Mental Health Care in Nigeria: Has the Time Come?
Like many people in the 21st century, I spend time on Facebook. In the time since I set up my account, I have made new friends, reconnected with old ones, read startling news, seen several peculiar updates, and prayed for missing children. But nothing has broken my heart as the pictures that were circulated on that site last Friday. They were pictures of a young man,probably not more than twenty-one. He had hung himself at a Nigerian university. One picture depicted the man hung. Another showed him lying on what looked to be a stretcher or a slab, his face bearing the goriness of his manner of passing. I am sorry to have started your morning on this note. But has the time not come to take another look at our mental health care?
I will offer here a caveat: I am not a psychiatrist. Neither my doctorate degree in law, nor my expertise in health law and policy qualify me to make medical diagnoses. But it is very likely that this young man was severely depressed. Suicide is a clear category under mental health concerns, and often results from severe depression. Even if I am wrong in this, this young man would most likely have benefited from seeing a therapist, a psychologist, or a spiritual counsellor. Which leads me to the question: How many universities in Nigeria have an office which deals with mental health, psychological or emotional issues?My research shows that not many have specific mental health services dedicated to students. If there are any such offices, it is very unlikely thatmany students know about them.
Inadequacy of mental health services is by no means confined to our higher institutions, but is rather, unfortunately, a country-wide problem. A World Health Organisation report on mental health services in Nigeria indicates that mental health services are grossly inadequate. Stigma remains a very critical barrier to accessing treatment. In addition, due to the limited education available on mental disorders, many mentally ill persons end up in the hands of quacks, both of the medical and spiritual variety, where they suffer unnameable horrors and terrible violations of human rights. This leads one to ask what regulations we have established to protect the mentally ill and the mentally challenged.
Unfortunately, in terms of law and policy, the situation is not much better. Our current legislation on mental health is the Lunacy Act, 1958. Starting with its title, which is now considered derogatory, it is a law belonging to another time, a time when mental illness was more poorly understood, and when the human rightsof the mentally ill were taken much less seriously. There is currently no clear regulation of mental health care, no direct legal protections, and no financial or welfare provisions for mentally ill persons.
Perhaps in recognition of these issues, new mental health legislation was introduced in the National Assembly in 2003. Nine years later, that Bill is yet to be passed. Even in its current form, the Bill lacks certain provisions that are now considered de rigeur in mental health law internationally. While it addresses some of the outdated provisions of our current Criminal Code, the Bill fails to address certain critical issues. For instance, the Bill focuses on procedures for admission of involuntary patients, an admittedly essential part of any serious mental health legislation. However, it fails to address clearly access to care in rural areas. It is also very casual in its approach to human rights protections, non-discrimination of mentally ill persons, and regulation of traditional and faith healers. Hopefully, the Bill will not be passed in its current form but will undergo major review before its passage.Reviving the legislative process to pass the Mental Health Bill should be used as an opportunity to reform and revitalise mental health services. Provisions should be made in the Bill to provide financial resources and public education.
Finally, as a lawyer, it is easy for me to focus on mental health law, the content of such law, the effectiveness of legislation, and so forth. But, as I stated in my first article, true change begins with us. Change in socio-cultural attitudes towards mental illness must begin with individuals in the society. We need to develop an affinity for the mentally ill and the mentally challenged in this country. In the past month, I have read of two suicide cases. Many of us, if we are honest, know close family and friends who have, or have had mental health issues. These matters are not as far away, as rare, as we would like to imagine. We must begin to see the mentally ill and the mentally challenged as part of us.
And now, I come back to the sad pictures on Facebook, much has been said about the abuse and misuse of social media – lack of privacy, dependence on others view of us, non-genuine interactions with others, even outright addiction – and I will not rehash that here. But we cannot, we must not, lose our sensitivity to the plight of others, our common sense, our understanding of others’ need for privacy, our empathy, our very humanity to a non-reflective use of what would otherwise be a great resource when used properly. It is not, for instance, inconceivable that the deceased has a sister, brother, or other relative on Facebook, who may come across these pictures, along with several, frankly, cruel and insensitive comments.
Moreover, pictures like the one I saw, and the insensitive comments on such pictures exacerbate stigma. Stigma prevents us from helping those who are suffering, because they may not seek treatment for fear of such stigma. Advocacy for mental health is also affected by such stigma – few civil society organisationsin Nigeria focus on mental health. The result is much unmet need with respect to human rights protections, general education, and support for mentally ill persons and their families.
Finally, while we wait for our mental health law and services to move from the twentieth century into the present century, we must take responsibility for making our sphere of influence better – our families, our neighbourhood, our Facebook pages. We must begin to demand better services for the mentally ill and mentally challenged. We must call out those who maltreat the mentally ill, including in spiritual/religious circles, and yes, on Facebook.
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