WHEN Akin Akinlade (not real names) started to hear voices and see things that others couldn’t experience in November 2018, his parents took him to church for prayers, hoping he would be cured of whatever was wrong with him. His mother was of the opinion that his illness was a ‘spiritual attack’.
But even with a series of prayers and in different churches trying to ward off evil spirits, the expected healing did not happen. They even brought in another pastor to pray for him at home.
Akin’s family doctor eventually referred him to a psychiatric hospital after hearing about his symptoms. He was later diagnosed with paranoid schizophrenia and placed on drugs. This brought respite to his parents knowing it was nothing spiritual.
Ifeanyi Udoma, 30, ended up in prison for trying to kill himself. He was locked up for trying to take his own life because in Nigeria, attempt suicide is a crime.
In parts of Nigeria, it is common to attribute mental illness to supernatural factors such as witchcraft or repercussions for sins against God. As a result, people with perceived symptoms of disorders are believed to be possessed or in need of unorthodox healing from traditional healing centres, and at Christian and Islamic faith-based facilities.
Mental health has historically been neglected on Nigeria’s health and development policy agenda. Apart from the many challenges in besetting Nigeria, including intractable poverty, infectious diseases, maternal and child mortality, as well as insurgency, approximately 80 percent of individuals with serious mental health needs cannot access care.
All of these are about to change, however, with President Muhammadu Buhari signing the National Mental Health Bill 2021 into law. The bill was sponsored by Dr Ibrahim Oloriegbe, a senator.
Professor James Obindo, president of the Association of Psychiatrists of Nigeria (APN), stated that the signing of the National Mental Health Bill is a watershed in mental health services in Nigeria since it will ensure more humane mental health services and address many areas neglected by previous bills.
Mental health legislation in Nigeria first appeared as the Lunacy Ordinance of 1916, which was modified as the Lunacy Laws of 1958 (State Laws). Thus, it can technically be argued that Nigeria has no national mental health legislation.
The name of the law and the choice of words deployed in the bill, such as ‘lunatic’, ‘idiot’, ‘proper subject for confinement’ etc. have been perceived as a major source of embarrassment. These expressions are also anachronistic and not in keeping with the current best practices for the treatment and rehabilitation of affected persons.
Professor Obindo said while three state governments have some mental health bills, the new national law will ensure, among other things, the rights of people with mental health needs; funding for mental health; integration of mental health into primary health care across local governments, as well as stop discrimination and stigmatization against people with mental health problems.
Also, the establishment of a Department of Mental Health Services in the Federal Ministry of Health and a Mental Health Fund are some of the provisions of the National Mental Health Bill.
It will also help in improving care by guaranteeing that those receiving treatments have the right to participate in formulating their medical plans, eliminate forced treatment, seclusion and other methods of restraint in facilities, as well as expand community-based coverage.
He added: “So, it is a win-win for all and in particular those who have mental illnesses and their relations.
“As I speak, three states in the country have such laws and therefore, it needs to be taken further.
“We need to educate everybody about what mental illnesses really are. It is not only those who are unkempt and walking with rags on the road that have mental illnesses. Those are probably less than one percent of those with mental illnesses. They are humans and have the right to care.
“How much of our national health budgets gets to mental health? Even the one that comes to mental health, the major chunk goes to the Federal Neuropsychiatric Hospitals, leaving others also offering mental health services like the Federal Medical Centres.”
Although the Mental Health Bill was finally assented to by President Buhari after two failed attempts, Professor Oye Gureje, a consultant psychiatrist, stated that the Federal Government needs to put in resources for its implementation.
He said: “The main point now is its implementation. The law is more concrete in that it specifies things to do. There are some aspects of this law that will make it imperative for the government to actually commit financial, material and human resources for its implementation.
“One of the important aspects of the law is the protection of the rights of persons with mental health needs; so they alongside their relatives and their caregivers should be in the forefront of advocacy, awareness creation and the implementation of the law.”
Also speaking, Dr Jibril Abdulmalik, founder of Asido Foundation, a not-for-profit mental health advocacy organization, applauded the passage of the law, but wondered if the implementation would be backed up with the political will from the coordinating ministry and other relevant ministries and agencies.
According to him, without financial backing for its implementation, it could end up gathering dust on the shelves.
Dr Abdulmalik stressed the need for the law to be adopted and domesticated by all states in the country as well as the regulation, supervision and accreditation of persons providing mental health services in order to ensure that the wellbeing, safety and rights of people with mental needs are sustained.
“Most of the time, we tend to regulate medical facilities alone, and those who make claims under whatever umbrella tend to have very poor or little regulation or supervision. But with the law, there will be checks and balances in mental health, which is ultimately to protect the well-being and safety of all Nigerians.
“Medicine has moved far beyond the Lunacy Act of 1958, (which was emplaced) before effective medications were discovered that could allow people with mental illnesses recover and return to normal functioning within the society. We are now in an era of humane care that protects personal dignity and their fundamental human rights.”
