… Demands urgent implementation of Mental Health Act, stronger funding

By Chioma Obinna

A Professor of Psychiatry at Ahmadu Bello University, Zaria, Prof. Taiwo Lateef Sheikh, has said that Nigeria is facing a deepening mental health crisis, with fewer than 300 psychiatrists available to serve a population of over 200 million people.

Sheikh, a member of the Advisory Committee to Africa Centres for Disease Control and Prevention, Africa CDC, said the severe shortage of mental health professionals, inadequate funding and poor access to community-based services were widening the gap between Nigerians who need mental healthcare and those who receive it.

He spoke at the Mental Health Leadership and Advocacy Public Lecture, where he called for urgent implementation of the Mental Health Act and stronger policy, financing and legislative reforms to strengthen Nigeria’s mental health system.

According to him, mental health remains one of the most neglected areas of healthcare, particularly in Africa, despite its enormous impact on individuals, families, communities and national economies.

“Legislation provides the skeleton, policy provides the direction, and financing provides the muscle. Closing the mental health systems gap requires all three to move together,” Sheikh said.

He said Nigeria’s Mental Health Act, signed into law in December 2022, represented a major milestone but warned that the law would have limited impact without adequate funding, trained personnel, functional services and effective implementation.

“Without legislation, policy is just paper. Without policy, legislation has no direction,” he stated.

Sheikh said mental health services in Nigeria remained concentrated largely in federally owned tertiary psychiatric hospitals, most of which are located in state capitals and therefore out of reach of many people requiring care.

He noted that although mental health had been recognised as a component of primary healthcare in Nigeria, mental health services remained largely unavailable at the primary healthcare level.

The psychiatrist said the country’s shortage of specialists was compounded by inadequate numbers of psychologists, psychiatric nurses and other mental health professionals.

He said trained psychiatric nurses were sometimes deployed to other duties because of the absence of functional mental health units and inadequate commitment to mental healthcare.

Sheikh also expressed concern over poor financing, noting that mental health receives less than 3.5 per cent of the health budget, with more than 90 per cent of available mental health resources going to hospitals.

He argued that such an arrangement was unsustainable and inconsistent with the goal of universal health coverage.

“The treatment gap is about demand versus supply. Demand is all over, but barriers restrict access,” he said.

To bridge the gap, Sheikh advocated a decentralised mental health system in which most people receive care at the lowest appropriate level, including self-care, community services and primary healthcare, while patients requiring specialised intervention are referred to higher levels of care.

He called for greater integration of mental healthcare into primary healthcare and the adoption of task-shifting, whereby trained nurses, community health workers and other non-specialist health workers provide mental health services under appropriate supervision.

“Treat at the lowest level. Integrate into primary healthcare. Task-shift. No discharge to nowhere,” he said.

According to him, the “no discharge to nowhere” principle requires patients leaving psychiatric hospitals to be linked to community-based follow-up services rather than being discharged without continuing care.

He said common conditions such as depression could be managed at the primary healthcare level through appropriate training and the World Health Organisation’s Mental Health Gap Action Programme, mhGAP.

“Seventy per cent of mental health problems can be treated by trained doctors, nurses and primary health workers with adequate supervision and support,” Sheikh said.

The professor warned that neglecting mental health could undermine Nigeria’s economic and social development, stressing that untreated mental health conditions impose significant costs on individuals, families, workplaces and governments.

“Africa needs to invest in mental health as mental health is not only a key part of healthcare but also of education and labour. If ignored, the economic development of the countries in Africa will be compromised,” he said.

“The message is clear for policymakers: invest in mental health and get good returns.”

Sheikh also called for mental health to be integrated into education, employment, social protection and other sectors, arguing that mental healthcare cannot be addressed by the health sector alone.

He urged stronger suicide prevention strategies, anti-stigma programmes and measures to protect the rights of people living with mental health conditions.

The psychiatrist said Nigeria’s mental health legislation had historically been rooted in colonial-era laws focused largely on custodial care rather than treatment, recovery and human rights.

He noted that mental health legislation in Nigeria dates back to 1916 and evolved into a law in 1959, retaining its colonial orientation for decades before the country eventually moved towards a modern rights-based framework.

According to him, sustained advocacy by mental health professionals, civil society organisations, lawmakers, development partners and other stakeholders played a critical role in the eventual passage of the Mental Health Act.

He, however, stressed that the passage of the law was only the beginning.

“The Mental Health Act is a major achievement, but the real test is implementation,” he said.

Sheikh called for sustainable domestic financing, stronger governance, reliable mental health data, adequate human resources, essential medicines and technologies, as well as effective monitoring of the implementation of the law and national mental health policy.

He also advocated mental health parity in health insurance, anti-discrimination measures, school and workplace mental health programmes and greater protection of patients’ rights.

The psychiatrist urged policymakers to involve people with lived experience of mental health conditions in the development of policies and legislation, saying their experiences were essential to building humane and effective services.

He warned that stigma and discrimination continue to prevent many Nigerians from seeking help, often forcing people to present at hospitals only when their conditions have become severe.

“Protecting the rights of persons with mental illness is not optional. Modern mental health legislation must be rights-based, promote autonomy and consent, provide the least restrictive care and ensure access to appropriate services,” he said.

He called on the Federal Government and states to move mental healthcare closer to communities by integrating services into primary healthcare facilities and strengthening referral and follow-up systems.

Sheikh also urged government to reduce dependence on donor funding by providing sustainable domestic resources for mental health.

He said Nigeria could no longer afford to treat mental health as a peripheral issue, warning that the country’s development aspirations would remain threatened unless mental health was made a national priority.

“Mental health is a significant part of development,” he said.

Also speaking, Emeritus Professor of Psychiatry at the University of Ibadan and Director of the WHO Collaborating Centre, Ibadan, Prof. Oye Gureje, stressed the importance of strong leadership and sustained advocacy in tackling Nigeria’s mental healthcare challenges and driving reforms across Africa

Gureje explained that the Mental Health Leadership and Advocacy Programme, now in its 13th edition, was established to develop leaders capable of influencing policy, mobilising stakeholders and championing improvements in mental health systems.

He noted that there is growing global recognition that “there is no health without mental health,” stressing that mental disorders remain common, underdiagnosed and inadequately treated despite their impact on individuals, families and national productivity.

According to him, inadequate funding, weak political commitment and poor implementation of policies have contributed significantly to the treatment gap.

He said trained leaders and advocates were needed to keep mental health on the policy agenda, raise public awareness and pressure governments to prioritise quality mental healthcare.

Speaking, the Head of the Division of Disease Control and Prevention at the Africa Centres for Disease Control and Prevention, Africa CDC, Dr Mohammed Abdulaziz, also called for stronger leadership, reform of outdated mental health laws and adoption of a public health approach to close Africa’s widening mental healthcare gap.

Abdulaziz said the Africa CDC Mental Health Leadership Programme was established to develop leaders capable of driving policy reforms and strengthening mental health systems across the continent.

He said the programme rests on four pillars: the Kofi Annan Fellowship, the Field Epidemiology Training Programme, FETP, short leadership and advocacy courses, and support for civil society organisations and people with lived experience of mental health conditions.

He disclosed that Africa CDC was supporting countries including The Gambia and Sierra Leone to modernise their mental health laws, while encouraging other countries to adopt rights-based legislation.

Abdulaziz urged African governments to replace archaic laws that stigmatise people living with mental health conditions, strengthen surveillance and research, and generate evidence to guide policymaking.

He called for a whole-of-government and whole-of-society approach to mental health.

“We cannot continue to say mental health is underfunded without making deliberate efforts to change the narrative,” Abdulaziz said, reaffirming Africa CDC’s commitment to supporting mental health reforms across the continent.