Nigeria’s Mental Health Bill: Gray areas Persist -By Oluwatosin Victoria Adegboye

On January 11, 2023, a giant stride was made in the history of Nigeria’s Mental health as the President signed the enactment of the Mental Health Bill into law. This has been a longing for many, primarily mental health enthusiasts and families of those impacted by mental health. However, some aspects of the bill have left many wondering what to do with the information. Some of its contexts still need to be clarified to general health workers, mental health and addiction workers at lower levels of care, and the general public.

In as much as the new bill remains a significant stride in policy change since 1958, when the law was first amended from the 1916 Lunacy ordinance, which authorized Physicians and the Judiciary to incarcerate (admit persons identified as severely mentally ill unwillingly). The laws remained unchanged for more than five decades afterwards. However, in 2003, the National House of Assembly(the legislative arm of the Government) began the introduction of the Mental Health bill to protect individuals with substance use Addictions and mental health challenges. It faced opposition and has had intermittent breaks until December 2022 due to a lack of support. Nevertheless, many soon realize some aspects of the new bill could be more disconcerting. (Aluh et al., 2023) 

Gray Areas of the Bill needing Amendment

The bill states that the Federal Ministry of Health will integrate mental health into disease-specific programs such as HIV/AIDs, maternal health, and other existing health programs. This is a good initiative, except it might rely on a broad assumption that the primary healthcare systems will easily integrate Mental health services into other disease-specific programmes. In actual terms, these programs thrive with funds and support from donors (Onwujekwe et al., 2019). Having worked in one of such programs for seven years as a donor partner, funders’ support has been partly responsible for efficient service delivery.

Also, having voluntary donations from organizations and the private sector top the list as means of financial resources may be daunting. The bill needs to highlight the proportion of funds allotted for implementation. In a country where mental health is highly stigmatized, it’s unlikely for voluntary contributions to be relied on for program implementation.  A specific fund source is more beneficial(Wada et al., 2021).

Additionally, a portion of the bill boarder on issues relating to the public, such as a mental health-challenged person, must not be evicted solely based on Mental health challenges. While this is right, the general public may need help to ascertain who exactly fits in the context and the individual and their family members who need to exercise such rights. (Aluh et al., 2020) The Committee or Department needs to put into perspective that the mental health literacy of the population is generally low, which often results in considering non-medical options such as spiritual and traditional means. Also, some themes in the bill may be challenging for the citizens to comprehend. The National Committee needs to consider recommending public literacy intensification (Okafor et al., 2022; Adewunmi et al.,2020). Mechanisms should include public-facing documents, radio jingles, TV adverts and other communication mechanisms for reaching the entire population.

Furthermore, the bill highlights the need for training for Physicians. There needs to be a mention of Law enforcement agents in charge of confinement and returning a mentally challenged person to safety as well as other non-physician health workers. There is a need to train law enforcement personnel and general health workers on basic knowledge of mental health that will aid their job. Evidence shows increased Knowledge and improved service when such training is conducted. (Sebere et al., 2022, Dedeken et al.,2021)

Lastly, the bill has only identified creating a Committee at the National level meanwhile, there is a high chance of knowledge gaps at the state and local Government levels if there is no replication at these levels. (Effective Health Care Program,n.d.)  This will ensure guidance and leadership for health workers at primary health centres, which is a core objective of the bill. The Committee should also consider expanding to allow other mental health professionals or create an avenue for interfacing with these professionals for collaboration and experience sharing at all levels. It will also create Synergy between the public and private sectors on implementation.

In conclusion, enacting the Mental Health Bill is the most progressive law ever made since 1958. It also follows WHO recommendations for countries regarding decriminalizing persons with mental challenges. (WHO, 2017). However, there is a need for improvement to implement the bill effectively and early implementation as many people with mental health challenges experience infringement of rights. 

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