The time is now: reforming Nigeria's outdated mental health laws

Nigeria's mental health legislation was first enacted in 1916 and was called the Lunacy Ordinance. In 1958, these laws were amended to give medical practitioners and magistrates the power to detain an individual suffering from mental illness. 1Westbrook AH Mental health legislation and involuntary commitment in Nigeria: a call for reform. https: //openscholarship. wustl. edu/cgi/viewcontent. cgi? article=1022 291: 2581-2590Crossref PubMed Scopus (2264) Google Scholar With fewer than 300 psychiatrists for a population of more than 200 million, most of whom are based in urban areas, and in view of poor knowledge of mental disorders at the primary health-care level, caring for people with mental illness is typically left to family members. 5Odejide AO Morakinyo JJ Oshiname FO Omigbodun O Ajuwon AJ Kola L Integrating mental health into primary health care in Nigeria: management of depression in a local government (district) area as a paradigm. Seishin Shinkeigaku Zasshi. 2002; 104: 802-809PubMed Google Scholar A paucity of community-based and primary health-care services means that access to care is restricted to the most severe cases, usually in the form of psychiatric inpatient care or makeshift institutions. The result is a chronically and dangerously under-resourced mental health system catering to the needs of an estimated one in eight Nigerian people who suffer from mental illness, 3Federal Ministry of HealthNational policy for mental health services delivery. https: //cheld. org/wp-content/uploads/2015/02/nationalₚolicyforₘentalₕealthₛervicedelivery_₂013_. pdfDate: August, 2013Date accessed: June 17, 2020Google Scholar poor awareness of the causes of mental health, widespread stigma and discrimination, poorly equipped services, and abuse of people with mental health problems. A reform of the mental health law that is in keeping with international standards is urgently needed to drive change. The global target of WHO's mental health action plan6WHOMental health action plan 2013–2020. https: //www. who. int/mentalₕealth/publications/actionₚlan/en/Date: 2013Date accessed: June 17, 2020Google Scholar aims for 50% of countries to have developed or updated their law in line with international and regional human rights instruments by 2020. In 2017, only 40% of WHO member states had updated their legislation in the previous 5 years (ie, since 2013). 7WHOMental health atlas. https: //www. who. int/mentalₕealth/evidence/atlas/mentalₕealthₐtlas₂017/en/Date: 2017Date accessed: June 17, 2020Google Scholar Africa had the lowest rate at 21%, although this rate had doubled since 2014. On Feb 19, 2020, the Nigerian Senate held a public hearing for the Mental Health and Substance Abuse Bill. If passed, the Bill would allow for much needed budgetary allocations for mental health facilities and mental health providers. The time is now for a mental health legislation and policy in Nigeria to protect individuals suffering from mental illness from being subjected to gross human rights violations, including degrading treatment and destitute living conditions. 8Human Rights WatchNigeria: people with mental health conditions, chained, abused. https: //www. hrw. org/news/2019/11/11/nigeria-people-mental-health-conditions-chained-abusedDate: Nov 11, 2019Date accessed: June 17, 2020Google Scholar Widespread consultation with key stakeholders, including the Association of Psychiatrists of Nigeria and community representatives, is currently in process. In strong support of this Bill, we further put forward several considerations. Specifically, we call for any resulting legislation to be in accordance with the WHO Checklist on Mental Health Legislation to ensure that it meets international standards. Second, legislation should be culturally sensitive and meet the human rights standards as set out by the International Covenant on Economic, Social and Cultural Rights9UN Human Rights Office of the High CommissionerInternational Covenant on Economic, Social and Cultural Rights. https: //www. ohchr. org/en/professionalinterest/pages/cescr. aspxDate: Jan 3, 1976Date accessed: June 17, 2020Google Scholar and the African Charter on Human and Peoples' Rights. 10UNAfrican Charter on Human and Peoples' Rights. https: //treaties. un. org/doc/Publication/UNTS/Volume%201520/volume-1520-I-26363-English. pdfDate: Dec 28, 1988Date accessed: June 17, 2020Google Scholar Third, we call for mental health services to be a covered mandate in the national health insurance scheme to ensure accessibility and affordability of care. Fourth, and in line with best practice, we urge additional support for outpatient, primary, and community care services for people with mental illness. Finally, and in view of the severe dearth of human resources for mental health, we call for the integration of mental health training, responses, and psychoeducation within primary care settings, as contained in the National Mental Health Service Delivery Policy of Nigeria. Legislation that works for all is important to help improve the health of the nation and to safeguard the care of all Nigerian people, today and for the future. OU, NM, SAL, and FV conceptualised and drafted the Comment. CA and TLS provided useful insight to finalise the Comment. TLS participated in the development of Mental Health Service Delivery Policy for Nigeria and is a member of the committee working on the National Mental Health Bill, currently in the legislative process to be passed into law by the Nigerian National Assembly. CA is a member of the Nigerian National Assembly. OU, NM, SAL, and FV declare no competing interests.