Case 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. Potentially, he could be sentenced to one year in prison.
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. The Lunacy Law of 1958 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 labeling 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 1958 (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 1958). 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 the current best evidence for the treatment and rehabilitation of affected persons. Furthermore, Nigeria remains one of the ignoble few countries where suicide and attempted suicide remain a crime – instead of recognizing it as a red flag and a cry for help and treatment. 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 day and was rested. The 2013 version equally failed to materialize.
Current Status: The current National Assembly has made the most progress with regard to expeditious attention to the mental health bill. The current heads of both the Senate and House Committees on Health, ably led by Senator (Dr) Yahaya Oloriegbe and Hon (Dr) Tanko Sununu have ensured that the draft bill has passed through the first, second, and third hearings; public hearing in February 2020 and a harmonized version sent to the Presidency for Signing into Law. This progress is gratifying to note, and we acknowledge that 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.
Call To Action: We now have a pressing need to increase advocacy and encourage Mr. President to sign the Mental Health Bill into Law. There is a critical window of opportunity within the 90 days allotted time, ending on the 28th of February 2023 for this to be signed into law. It will be a huge shame if the strenuous hard work of the past two decades still ends up failing at this last hurdle. We are cautiously optimistic that this administration will do the needful and Mr. President will sign before the February Deadline.
We all have to roll up our sleeves and support the excellent work of the Federal Ministry of Health, Senate and House Committees on Health, civil society organizations such as the Asido Foundation, organizations of mental health professionals, the media, all stakeholders, and indeed, every citizen of Nigeria by pushing for the signing of the Mental Health Bill into Law.
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 mental health legislation that protects and promotes human rights, and personal dignity as well as guarantees adequate oversight to ensure qualitative and evidence-based mental health services could not have been more urgent.
Dr Jibril Abdulmalik
Thursday, 15th December 2022
Tribune Article for the column “Your Mental Health & You”