According to the World Health Organization, one in four Nigerians—about 50 million individuals, suffer from a mental health condition. The Mental Health Act 2021, the first proper revision of the Nigerian mental health laws in over a century, elevates Nigeria’s mental health policies in line with global best practices.
On 05 January 2023, President Muhammadu Buhari signed the Mental Health Bill 2021 into law after two failed attempts. The Mental Health Act addresses access to mental healthcare and the rights of people living with mental illnesses. The Act, which replaces the Lunacy Act of 1958, notably provides for a mental health services department to be created within the Federal Ministry of Health.
A HISTORY OF NEGLECT
Nigeria’s first-ever mental health law, the Lunacy Ordinance, was enacted in 1916. Its content was written in the 1800s and characterized persons with mental illnesses as lunatics and idiots to be removed from society. In 1958, the law was amended to allow for forced detention of the mentally ill by magistrates and medical practitioners, including those who attempt suicide and engage in self-harm. It was then renamed the Lunacy Act of 1958 and was in effect until January 2023.
Needless to say, the Lunacy Act of 1958 did more harm than good for the Nigerian mental health community as it reflected a time when stigma and superstition informed how people with mental illnesses were treated. While in effect, people with mental health conditions were routinely denied access to basic services such as healthcare, employment and education. In 2019, Human Watch reported that thousands of people with mental health conditions were locked up in institutions where they routinely faced psychological and physical abuse. People with actual or perceived mental health conditions were picked up from the streets by the police and placed in religious or state facilities, where many are chained to heavy objects and/or other detainees and are confined to unhygienic spaces for weeks on end.
NIGERIA’S MENTAL HEALTH PROBLEM
The World Health Organization (WHO) says one in four Nigerians—about 50 million individuals, suffer from a mental health condition. As a result of archaic legislation, terrible societal perception of mental health conditions, inadequate resources and mental health staff, fewer than 10 per cent of those people have access to the mental healthcare they need. The Nigerian healthcare system is also severely underfunded, with the total healthcare budget coming to roughly 4 per cent of the GDP. There are also less than 300 psychiatrists serving an estimated population of 210 million people. To put things into perspective, the ratio is one psychiatrist to a million citizens in Nigeria.
Nigeria also has Africa’s highest caseload of depression, and its frequency of suicide attempts ranks 15th highest in the world. Annually, about 7,019 people die by suicide in Nigeria, with existing research showing that the poor and people with pre-existing mental health conditions are more likely to attempt it. This figure puts Nigeria behind South Africa with 13, 774 deaths and ahead of Ethiopia with 6, 030 deaths. Despite being recognized by WHO as a significant health and social problem, there is still a dearth of information on suicidal behaviours. There’s also the fact that attempted suicide, under sections 327 of the Nigerian Criminal Code and 231 of the Penal Code, can be penalized with a one-year jail term.
THE LONG ROAD
In 2003, a bill to introduce the Mental Health Act and reform the Nigerian mental health sector was put forward to the National Assembly by serving senators, Ibiabuye Martyns-Yellowe and Dalhatu Tafida, who were medical practitioners. It was withdrawn in April 2009 after the death of Martyns-Yellowe and the dissolution of that Senate. As part of the National Policy for Mental Health Services Delivery, another bill was introduced in 2013. It was also dropped due to a lack of support.
In 2019, ‘A Bill for an Act to provide for the establishment and regulation of mental health and substance abuse services, protect persons with mental health needs and establishment of National Commission for Mental and Substance Abuse Services, for the effective management of mental health in Nigeria and for other related matters, 2019’ was introduced to the Senate. It was passed on second reading and had a public hearing in 2020. On 28 November 2022, the Mental Health Bill 2021 was passed by the National Assembly and forwarded to the president for assent. On 5 January 2023, President Muhammadu Buhari signed the bill into law.
WHAT’S IN THE ACT?
The Act sets out not only to ensure a better quality of mental healthcare services and promote recovery in Nigeria, but to protect the rights of persons who have mental health conditions. The establishment of a department of mental health within the federal ministry is to see that mental health policies are proposed and implemented.
On a positive note, the Act defines and protects the rights of Nigerians with mental health conditions. Section 12 of the Act states that any person needing mental health services should not be subjected to any form of discrimination based on their condition. They have the right to access all healthcare services, the right to protection from physical and mental abuse or exploitation, the right to humane and dignified treatment, the right to expression and opinion, and the right to receive reasonable care from their family, legal representatives, carers, and the government. It also provides for the right to a quality standard of treatment, the right to appoint legal representatives, the right to participate in treatment planning, the right to privacy and dignity, the right to access information, and the right to confidentiality.
The Act provides for the employment and housing rights of people living with mental health conditions, making it illegal for an employer to terminate their employment on those grounds or for receiving treatment for it. It is also illegal for a tenant who develops a mental health condition to be evicted from his residence solely on those grounds.
Unlike the Lunacy Ordinance of 1916, the Act provides that a person can only be involuntarily admitted where a Medical Officer has determined that because of the mental health condition, there is a serious likelihood of imminent harm to themselves or another person; or where there is evidence that failure to admit the person is likely to lead to a serious deterioration of that person. Even then, the Act provides that the principle of the least restrictive alternative must be applied, and the person (or their legal representative) has the right to appeal against involuntary admission. Accreditation by the government is also required before any facility can admit an individual involuntarily.
Furthermore, the Act provides that persons with mental illnesses should be protected from the use of forced treatment, seclusion, and any other method of restraint in facilities, including physical, mechanical and chemical restraints.
Mental health practitioners have welcomed the Act as it provides hope for the mental health sector in Nigeria.
For Ibifubara Davies, a psychologist living and working in Lagos:
Now that the bill has been passed, there will be better quality in the delivery of mental health services, a government team assigned to create policies that will help protect the fundamental human rights of all people with mental health conditions, and hopefully more research on mental health issues in Nigeria.
The Act also restores some confidence that the Nigerian government is capable of prioritizing the well-being of its citizens when necessary. ‘Overall, we hope to see more involvement and growth from the government,’ Ibifubara continues. ‘[This will] ensure that we are better equipped to deal with mental health issues in the future.’
The Mental Health Act 2021 is a major step in the right direction for persons with mental health conditions. The first proper revision of the Nigerian mental health laws in over a century, the Act brings Nigeria’s mental health policies to the same level as global best practices. The Act in itself also starts a conversation about societal perception, awareness and acceptance of mental illnesses and people with mental health conditions. All that is left is for the Nigerian government to implement these developments on both the state and federal levels.
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