Challenges of mental health legislation

Adeoye Oyewole

The psychiatrist plays a very crucial role in the mental health care of any community, especially that of determining normality or otherwise of human behaviour, which leads to reasonable intervention in the context of the diagnosis made and protection of members of the society, especially significant others, from harm.

This becomes more crucial as de-institutionalisation efforts are gaining ground with vigorous emphasis on community care.

Psychiatry is primarily a biological science with potent social correlations. Diagnosis of mental illness is made on clinical grounds, with a robust consideration of impact on social and occupational functioning.

By implication, the care of the mentally ill presents many complex  social issues that require conducive legal instrumentation to guarantee that the patient obtains  maximum benefit  from  care; that the powers of the psychiatrist is not abused and that the community is also protected from danger that may occur when the patients are not treated.

Mental health legislation, therefore, is concerned with the balancing of complex, and, sometimes, opposed interests.

Human right activists allege that psychiatric patients are sometimes deprived of their basic rights. Certainly, the history of psychiatry has been marred by some abuse of power, but contemporary psychiatry has recognised the extensive nature of the powers entrusted to it and sought to exercise them cautiously.

Although these issues are of paramount importance within the context of an ideal psychiatric practice that obtains in developed countries with well-established mental health care delivery system, there is a different scenario in Nigeria where the  greater  percentage of our psychiatric patients go to spiritual healers and traditional mental health practitioners who employ  dehumanising and abusive methods in their care, ranging from starvation, to barbaric physical restriction, sleep deprivation, physical torture and manual labour.

Some of them invariably get referred to the psychiatrists only when their physical state is almost compromised as a result. It is paradoxical but true that the checks of mental health legislation in developed countries for doctors should be designed in Nigeria for the alternative medical practitioners that use non-empirical methods that endanger the lives of the mentally ill.

While their beneficial roles are appreciated, there is a need for legislative sanctioning and modification of some of their methods that are capable of endangering the lives of the mentally ill.

The records of death in our orthodox psychiatric facilities are extremely low; and whenever it happens, it’s usually due to concomitant physical illnesses.

Legislative function in a post-colonial country like Nigeria is very crucial because it is one of the viable channels for critical discourse of issues, by providing a template to intellectually engage existing patterns of structural relationships and cultural sentiments, with a motivation towards the reconstruction of the social system.

This is critical, not only for mental health but in all spheres of our national life.

Every society raises the issues of rights that are considered germane to the all-important role of nation building, as the constitution is developed to serve the fundamental roles of protecting individual rights to life, rights to dignity and rights to protection of property.

The challenge of mental health legislation in Nigeria is to ensure that we do not import foreign, unprocessed practice that may be incapable of furnishing our people a culturally sensitive but effective mental health care.

There is a need for robust legislation to compel our health policy instruments to make care available for the mentally ill at minimal cost by all tiers of government. The only available mental health care document in Nigeria is of colonial origin, with prescriptions like getting any individual that survives a suicide attempt to be imprisoned for one year.

Consideration of more egalitarian and relevant issues of mental health care, such as compulsory intervention, consent to treatment, protection of patient’s rights, and restriction of certain forms of treatment are, apparently, not addressed.

When practices get institutionalised, they acquire structures and become bureaucracy which will always require continuous discourse to improve in its effectiveness. Discourses are dialogues which involve an informed intellectual exchange that explains issues from various angles to bring public and professional awareness, with the ultimate goal of achieving sound resolution. Culture can be an asset and a liability; but the operational dynamics of our culture must be intellectually challenged to build an egalitarian community.

No national assembly has all the repertoire of intellectual resources that are crucial for useful legislation on any particular issue, but opportunities for input from the public should be seized by our intellectuals and human rights activists to make presentations emanating from sound knowledge and experience.

Our myths and superstitions, although difficult to break because they are tied to supernatural consequences, can be intellectually engaged in the setting of a discourse, with the ultimate goal of producing relevant legislation.