Nigeria Passed its First Mental Health Bill to Replace the Lunacy Act 1958

1 in 4 Nigerian is suffering from mental illness (an average of 50 million people). There are less than 150 psychiatrists and 8 federal neuropsychiatric hospitals in the country serving this large number of people.

[This text has been written Ebenezer Agbana, a physician currently studying Master of Clinical Research: International Health Track at ISGlobal, University of Barcelona.]

The Lunacy Act of 1958 proposed by the British government guided the operations of mental health services in the country for 64 years until the National Mental Health Bill was passed in January 2023. This is good news and hopefully it heralds a change in the mental health service. However, assent does not always equal successful implementation. This article will explore the potential enablers and barriers of the implementation process.

Potential Enablers of the Implementation of the Mental Health Act in Nigeria

1. Individuals with lived experiences on mental health issues should be employed as support staff

One of the provisions of the National Mental Health Bill is to create a Department of Mental Health at the Federal Ministry of Health. While this is a good initiative, individuals with lived experiences on mental health issues should be employed as support staff both at the national and grassroot level (primary health care). This should be prioritized because the experiences of this group will bring a survivor perspective in every decision-making process. This will also show that the government is serious about ending all forms of discrimination against people with mental health issues.

2. Mental health assessment should be incorporated as part of routine clinical investigation

I also think it is worth considering the possibility of increasing case detection and early intervention. Incorporating mental health assessment as part of routine clinical investigation will help in this regard. Health care workers should be deliberate about identifying subtle signs of mental illness when patients or their relatives present to the hospital and make prompt referral to specialists. An individual with diabetes who comes to the hospital for follow up visit should not just have his blood sugar and kidney function checked, we should also be interested in what is going on in his mind and that of those who brought him.

3. An impact assessment committee should be set up

To ensure successful implementation, an impact assessment committee should be set up who will periodically monitor the successes and failures of this new intervention and make necessary adjustments based on feedback. This committee should be independent, committed and have no personal interest.

An individual with diabetes who comes to the hospital for follow up visit should not just have his blood sugar and kidney function checked, we should also be interested in what is going on in his mind and that of those who brought him

Nigeria, 2021. Photo: TOYINVISUALS / Wiki Commons.

Potential Barriers of the Implementation of the National Mental Health Bill in Nigeria?

1. Nigerian Government should prioritize the wellbeing of the people at all levels

The primary function of government is protection of lives and properties. Humanitarian crisis such as hunger, poverty and conflict are the leading causes of anxiety and depression. No matter how promising the provisions of the Mental Health Bill might look, it will not achieve its aim if people can’t feel safe and satisfied in their own country. While not all life stresses can be controlled, the leadership should be seen to prioritize the wellbeing of the people at all levels.

2. Child fostering practices and family reunification services should be reviewed

Child fostering practices and family reunification services should be reviewed. One of the key drivers of mental health issues among children and young adult is illegal fostering which often lead to child molestation and child sexual abuse. The department of mental health should have a legal practitioner on the team who can advise on this.

3. Nigerian Government should embrace inclusiveness by prioritizing migrants’ mental health

The government should embrace inclusiveness by prioritizing migrants’ mental health. Having a unit in the proposed Mental Health Department that caters for this group will promote multilateralism and also help align the country with the best global mental health practice. Integrating into a new system can be quite challenging which may subsequently lead to anxiety and depression, no one should be left out.

4. There should be collaboration among stakeholders both locally and internationally to pool resources

Finally, the National Mental Health Bill offers a ray of hope but funding could be a challenge considering the overall health budget. To domesticate the law at the national, state and community level, there should be collaboration among various stakeholders both locally and internationally to pool resources. A system that drives transparency and accountability at all levels should be adopted.

Hunger, poverty and conflict are the leading causes of anxiety and depression. No matter how promising the provisions of the Mental Health Bill might look, it will not achieve its aim if people can’t feel safe and satisfied in their own country