Law expected to provide for mental health campus facilities

Sometime in 2014, a well-dressed young man, appearing cool, calm and collected, was admitted to the male ward of the Federal Neuropsychiatric Hospital in Yaba, Lagos, a Nigerian government-run mental health service provider. The patient, who agreed to be interviewed on condition of anonymity, was a third-year student of biochemistry at a university in Ogun State at the time.

Before his admission to the hospital, he was incoherent and could be heard talking to unseen voices – all symptoms of mental illness, according to psychiatrists who evaluated his condition. As he could no longer function properly during classes, the university authorities reached out to his parents, who took him to the neuropsychiatric hospital.

The former patient, now 32, told University World News his problem began when he started consuming codeine, an opioid used to treat mild to moderate pain, when he began his second year at the university. Of course, nobody knew of his addiction – except his roommate.

“I started getting into codeine during my second year in school because of the stresses and rigours of my course. I consumed the substance most nights after reading so I could sleep well. This continued till the third year. Then it became a huge problem,” he told University World News.

“When my speech became incoherent, my roommate informed the university authorities. I was first referred to the campus clinic, but my case was beyond their capability, so my parents were called upon and they took me to the neuropsychiatric hospital,” he added.

Now a graduate, he regrets his actions and said if he had known what he was getting into, he would not have indulged in codeine, a substance blamed as the cause for widespread addiction among Nigerian youths as reported in a 2018 BBC documentary. The Nigerian government has subsequently banned it.

“My roommate graduated years before me while I had to go back to school after rehabilitation. This sort of makes me feel unhappy about my actions, especially when I think about what my parents went through,” he said.

Professor Taiwo Obindo, an expert in psychiatry at the faculty of health sciences, University of Jos, described as unfortunate a situation in which students are sent home and not properly cared for on campus because they are exhibiting symptoms of mental illness, whether as a result of drug abuse, depression, or other factors.

The findings of a recent mental health survey among students in South Africa, published in a 2022 article in the Journal of Affective Disorders, raised continental alarm about the enormity of mental health problems that should serve as a wake-up call for governments and universities in Sub-Saharan Africa to start realising the need for effective campus-based interventions.

In Nigeria, there has been movement on this front already. The country’s new Mental Health Bill, was signed into law in January by outgoing president Muhammadu Buhari. According to the act, students of higher institutions exhibiting mental illness will not be discriminated against and will have easier and better access to mental health services. The law, of course, applies to all Nigerians with mental health issues.

“The law supports the rights of people with mental illness; it cites that people with it should not be discriminated against. When applied to the university [and, generally, higher education] system, it means that a student’s enrolment cannot be terminated because they have a mental illness,” Obindo, who is also the president of the Association of Psychiatrists of Nigeria, or APN, told University World News.

An emphasis on human rights

The legislation provides that a person with mental and substance use disorder has the right to enjoy a decent life as normal and as full as possible, which includes the right to education, vocational training, leisure, recreational activities, full employment and participation in civil, economic, social, cultural and political activities, and that any specific limitations on these rights shall be in accordance with an assessment of capacity.

The law also provides that a person with mental illness shall receive treatment in the least restrictive environment and restrictive manner, and be protected from torture, cruel, inhuman and degrading treatment. Overall, the law protects all persons with mental health challenges, including students at higher education institutions, from being stigmatised or discriminated against.

Before the new law, Nigeria operated under the Lunacy Act of 1958, which, among many lacunas, gives medical practitioners and judicial officers the authority to detain anyone with suspected mental illness. Under the Lunacy Act, police officers could arrest individuals with mental health disorders and transport them to government-run rehabilitation facilities, where they are usually forcefully shackled for months or years.

Also, mental health desks were not provided at hospitals and higher education institutions, even though mental illness is a big issue in the country.

A study on mental health in Nigeria published in 2004 by the World Health Organization Collaborating Centre for Research and Training in Mental Health, Neurosciences & Drug & Alcohol Abuse at the University of Ibadan stated that one in eight Nigerians had had a mental illness in their lifetime.

No newer study has been conducted, Professor Oye Gureje, the director of the centre, told the non-profit fact-checking organisation Africa Check in a report.

“When the law comes into full implementation, it will change the way people with mental illness, including students and staff, are cared for,” Olatunji Aina, a professor of psychiatry at the College of Medicine, University of Lagos, told University World News.

Aina said that, before now, at the University of Lagos, students with mental health issues were cared for at the university health centre but, with the new law, the services would improve.

Big burden

There is no general data on the state of mental health in higher education in Nigeria, perhaps due to the country’s poor data culture. However, researchers like Obindo said undergraduates suffering from mental illness abound across the country.

“We have had many cases, particularly among medical students. There have been cases of those who were into substance abuse,” he said.

A health official at the Federal Neuropsychiatric Hospital, Yaba, Lagos, who asked not to be named, told University World News the facility had always admitted students from both public and private institutions.

In 2018, Dr Ebenezer Amawulu, a researcher at the Niger Delta University, did a study on the mental health of students attending tertiary institutions in the southern Bayelsa State.

His study indicated that about 35% of students – over a third – in the state’s higher institutions showed symptoms of mental illness.

Sometimes, students with the symptoms survive rehabilitation and return to school. But, when they are not quickly cared for, they can develop serious mental health challenges whose outcomes can be fatal.

For instance, in May 2019, a fourth-year English and Literary Studies student at the University of Nigeria, Nsukka, committed suicide in an uncompleted building located at Sullivan Road, Nsukka, after consuming a pesticide, according to local reports.

Days before he committed suicide, he reportedly posted to his Facebook page: “My mental health has been on life support for a while now. Thanks to those who call. Text. Visit ... You may have added a few hours, months or days to my time here ...Thank you for trying. Amen.”

Also in May 2019, a third-year medical student of the Niger Delta University in Bayelsa State committed suicide after failing the Bachelor of Medicine, Bachelor of Surgery (MBBS) exam. The victim reportedly plunged into a river near the campus.

Ndoni Ingezi, the university’s spokesperson, told online newspaper Sahara Reporters the student took his own life after he got the news that he was one of 22 students short-listed to be withdrawn from the college.

In April 2021, a second-year student of Obafemi Awolowo University reportedly also consumed pesticide and was found dead behind one of the school’s lecture halls. The motive for the suicide was reportedly connected to academic pressure, Daily Post reported.

Changing the status quo

Obindo said most universities in Nigeria do not know what to do when it comes to caring for students suffering from mental illness. This will be addressed with the new mental health law, he said.

“The policy [to guide the implementation] of the Mental Health Law is presently being reviewed and I can assure you that the idea of mental health facilities on campuses will be incorporated into it,” he said.

“By the time the new law is fully implemented, students with mental illness will have better access to appropriate treatment. It will also be easier to identify students with mental health issues on time so they can be treated quickly without dropping out of school,” Obindo said.

“Under the old law, students were sent off campus to go home to be treated and sometimes some don’t return to school. The situation is going to change this time around. With students with mental health issues having better access to care, they would be restored to function quickly. They would be productive and be able to contribute to societal development,” he added.

Jude Ohaeri, a professor of psychiatry at the University of Nigeria, Nsukka, agrees.

“Universities have a role to play in the implementation of the Mental Health Law,” he told University World News.