C ASE A: A 23-year-old man had been struggling with depression and was having difficulties concentrating on tasks. He was frequently tired all the time and had no motivation to do anything. Thus, he stopped going to work and was terminated after a few months. He stayed indoors all the time and was not happy about his condition but felt helpless and hopeless. Sometimes he will cry silently to himself. He had no hope that things will improve and so he decided that it may be better for him to end it all. He jumped into the Lagoon but was rescued and promptly handed over to the police. He was arraigned in court and charged for attempted suicide. He pleaded guilty and was remanded in Prison custody while the court adjourned and a date was set for his sentencing.
Case B: Gubernatorial elections in at least two states in recent years have been characterized by allegations of being of unsound mind and therefore not fit for office. In Kogi State, court cases and affidavits have actually been activated on at least two occasions. The Lunacy Law of 1948 which utilizes language such as “a certified lunatic and a proper subject for involuntary confinement” has now become a political tool for discrediting opposition candidates, by simply labelling them as ‘Lunatics’.
Background: The mental health legislation in Nigeria first appeared as the Lunacy Ordinance of 1916, which was modified as the Lunacy Laws of 1948 (State Laws). Thus, it can technically be argued that Nigeria has no national mental health legislation. The existing law is about 104 years old (discountenancing the minor changes of 1948). It was passed at a time when custodial care and confinement was the default option as there were no medications at that time. The first antipsychotic medication (Chlorpromazine) was only just discovered in 1949.
Current Challenges: The name of the law and the choice of words deployed in it, remain a major source of embarrassment. Words such as ‘lunatic’, ‘idiot’, ‘proper subject for confinement’ etc. It is also ancient and not in keeping with current best evidence for treatment and rehabilitation of affected persons. Furthermore, our laws remain one of the ignoble few remaining legislations that criminalizes suicide and attempted suicide – instead of recognizing it as a red flag and a cry for help, – and ensuring such individuals receive the care they need. It also does not promote and respect the fundamental human rights of citizens with mental health challenges – deriving from the paternalistic colonial environment during which it was first crafted.
The Journey towards a Modern Mental Health Bill: Since the return to democratic rule in 1999, several efforts have been made with expert committees established, and working with the Federal Ministry of Health, Lawmakers, Professional Organizations (including those of Psychiatrists, Clinical Psychologists, Psychiatric Nurses, Medical Social Workers etc) to prepare a draft bill for consideration. The 2003 Bill failed to see the light of the day and was rested. The 2013 version equally failed to materialize.
Public Hearing on Mental Health Bill: The current National Assembly has made the most progress with regards to expeditious attention to the mental health bill. The current Senate Committee on Health, ably led by the Committee Chairman, Senator (Dr) Yahaya Oloriegbe, has ensured that the draft bill has passed through the first, second and third hearing and is now slated for public hearing on Monday, the 17thFebruary 2020. This is gratifying to note and presents an opportunity to all stakeholders and the general public to participate and engage with the progress, highlight areas of shortcomings and propose recommendations and amendments to improve on such areas.
Ultimately, there is no such thing as a perfect bill or legislation. But the worst form of the current bill will be a significant improvement on what currently exists. But we now have a window of opportunity to participate in the process and provide critical input for its improvement. Let’s do so, and ensure that all stakeholders rally round and push together for the collective benefit of our society. So, we don’t end up throwing away the baby with the birth water on account of perceived shortcomings.
Conclusion: Our nation is witnessing a worrying spike in the prevalence of mental health challenges, drug abuse, suicide and attempted suicide amongst others. The critical need for a mental health legislation that protects and promotes human rights, personal dignity as well as adequate oversight to ensure qualitative and evidence based mental health services could not have been more pronounced. It is a glorious opportunity that should be embraced and utilized. Let’s do the best we can and achieve some progress. If you are in Abuja on Monday, the 17th February, please attend the public hearing and participate in the process.