Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Lisbon, Portugal; Lisbon Institute of Global Mental Health, Lisbon, Portugal; Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nigeria.
Department of Mental Health, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nnewi Campus, Anambra State, Nigeria.
Int J Law Psychiatry. 2022 Jul-Aug;83:101817. doi: 10.1016/j.ijlp.2022.101817. Epub 2022 Jun 27.
Countries are struggling with reconciling their national mental health legislation with the CRPD approach, which stresses equality as the focal point of legislation, policies, and practices that affect people with disabilities. Several failed attempts have been made over the last two decades to update Nigeria's obsolete mental health legislation. The most recent attempt is the Mental Health and Substance abuse Bill 2019, which aims to protect the rights of people with mental health needs. It addresses many areas neglected by previous bills, such as non-discrimination of people with mental and substance use problems in the exercise of their civil, political, economic, social, full employment, religious, educational, and cultural rights. It categorically prohibits the use of seclusion in the treatment of people with mental health problems, makes provision for service users to be members of the Mental health review tribunal and allows for the protection of privacy and confidentiality of information about people with mental health problems. While keeping to most of WHO's recommendations for mental health legislation, the bill diverges from the CRPD's recommendations by allowing forced admission and treatment based on mental capacity, substitute decision-making by legal representatives or closest relatives, and non-prohibition of coercive practices. The bill does not make provisions for advance directives and is silent on informed consent to participate in research. Despite the bill's deficiencies, it would be a significant step forward for the country, whose current mental health legislation is the Lunacy Act of 1958. Although the CRPD has left it unclear how countries, especially low resource countries, should go about creating a workable legal framework, it is clear that all countries are expected to join the current global effort to eliminate, or at least reduce to the barest minimum, the use of coercion in mental health care. We expect that future revisions of this bill will examine its limitations in light of Nigeria's socio-cultural context.
各国在努力使国家精神卫生立法与《残疾人权利公约》的方法保持一致，该方法强调平等是影响残疾人的立法、政策和做法的重点。在过去二十年中，尼日利亚曾多次试图更新其过时的精神卫生立法，但均以失败告终。最近的一次尝试是 2019 年的《精神卫生和药物滥用法案》，旨在保护有精神卫生需求的人的权利。它解决了以前法案忽视的许多领域，如在行使公民、政治、经济、社会、充分就业、宗教、教育和文化权利方面，不歧视有精神和药物使用问题的人。该法案明确禁止在治疗精神健康问题的患者时使用隔离，规定服务使用者可以成为精神健康审查法庭的成员，并允许保护精神健康问题患者的隐私和信息机密性。该法案在遵守世界卫生组织关于精神卫生立法的大部分建议的同时，允许根据精神能力强制入院和治疗、法律代表或最亲近的亲属进行替代决策，以及不禁止强制做法，这与《残疾人权利公约》的建议背道而驰。该法案没有为预先指示做出规定，也没有规定知情同意参加研究。尽管该法案存在缺陷，但对于尼日利亚来说，这将是向前迈出的重要一步，因为尼日利亚目前的精神卫生立法是 1958 年的《精神错乱法案》。尽管《残疾人权利公约》没有明确说明各国，特别是资源有限的国家，应该如何建立可行的法律框架，但很明显，所有国家都应该加入当前消除或至少将精神卫生保健中使用的强制手段减少到最低限度的全球努力。我们预计，未来对该法案的修订将根据尼日利亚的社会文化背景，审查其局限性。
