Nigeria’s first mental health legislation, the Lunacy Ordinance, was enacted in 1916. In 1958, the Lunacy Ordinance was revised to provide medical practitioners and magistrates with authority to imprison mentally ill people. However, these laws have not been amended more than five decades after. In 2003, the National Assembly introduced a Mental Health Bill. Unfortunately, the bill was dropped in 2009 after making little progress for more than six years.
In 2013, a new bill was introduced as part of the National Policy for Mental Health Services Delivery. The aim was to establish the foundations for delivering care to people with mental, neurological, and substance addiction difficulties. Due to a lack of support, the new bill has yet to come to fruition.
Mental health care in Nigeria is currently undergoing a catastrophe. Approximately 80% of Nigerians with mental health needs cannot access care due to several factors. The significant obstacles are lack of funds, facilities, mental health personnel, and poor cultural and religious stigma targeted at mental health themes. In Nigeria, mental health patients are frequently left to family members and the cold hands of spiritual therapies. Nigeria’s mental health need is currently borne by less than 300 psychiatrists, most of whom live in the cities.
The lack of a reformed mental health bill has caused several obstacles for progress to mental health in the country. This influence on the quality of care and life for those living with mental health disorders in Nigeria is enormous. The Nigerian mental health system is chronically underfunded, serving the needs of one out of every eight Nigerians who have a mental illness. The mental health budget is roughly 3.3–4% of GDP, with over 90% going to a few neuropsychiatric hospitals, primarily funded through the national government’s health budget. A mental health law reform that complies with international standards is therefore essential to encourage change.
Mental healthcare must be treated as an essential part of primary care. However, this is impossible in the absence of reformed laws and policies. Some African countries like South Africa, Uganda, and Ghana have recognised mental health as an essential element of primary care. Mental health diseases should be treated the same way as any other illness covered by primary care. Integrating and offering mental health care and treatment through primary care will increase access, affordability, and cost-effectiveness while promoting human rights. Some of these activities would involve the establishment and integration of community-based rehabilitation facilities in rural regions and the establishment of a robust primary care network that provides extra care in close collaboration with secondary and tertiary care institutions.
It is most successful when mental health integration into primary care is supported and included in the health policy and legislative framework with sufficient resources and good governance. The WHO set a global goal for 50 per cent of countries to adopt or revise their mental health laws in conformity with regional and international human rights standards by 2020, as part of the world body’s mental health action plan 2013–2020. Nigeria has fallen behind this goal.
Nigeria needs to reform the outdated existing laws and formulate new policies to protect and support Nigerians with mental health needs.