At last, a modern Mental Health Law for Nigeria
By Femi Olugbile
On the 5th of January 2023, President Muhammadu Buhari signed a new Mental Health bill into Law, repealing heretofore extant law, which was known as the Lunacy Act CAP 524, of the Laws Of Nigeria 1964.
The signing of the Law is likely to be one of the achievements the beleaguered Nigerian leader is remembered for through history.
It is instructive to pause to reflect on where the journey of making laws to protect the interests of people suffering from Mental Illness started in the world, and to get a measure of the difference between a ‘Lunacy’ law, and a ‘Mental Health’ law. The original Lunacy Act came into being in the United Kingdom in 1890. It has undergone several transformations since then. Vigorous advocacy led by the Royal College of Psychiatrists, and several NGOs, as well as changing perceptions and sensitivity in society have led to regular revisions of the law. As recently as January 2021, the Government of the United Kingdom put out a White Paper containing wide-ranging proposals for the reform of the Mental Health Act 1983 (as amended in 2007). It is an area of continuous engagement between the government, the mental health profession, and the society at large. The changes in the law reflect and accommodate developments in the Science, as well as evolving sensitivities in society itself.
The Nigerian legislation, which was in force during the colonial era – was known as the Lunacy Ordnance of 1916. It derived its roots, and its knowledge base, or lack of it, from the Lunacy Act of 1890 in England. In 1958, it underwent some minor tinkering and was renamed the Lunacy Act. In essence, up till the moment President Buhari appended his signature to a new document a few days ago, this faulty, archaic piece of legislation was evidence that Nigerians saw mental illness as a monolithic and rather abhorrent entity, instead of hundreds of different diagnoses with different causations and trajectories, like physical illness. All the developments in the Science of understanding the human mind had essentially passed Nigeria by. The failure to advance the perception of Mental Health in Nigerian society is reflected in the pejorative language that is used to describe any form of mental illness in common parlance, in the denial of symptoms as a result, and in the shabby way anyone with a record of mental illness, even if fully recovered, is treated everywhere. It has led to widespread stigma and neglect, and is reflected in the depictions of mental illness in Nollywood films.
The effort to pass Mental Health legislation reflective of the state of modern knowledge and international standards as codified by the World Health Organisation has been in the works for more than twenty years. The first draft legislation was introduced by Dr Martyns-Yellowe, a notable psychiatrist and Senator, along with Senator Dalhatu Tafida in 2003. It struggled vainly for attention in a National Assembly that was more interested in other things, and was withdrawn after six years of futile effort. Given the rapid pace of advancement in the Science, it is not surprising that the draft legislation, originally packaged by the Association of Psychiatrists in Nigeria (APN) at the turn of the century, would itself have aged and become obsolete in parts by the time it finally negotiated a passage through the bric-a-brac of Senate discussion, interrogation and amendment in 2020. Its final, successful passage was championed and by Senator Ibrahim Yahya Oloriegbe – a soft-spoken medical doctor with a passion for mental health.
Even the best Mental Health laws in the world are not set in stone, and will always require regular updating, if only to keep pace with the state of knowledge on the workings of the human mind and the management of its frailties.
Looking through the draft law that was transmitted from the National Assembly to the Presidency for executive ratification, some interesting changes jump at the eye. There is not now going to be an independent ‘National Commission for Mental Health and Substance Abuse Services’. Instead, a Department for Mental Health Services, within the Federal Ministry of Health (‘The Department’) will take charge of the duty, and the resources, needed to oversee the structures and implementation of the Mental Health law. The body set up monitor and protect the rights and interests of the mentally ill, especially when they are involuntarily admitted into designated treatment facilities, will not be known as a ‘Mental Health Review Tribunal’, which is the usual description in many countries. It will carry the rather grand title of ‘Mental Health Assessment Committee’. A Mental Health Fund is to be set up, funded from contributions, grants and official allocations, with the objective of providing financial resources for the implementation of the provisions of the law. The law does not state if access to treatment will be funded across the board, or restricted to the needy, or if there is going to be some form of connection with National Health Insurance. And the law itself is rather ‘unitary’, with a concentration of power and responsibility in the Federal Ministry of Health, which may encourage a mindset that is detrimental to effective implementation at state level.
The landmark event of the 5th of January 2023 is a belated, but welcome development for Nigeria. Though the protections of the law are almost exclusively for the most extremely ill and vulnerable minority among the one in five people in society who have, or will have, some form of mental illness at some time in their lives, it acknowledges the reality of Mental Illness and seeks to develop a humane official attitude that will make treatment a right for citizens, oppose discrimination, fight stigma, and protect the human rights, including legal rights, of vulnerable citizens.
Members of the mental health professions, depleted in their numbers, often driven to despair by widespread ignorance and negative social attitudes, have a cause to smile at last.