According to the recent Human Rights Watch report,[1] Nigeria has recorded high level of insensitivity and stigmatization towards those diagnosed with mental illness across many communities. Abuse and discrimination continue to be serious problems. The chaining or restraining of people diagnosed with mental illness, keeping them out of work, and denying access to proper health care services are just a few examples. Lack of knowledge, cultural and religious beliefs have been shown to have an impact on the type of care given to people diagnosed with mental illness.
The situation is even more complicated by prevalent beliefs about the nature and causes of mental illness. Some communities believe that mental illness is some form of a spiritual attack (being possessed by an evil spirit), some also believe that it is a form of curse placed by an enemy (either by being poisoned or reciting incantations). Families/relations of people diagnosed with mental illness believe that the way to deal with this form of spiritual attacks are by resulting to traditional healers, and ‘‘prayer houses’’ (Churches, Islamic homes who specialize in spiritual cleansing (deliverance). These methods of treatment may involve all forms of “treatment” which include chaining, beating, cutting of the skin, starvation (‘‘fasting’’) which they believe serve as a means of healing. These practices are repugnant with the law, have no healing value, and expose individuals to more trauma. People diagnosed with mental illness are entitled to human and civil rights and equal justice under the law. The constitutional rights of people diagnosed with mental illness should be protected and they should be treated with equal respect.
Unfortunately, there is no Federal legislation regulating mental health care in Nigeria. The Lunacy Act LFN 1958 is derived from the common law. The Discrimination Against Persons with Disabilities (prohibition) Act (2018) makes no specific provision for persons that suffer from mental illness. It provides generally for persons with disabilities. The Act defines “disability” as long term physical, mental, intellectual or sensory impairment which in interaction with various baniers may hinder full and effective participation in society on equal basis with others. There is no specific provision for mental illness. There is an ongoing effort by the National Assembly to pass a Mental Health legislation -Mental Health Bill 2013. However, it is important to note that this bill does not specifically provide for the rights of users of mental health care services. It does not regulate forms of treatment mental illness. The 1999 Constitution of the Federal Republic of Nigeria does also does not specifically provide for the rights of this vulnerable group. It provides for the protection of the Fundamental Human Rights of its Citizens
Some of these provisions include- (i) Right to dignity of the human person- S.34 (1) provides that every individual is entitled to respect for the dignity of his person, and accordingly- (a) no person shall be subjected to torture or to inhuman or degrading treatment; (b) no person shall be held in slavery or servitude .
Mental illness by itself does not constitute sufficient reason to deprive a person of his/her civil rights It is unconstitutional and a criminal offence to subject a person diagnosed with mental illness to all forms of inhuman treatment which include chaining, beating, cutting of the skin, starvation.
It is therefore important that we create awareness and enlighten people. Rural Health Workers in various communities in Nigeria are a vital component when considering community psychiatric service. This would have a significant impact in creating awareness and enlightening people. Without it, those in need of mental health care services are likely to resort to services they know best (traditional/religious method of care) rather opting for effective medical health care service, however effective it may be.
Specific legislation against discrimination against persons diagnosed with mental illness should also be implemented and enforced. There should be more specific legislative provisions and policies to ensure that the rights of this vulnerable group are protected. Isolation and restraint should be totally abolished. Such methods should only be used in response to violent behavior that constitute danger to life and safety of the public. Law enforcement agencies, health workers, policy/law makers should work together to create laws and other measures that do not use isolation and restraint. The enactment of the Mental Health Bill will improve mental health care in Nigeria. Mental health Advocacy driven by various stakeholders must be given swift attention to ensure that the rights of this vulnerable group are equally protected and offenders duly penalised.
Ifeoma Okemini Arowolo
Senior Associate
Health Ethics and Law Consulting.
[1] Nigeria: People with Mental Health Conditions, (Nov. 11,2019). https://www.hrw.org/news/2019/11/11/nigeria-people-mental-health-conditions-chained-abused