Revisiting the Mental Health Act

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World Mental Health Day
As we mark “World Mental Health Day” today, October 10th, first celebrated in 1992, “a day for global mental health education, awareness and advocacy against social stigma”, my heart goes out to all those who are suffering from one mental health disorder or the other.

What is Mental Illness?
Mayo Clinic defines mental illness as “a wide range of mental health conditions – disorders that affect your mood, thinking and behaviour. Examples of mental illness include depression, anxiety disorders, bipolar disorder, schizophrenia, eating disorders, and addictive behaviours”. The Mayo Clinic goes on to say that, though many people have mental health concerns from time to time, “a mental health concern becomes a mental illness when ongoing signs and symptoms cause frequent stress and affect your ability to function”.

There does not seem to be one definite cause of mental illness. It could be caused by genetic factors, that is, inherited traits running through the family bloodline, it could also arise from psychological trauma suffered by the person in childhood, maybe sexual or physical abuse, emotional trauma like losing a beloved parent, especially in difficult circumstances, adolescent stress, even exposure to things like drugs, alcohol and toxins during pregnancy can affect the baby in the womb and lead to mental illness, or taking of drugs in adolescence, impairment and malfunctioning of brain chemicals sometimes leading to depression.

Most mental illnesses cannot be prevented, but can be treated in several ways, including medication, psychotherapy, hospitalisation, cognitive behaviour therapy, electroconvulsive therapy (ECT) which is usually used when the use of medication and psychotherapy have been unsuccessful on a patient suffering from illnesses like severe depression and schizophrenia. Transcranial Magnectic Stimulation (TMS), is also a newer form of treatment, “a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression”. TMS is also used when other forms of treatment for depression fail.

My Visit to My Friend at Royal Free Hospital, London
Many years ago, I had cause to visit someone at the Mental Health Wing at Royal Free. He had had a nervous breakdown, and had been detained at the mental health facility of the hospital under Section 2 of the Mental Health Act, 1983 (the 1983 Act). After reports by family members and neighbours, of ongoing strange and unruly behaviour, an approved Medical Health Practitioner had made an application by virtue of Section 2 of the 1983 Act, to compulsorily admit my friend to the hospital for medical assessment and treatment, if the need arose. The law allowed him to be detained at the Facility for up to 28 days (Section 2(4) of the 1983 Act).

It was the first time, that I had visited such a Facility. Not that there was anything particularly austere or bad about the environment, it just had more secure doors than the other areas of the hospital, to prevent the patients from escaping. For the one hour or so that our visit lasted, my friend was not violent, but rambled on incoherently for the entire visit, not making much sense. I wondered what had happened to him. He was someone that we saw regularly, and I must confess that, I didn’t see the breakdown coming at all. His long time girlfriend whom he was hoping to marry, had dumped him unceremoniously. Could this be the cause of his breakdown?

Diagnosis and Treatment
The diagnosis was that he was Bipolar, that is, he is a manic-depressive, “a brain disorder that causes unusual shifts in mood, energy, activity levels and the ability to carry out daily tasks….episodes of depression with mixed features – the highs are called “mania” and the lows, depression”. Again, I wondered whether it was the break up of the relationship, that had such a devastating effect on him. Could it be? I did a little bit of research, and discovered that it is also a condition that runs in families (genetic), and can last a lifetime. Though, I later found out that his mother’s sister had mental health issues, I didn’t know what her specific ailment was. Was my friend’s illness a result of a combination of the heartbreak and genetic factors?
Anyway, my friend was given medication, and just before the 28-day period was over, the Doctors reported that though his mental state had improved from when he had initially been admitted, he was not yet cured. They recommended that he stay on in hospital, but on a voluntary basis. Of course, my friend refused to stay on in hospital.

I disagreed with the Doctors’ report. I felt that my friend should have been further sectioned (detained) under Section 3 of the 1983 Act, which permits detention for up to 6 months. Since the Doctors said that he was not cured, I believed that this was good enough grounds for his further detention in the hospital, so he could receive the comprehensive, properly supervised treatment, which he had received during the initial 28 days, resulting in the improvement in his condition. After all, he didn’t necessarily have to be in the hospital for the whole 6 month period.

I saw the decision not to keep my friend sectioned, as a flaw in the system. I felt that the Mental Health Act, was a bit too lax in this regard. It was then explained to me that, despite his mental state, my friend has fundamental rights that must be respected, and since he was not a danger to himself or anyone else, and was not running round the streets of London naked, the decision to stay in the hospital had now become his.

Sadly, over the years, my friend has been in and out of mental health facilities since then. When he feels better and goes home, he stops taking his medication after a while, he relapses, and ends up back in the hospital. I feel some sense of consolation, that at least, in London, he has the benefit of better care in a decent environment. What would have happened to him if he was here in Nigeria? Would he have suffered the same fate as a school senior of my brother, who had started taking drugs in secondary school? Recently, my brother was walking down the Marina, and saw people fearfully giving way to a half naked ‘madman’. On closer inspection, he realised that it was his senior from school. My brother said that, he seemed to have totally lost his mind, he had a vacant look in his eyes, no sign of recognition at all for my brother as he swayed past, roaming around the streets of Lagos in that terrible condition.

The Nigerian Position
Unfortunately, the situation with regard to the treatment of mental health illnesses in Nigeria, is poor. Seeing mentally unstable people roaming the streets naked, has always been a common occurrence here. In Nigeria, there is still so much stigma attached to mental illness. In a society where people are extremely superstitious, and still believe that mental illness is as a result of a ‘juju’ (black magic) attack. Locking such patients in a room at home, chaining them like prisoners and animals, giving them traditional treatment with ‘Agbo’ (herbs) and so on, while in confinement at the Traditional Healer’s Healing Home, Spiritual Intervention under ‘abo’ (Cover) in some Church or Spiritual Home, are still prevalent here.

As far as the Legal Framework is concerned, we have not gone past the outdated Lunacy Act, 1958 (enacted 59 years ago!). The title of the Act is inappropriate and derogatory. A Study by the College of Medicine, University of Ibadan in 2012, revealed that mental illness ranked 20% among other health issues. Obviously, it requires much more attention, than it is being given. Of course, like the poor state of medical facilities in the country, those for the treatment of mental health illnesses, are grossly inadequate. There seems to be a pending Mental Health Bill 2008 sponsored by Senator Manzo, seeking to replace the Lunacy Act, lying somewhere in the National Assembly, not passed till date.
Nigeria needs to step up its game, in terms of its handling of mental health illness, with regard to all aspects of it, as it is on the rise. From how we the people, perceive mental illness, less stigmatisation and poking fun at those who suffer from such ailments, to more enlightenment and understanding. It is a sickness, like any other, just of the mind and not the body. Many people are frustrated, on the edge. In countries like USA, it is the norm for people to have a session with their ‘Shrink’ (Psychiatrist) on a weekly or monthly basis, without being seen as ‘mad’, just as a Diabetic may go to hospital to check his/her blood sugar level regularly. Provision of modern day facilities to take care of patients, and an up- to-date legal framework, like the Mental Health Act in UK.

Appreciation
My Dear Readers, this month, it is exactly one year since I assumed the role of Editor of this esteemed publication, This Day Lawyer. I thank God for everything, especially for His support and the inspiration that He gives me. I would also like to say a special thank you to ‘Publisher’, Nduka Obaigbena, for the confidence he reposed in me, by appointing me to this position. When Publisher invited me to fill the ‘big shoes’ left behind by my predecessors, May Mbu and Funke Aboyade, SAN, I was somewhat taken aback. But it seems that, Publisher had seen qualities in me, which I myself may not have even recognised.

Of course, my schedule has become super-busy, but I have enjoyed every minute of this last year, challenges, deadlines and all, working through holidays when others are relaxing, there are never any dull moments. I must also thank Funke Aboyade, my pillar of support and main ‘critique’, especially when I was still a ‘Freshman’ (I think I may have graduated by now – Funke, over to you!), Eniola Bello, the Managing Director of This Day, my weekly ‘sounding board’, very knowledgeable about everything, Jude Igbanoi, the Deputy Editor of This Day Lawyer for his commitment, selflessness and invaluable ideas (I think Jude and I make an excellent team), Akin Akinwale our very capable Page Planner (who still gives me lessons on the dos and don’ts of journalism), Abubakar Sani, our most diligent columnist, INSIGHT, always very interesting and articulate, my good friend and ‘Justice Sector Reform Crusader’, Wale Fapohunda, and last but not the least, You, my Readers, not just for your attention, but for your constructive criticism and words of encouragement, which spur me on. Ese, Nagode, Dalu.