Mental health as human right

On the 10th of October every year, and for several days after it, people all over the world talk about mental health and mental illness.

There was a time when anything ‘mental’ was a taboo topic, or a term of abuse.

The COVID-19 pandemic of 2021-2022 was an eye-opener globally. For the first time, many people realised how vulnerable they were. The daily threat to life from a disease that was poorly understood, coupled with enforced movement restriction, and further compounded by loss of income and uncertainty pertaining to the future proved to be too much burden for many people’s minds to bear. They developed psychological problems of such intensity that they were constrained not only to admit helplessness, but to seek assistance. For some, their unwellness became obvious to people around them, and was disruptive to their relationships and their ability to function. Loved ones quarrelled endlessly or became violent towards each other as mood and behaviour deteriorated. In a few cases domestic abuse ended in homicide. The risk of suicidal behaviour became an increased danger in society.

Stigma remains widespread, and the jokes and snide remarks about people who have encountered mental illness of any sort are still very damaging

Mental health services in many countries were overwhelmed by heightened demand. In Nigeria, the traditional reluctance to admit to anything ‘mental’, and to seek help, was overcome, especially among younger people. This led to pressure on the sparse services. The sense of alarm created by the sudden surge of people demanding mental health services triggered a response from the government, as well as private individuals and organisations. This response included the setting up of telephone help lines and walk-in services. The general atmosphere of heightened danger fostered a greater readiness to discuss mental health and provide mutual support in the public space.

Mental illness is a description for a group of illnesses that statistically will afflict between one quarter and one eighth of the population anywhere in the world sometime during their lives. They will result in 418 million ‘disability adjusted life years’ (DALYs) globally. This means that Mental Health conditions are among the highest causes of disability and lost man-hours. Even if the more modest estimate of one-in-every-eight citizens’ lifetime- prevalence of mental illness is accepted, Nigeria, with a population of two hundred million, will have twenty-five million people who will be burdened with a diagnosable psychiatric illness at least once in the course of their lives.

Nigerian society’s awareness of the enormity of this statistical burden is still work in progress. Its preparedness to cope is almost non-existent. Stigma remains widespread, and the jokes and snide remarks about people who have encountered mental illness of any sort are still very damaging. Some employers routinely find ways to get rid of any employee known to have experienced mental illness, even where work performance could not be faulted. And there remains a widespread misperception of mental illness as being of spiritual or magical provenance, as depicted in many Nollywood films. In addition, all mental illness is seen in the eyes of many Nigerians as equivalent to ‘madness’ or psychotic illness. The reality is rather different, and it is that the overwhelming majority of people who have mental illness are not ‘mad’, but rather suffer from Depression or Anxiety or other ‘neurotic’ illness.

Since 1994, the annual celebration of World Mental Health Day has centred around a unique theme for each year. This helps to drive home the message that mental health is a pleomorphic subject that has implications for all aspects of a human being’s life and wellbeing. Indeed, as the slogan goes, ‘There is ‘No health without mental health’.

The World Mental Health Day has evolved into a platform for educating the public, raising awareness, and advocating against stigma.

The theme for the 2023 World Mental Health Day is ‘Mental Health is a universal human right’.

The theme represents an ambitious task for most African countries. The realities on the ground are grim. Around 70% of Nigerians with mental illness get no treatment at all, because it is not available, because they are too ashamed, or because they cannot afford the cost.

Declaring Mental Health a ‘Human Right’ makes it an enforceable right that the citizen can demand of his government, and even sue for in a court of Law.

For Nigerian society and the new government of President Tinubu, it is a challenge, and an opportunity.

The duty of government to its citizens as it concerns Mental Health is threefold – Maximising their Wellness to reduce their vulnerability to illness, ensuring there is Treatment for those who are Ill, and making sure that Treatment is Affordable and Accessible. It is not so much about building scores of hospitals as rearranging the thinking around the subject.

Take Wellness. It is affected by economic circumstances, transportation difficulties, power challenges and all the turbulence and acrimony contaminating in Nigerian space currently. These adversities need to be intentionally mitigated for the common man, along with a determined promotion of Healthy Living.

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Regarding Treatment, recognition and treatment of common, basic Mental Illnesses need to be built into the capabilities of primary care facilities – ‘public’ or ‘private’, in all the 774 LGAs of Nigeria. Pilot PHC personnel training exercises in Lagos have shown that this can be done.

And regarding Finance and Access, while government funding needs to be scaled up, the real game changer will be a political and societal will to enforce compliance with compulsory Health Insurance for the citizens, and a regulatory insistence that mental healthcare is entrenched in the ‘Benefits Package’ of every Health Insurance.

Yes, there is a need for more hospitals and rehabilitation facilities, and better conditions and retention for healthcare workers.

The signing of the Nigerian Mental Health Act into law was one of the few real achievements of the Buhari government. Implementing its commitments, in an era when Mental Health of citizens has now been declared a Human Right, falls to the new President, and requires new thinking. It is tough, and it is tight, but it can be done.