Since the first COVID-19 case was detected in Feb. 2020 in Lagos State, Southwest Nigeria, the virus has so far taken a toll on the country.
As COVID-19’s reach widens, the federal government and medical authorities have put in place various precautions, such as compulsory wearing of face masks, social distancing, and compulsory vaccination by giving free access to doses.
However, despite these measures, the federal government is yet to show concern for mentally ill persons which could have a negative impact on the wellbeing of the society.
Mental health in Nigeria
According to the World Health Organisation (WHO), mental health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stress of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”
Despite Nigeria being the seventh-largest country in the world, there are less than 150 psychiatrists in the country of about 200 million citizens, and WHO estimates that fewer than 10 per cent of mentally ill Nigerians, most of whom are urban-based, have access to the care they need. Also, in view of the poor knowledge of mental disorders at the primary healthcare level, caring for people with mental illness is typically left to family members.
According to experts from Lancet Global Health, “Nigeria currently faces a global human rights emergency in mental health. Underpinned by poor societal attitudes towards mental illness and inadequate resources, facilities, and mental health staff, it has shown that most individuals suffering from mental health needs in Nigeria cannot access care.”
Moreso, there are only eight federal neuropsychiatric hospitals in Nigeria. They are mainly available at tertiary healthcare centers to review and treat complex cases.
Mental health policy and Covid-19
Nigeria’s first mental health policy was formulated in 1916. Called the “Lunacy Ordinance”, it was later amended in 1958 to grant authority to medical practitioners and magistrate courts to detain anyone suffering from mental illness. But up to date, no provision for disaster/emergency and implementation preparedness plan has been made in case of challenging public health crises like COVID-19 pandemic.
Today, the Lunacy Act is out-of-date and defunct, showing that mental healthcare in Nigeria is ineffective despite the deadly COVID-19 spreading widely. With Nigeria Center for Disease Control (NCDC) reporting over 2,000 confirmed cases of the virus, the Nigerian and other relevant health authorities have not passed or enacted a bill/law that ensures vaccinating or testing mentally ill persons despite the fact that they are at risk of spreading the virus.
Andrew Peters*, a medical practitioner, stated that in a critical situation like COVID-19 and with the issue of consent dangling, “If these people are to be vaccinated against the virus, the government should probably collaborate with health workers on how to accommodate these groups of citizens. Modalities need to be worked out. It is not the prerogative of the medical workers.”
Similarly, Abba Hikima, a practising lawyer pointed out that generally in law, where someone is by reason of young age or ill health or mental incapacity, unable to consent to anything, his/her guardian does the same on his/her behalf.
But in the absence of a guardian or those living on the street, “the court is the relevant authority to assign a guardian for anyone, called ‘guardian ad Litem, which means one who has the legal authority and duty to take care of another person especially because of the other’s infancy, incapacity or disability.”
In 1991, the United Nations (UN) adopted a policy to address and recognise the 25 principles outlined in the protection of persons with mental illness and the improvement of mental healthcare.
These 25 principles include: Statements of fundamental freedom and basic rights of mentally ill persons, criteria for the determination of mental illness, protection of confidentiality, standards of care, and treatment including involuntary admission and consent to treatment.
Also, rights of mentally ill persons in mental health facilities, provision of resources for mental health facilities, provision of review mechanisms, providing for protection of the rights of mentally ill offenders, and procedural safeguards to protect the rights of mentally ill persons.
The Lunacy Act 1958 made no provision for confinement of persons suffering from mental health illness for the purpose of protecting the society from any form of violence or disease.
Peters* said never has the health system in Nigeria really considered the homeless in the event of an emergency. “The ones remanded in mental facilities are at least benefitting from the care of the government,” he told HumAngle.
Dr. Obabire Yemi, a psychologist, however clarified that mental illness does not especially mandate vaccine consideration. He added that to get consent for vaccination, “the special issues raised by mental illness will be ethical and legal issues around consent, which will include do no harm, ensure your intervention is of benefit, respect everybody’s autonomy.”
“Vaccination mandates are in the epidemiologist purview. The society should be asking the government and medical practitioners if the mandatory vaccination will be based on the expected benefits weighed with the risk,” he told HumAngle.
Experts have recommended that the Lunacy Act be amended because it does not protect the rights of a person with mental health illness. “This policy was implemented through the establishment of the asylum system. It became oppressive and unjust to the most vulnerable population,” the policy reads.
They also recommended that the current proposed Nigerian Mental Health bill that was presented and is yet to be enacted would have to recognize the need to focus on individuals in view of their mental health as well as finding alternative ways for securing public safety in the aspect of health and security concerns.
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