In January 2023, a little over six decades after the Lunacy Act of 1958 was established, giving medical practitioners the power to detain people suffering from mental illnesses, President Muhammadu Buhari signed into law Nigeria's first Mental Health Bill, the National Mental Health Act, 2021. The Lunacy Ordinance enacted in 1916, which preceded the Lunacy Act of 1958, was Nigeria's first mental health legislation. The Act is a significant step forward for mental health in Nigeria as it seeks to promote and protect the lives of people suffering from mental illnesses while also addressing and correcting the flaws in the Lunacy Act. It also emphasises the government's commitment to closing Nigeria's massive mental health care gap and eventually, achieving Universal Health Coverage.
But what does this mean for a sector that was previously regulated by an Act that failed to meet the international standards for a good mental health policy because it labelled mental illness as 'lunacy', violated the rights of the people it was supposed to protect, and fostered stigma and discrimination?
Here are five things to note about the Mental Health Act, 2021 -
- Mental health, not lunacy
The Act will redefine mental health in Nigeria, moving away from the term 'lunatic' to the more acceptable term, 'mental health'. While the Lunacy Act of 1958 was enacted prior to independence and therefore represented a period in history when mental health was not adequately understood, resulting in inhumane and ineffective treatment and stigma for mental health patients, the new Act seeks to change perception and understanding of mental health, while also addressing access to 'a better quality of life' and better quality mental health services for people with mental health conditions.
The Mental Health Act has ushered in an era in which mental health interventions will be designed to provide the highest quality of care while also protecting the rights and dignity of people with mental health needs.
- A strong community-based focus
Nigeria's mental health system faces numerous challenges and gaps, particularly at the community level, where a lack of awareness and understanding, combined with stigma and discrimination, exacerbates existing issues and creates barriers to accessing quality care. Addressing these challenges will require a multifaceted community approach that considers both individual and systemic factors.
According to the World Health Organization (WHO), 'community-based mental health care" refers to any mental health care provided outside of a psychiatric hospital. This includes services available through primary health care, district or regional general hospitals, as well as relevant social services.
The Act has a strong community-based focus and when fully and appropriately implemented, it will ensure increased access to mental health services, community education and awareness, integration of mental health services into primary care and support for people with mental illnesses. Implementing these and other strategies can help to improve the mental health of people living in rural communities in Nigeria and reduce the burden of mental illness on these communities.
This community focus is consistent with the Comprehensive Mental Health Action Plan 2013-2030 which identifies one of its four core objectives as the need to develop comprehensive, integrated and responsive community-based mental health care services.
- A well-defined governance structure to drive implementation
Nigeria has many well-formulated policies, however ensuring that these policies are effectively implemented can be difficult at times. This is often a function of implementation, and the new Mental Health Act has filled this gap by establishing a department in the Federal Ministry of Health (FMoH), to be referred to as the "Department of Mental Health Services". This is a step in the right direction because the department will be responsible for ensuring that the Act is fully operationalised.
However, it does not specify which cadre of staff will be in charge of this process. To ensure the effective implementation of the Act, it is crucial for the Department of Mental Health Services' leadership to develop operational guidelines to actively drive the process.
In addition to the coordinating role of the Department of Mental Health Services at the Federal Ministry of Health, the new Act establishes a Mental Health Assessment Committee.
The constitution of the mental health assessment committee is a great idea that serves as an accountability mechanism to ensure that people with mental health conditions receive quality services from providers, that their rights are protected and that other legal issues are addressed.
- Promotes and protects the human rights of persons with mental health conditions
Stigma and discrimination in homes, schools, workplaces, communities, and even the mental health care system itself often foster human rights abuses. Physical and sexual abuse and violence, denial of employment and other opportunities and limited or no access to quality mental health services are all manifestations of these abuses.
While the Lunacy Act of 1958 failed to protect the rights and dignity of people with mental illness, the Mental Health Act 2021 is designed to 'promote and protect the fundamental human rights and freedom of all persons with mental health conditions'.
The Act protects people with mental health illnesses from all forms of abuse, violence and torture. It empowers and advocates for their right to access social services such as healthcare, education, employment and housing. It also protects their right to voluntary admission and treatment, permitting involuntary admission only if necessary and in the best interests of the person with a mental health condition. Under this new Act, anyone who violates the rights of people with mental illnesses, if convicted, will be imprisoned for at least one year or fined 500,000 naira.
- Addresses the critical funding gap
Every government policy or law requires financial commitment to ensure its smooth implementation. As a result, a Mental Health Fund was established to provide financial resources for the implementation of the Act.
The government's commitment to prioritising mental health services will be demonstrated by the commitment of funds to mental healthcare through legislation would demonstrate. This will provide stability and certainty for mental health initiatives, as well as ensuring adequate resources are available to address the challenges in the field. Earmarking funds through legislation can also help in tracking the progress and impact of the mental health programmes, as well as holding the government accountable to their promises. However, there is no mention of including mental health care into health care benefit packages or health insurance schemes.
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Universal health coverage aims to provide access to quality and affordable health care services to all citizens, regardless of their financial status. To achieve this goal, adequate resources must be allocated to ensure that both physical and mental health services are equally accessible. This includes funding for health systems, training and support for healthcare providers, and investment in health infrastructure and technology. In addition, policies and regulations must be implemented to promote equity and ensure that health care is not driven by profit motives.
Progress through collective action
Despite the call for mental health reforms, 64% of African countries still lack mental health legislation or have outdated legislation. The transition from the "Lunacy" law to the Mental Health Act is a laudable achievement. However, it is crucial for all stakeholders to work together to create a supportive environment for people with mental illnesses and ensure that they receive proper care and treatment. This will require a comprehensive approach that involves collaboration between federal, state and local governments, healthcare providers, civil society organisations, and the general public. With collective effort, Nigeria can make significant progress in addressing the needs of people with mental health conditions and promoting their rights and well-being.
What are your thoughts on the new Mental Health Act? What stood out the most for you in the Act? We'd love to hear your thoughts! Let us know in the comment section below.
