Mrs Samuel expressed a similar hope.

“If there are more wards and more doctors, it will help families like ours,” she said.

Months after his daughter’s admission, Emmanuel John still remembers the uncertainty of waiting three days for a hospital bed. While he remains grateful for the care she received, he believes no family should have to wait during a mental health emergency because of inadequate facilities.

His experience reflects a challenge extending far beyond JUTH. As mental health needs continue to grow across Nigeria, experts say improving access to care will require more than new laws. It will demand sustained investment in specialist personnel, hospital infrastructure and community-based services to ensure that families seeking help can receive timely treatment when they need it most.