- On January 5, 2023, Nigeria’s President Muhammadu Buhari signed the Mental Health Bill 2021, replacing the Lunacy Act of 1958.
- Now known as the Mental Health Act, it addresses issues including access to care, involuntary commitment, and “the use of restraints.” It also addresses the rights of people with mental illnesses in the workplace, residential places, and other settings.
- The Act will improve the availability and quality of mental health care services in the country and reduce stigma and discrimination against people with mental illnesses.
Statistics show that 80% of Nigerians with mental health needs cannot access care due to societal attitudes toward mental illness and a lack of resources, facilities, and mental health staff.
But how did we get here?
Nigeria's first mental health legislation, the Lunacy Ordinance, was enacted in 1916. After being amended in 1958 to give medical practitioners and judicial officers the authority to detain anyone with a mental illness, it was renamed the Lunacy Act of 1958.
For context, an international non-governmental organisation, Human Rights Watch, discovered that people with actual or perceived mental health illnesses, including children, are placed in facilities against their will.
In some cases, police officers arrest individuals with mental health disorders and transport them to government-run rehabilitation facilities, where they forcefully shackle them for months or years.
This could explain the stigma associated with mental health, which prevents people from seeking help and leads to discrimination against people with mental illnesses.
A bill to establish the Mental Health Act was introduced in 2003 to change the narrative. In April 2009, following no significant progress, it was not enacted.
As part of the National Policy for Mental Health Services Delivery, a new bill was introduced in 2013. But it also was not enacted.
In March 2013, the bill was reintroduced to the National Assembly. However, they withdrew it due to a lack of support.
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In 2019, another mental health bill, titled the Mental Health and Substance Abuse Bill, was proposed. The Senate passed it on second reading and had a public hearing in 2020.
On November 28, 2022, the National Assembly passed the National Mental Health Bill 2021 and forwarded it to President Muhammadu Buhari for consideration and assent.
On January 5, 2023, President Buhari signed the Bill into law, establishing the Mental Health Act 2021.
Before we proceed, it’s critical to understand what mental disorders are.
What are mental disorders?
According to the World Health Organization (WHO), a mental disorder, also known as mental illness, is a clinically significant disturbance in an individual's cognition, emotional regulation, or behaviour. It is usually associated with distress or impairment in critical areas of functioning.
Mental disorders are also known as mental health conditions. It is a broader term that encompasses mental disorders, psychosocial disabilities, and (other) mental states associated with significant distress, functional impairment, or risk of self-harm.
Interestingly, the Mental Health Act 2021 defines mental health conditions as “impairments, activity limitations, and individual and participatory restrictions arising from diagnosable disorders which involve significant changes in thinking, emotion, or behaviour.”
Depression, anxiety disorders, schizophrenia, eating disorders, and addictive behaviours are examples of mental illnesses, disorders, or conditions.
What does the Mental Health Act mean for Nigerians?
Mental illness is a common problem in Nigeria, with estimates indicating that one in every four Nigerians has a mental illness.
With scarce mental health resources and limited healthcare access in Nigeria, the Act will significantly improve access to mental health care and support for Nigerians.
According to Tosan Etiwe, CEO of Insync, an African subscription-based mental health platform, "Coming from the Lunacy Act of 1958, this Mental Health Act means that Nigerians can and should receive mental health care with the same dignity and respect as other medical cases."
The Act defines and protects the rights of Nigerians with mental illnesses. It provides equal access to treatment and care, discourages stigma and discrimination, and sets standards for psychiatric practice in Nigeria, among other provisions.
Moreover, Melanie Okuneye, Co-founder and CEO of Akoma Health, a platform that connects African employees to mental health specialists in Africa, says, "The Act offers human rights protections as well as protections against discrimination in employment and housing."
It prohibits discrimination against people with mental illnesses in housing, employment, medical care, and other social services.
The Act also ensures that anyone receiving treatment has the right to participate in the development of their medical plans and is not subjected to forced treatment, seclusion, or other forms of restraint.
Individuals with mental health illnesses also have access to community-based platforms.
Nigeria is following in the footsteps of other African countries
Mental health is a critical issue affecting individuals and communities globally.
While many Africans believe that spiritual attacks cause mental disorders, some think people with mental illnesses are under a spell or bewitched. When describing the condition of a mentally ill person, some people often refer to evil spirits.
Consequently, in recent years, some African countries have recognised the importance of addressing mental health issues and have enacted legislation to protect the rights and well-being of people suffering from mental illnesses.
Mental health acts in African countries can play a critical role in promoting access to mental health services, protecting the rights and dignity of people suffering from mental illnesses, and regulating the mental health profession.
South Africa, for example, ushered in Mental Health Care Act 17 of 2002 on October 28, 2002, replacing the Mental Health Act of 1973. But it didn’t take effect until December 15, 2004. The Act provides care, treatment, and rehabilitation of persons with mental health illnesses.
In 2012, the Ghanaian government signed the Mental Health Act 2012 into law, establishing a structure to provide and monitor health care in the country. It also ensures the rights and quality treatment of persons with mental disorders.
On June 21, 2022, Kenya’s former President, Uhuru Kenyatta, signed the Mental Health Bill into law to protect persons with mental health conditions. The Act outlines the rights of people with mental illnesses, including the right to protect them from sexual exploitation.
Zambia’s Mental Health Act, 2019 also promotes and protects the rights of persons with mental illness.
In Nigeria, Chime Asonye, Founder of Nigerian Mental Health, a mental health platform, says, “The Mental Health Act will contribute to the broader discussion, awareness, and acceptance of those with mental health conditions. Moments like these are critical inflexion points that help alleviate misunderstandings and contribute to the normalisation of help-seeking behaviour that health tech startups offer.”
He also states that the Act requires people with lived experiences to work as peer support workers. Mental health will be integrated at all levels of the health industry, such as being mainstreamed in all public healthcare facilities and disease-specific programmes such as HIV, maternal, and reproductive health.
It establishes new structures, including a Mental Health Fund and a Federal Department of Mental Health Services, to mainstream care provision. Previous legislation was outdated, inhumane, and based on a regulatory regime with colonial origins.
What does it mean for healthtech startups?
The Mental Health Act's implementation in Nigeria could have a lot of implications for healthtech startups in the country.
It could help Nigerian healthtech startups develop and deliver innovative solutions for mental illnesses.
According to Ejiro-Oghene Paul, Co-founder and psychological lead at TruthShare, a mental health platform, "The Act creates an opportunity for mental health startups to function better. It proposes the establishment of more mental healthcare hospitals equipped to handle chronic mental health disorders and rehabilitation for people living with a mental health disorder."
Healthtech startups could develop more digital tools and platforms for mental health screening, diagnosis, and treatment, and mobile apps that enable people to track their mental health and communicate with mental health professionals remotely.
The Act could also increase demand for mental health services in Nigeria, creating a new market for healthtech startups to sell their products and services.
Paul claims that the Act’s goal of increasing mental healthcare service providers will reduce the burden on Nigeria's few mental health centres while driving investment in the mental healthcare sector.
While the Act may lead to more mental healthtech startups in the country and help existing and new startups get funding, partnerships and opportunities to access these resources and expand their operations, Moses Aiyenuro, Founder and CEO of Blueroomcare, a mental health platform, thinks the Act poses a challenge.
"It may introduce new regulations or requirements difficult for startups to comply with, or it may create competition for resources or funding," he says.
Etiwe also believes that the Act will present problems for mental health startups, such as complying with regulatory requirements and navigating complex and potentially bureaucratic processes.
However, If the Act can improve access to mental healthcare, it could have several positive effects for Nigerians.
“It could help reduce the burden of mental illness on individuals and their families and enable more people to live healthy and productive lives. It could also reduce economic and social costs of mental illness by allowing individuals with mental health conditions to work and participate in their communities,” Aiyenuro says.