A Critique Of The Autonomy Of Mental Health Patients Under Nigerian Laws

By Matthew Godfree

ABSTRACT

The society regarded them as unwanted elements. Less regards was given to them on any matter. Their fault was that there are mentally challenged, hence, series of derogatory identities are attributed to them. Worst of all, even the legal frameworks that ought to adequately protect them is lacking. The available law for the protection of their rights is archaic and outmoded. Allied with this is the fact, Nigerian Government shows little political and legislative commitment towards improving the legal regime of mentally challenged patients. Consequently, the rights and freedoms of these patients are not observed in most instances. It was these developments that gave birth to the authorship of this work. Therefore, the aim of this work was to highlights the specific and generic laws protecting the rights of mental health patients on Nigeria. The work aspires to explore the flaws inherent in the Lunacy Act, 1958. The work also highlighted the international and domestic legislations that complimented the rights of the mental patients. This work found that poor and inadequate legislation is no doubt, a challenge to the rights of mental patients in Nigeria. It is further established that poor health facilities are also bane on the rights of the mentally challenged patient. This work concludes by suggesting the enactment of updated modern legislations, capacity buildings of the staff of the mental institutions and well equipped facilities-as way forward to bolster the dignity of mental health patients. It was hope of this writer that this work shall be resourceful to learning.          

• INTRODUCTION

Consent is a vital aspect of any valid enterprise. It determines the willingness of the parties to engage in a particular task. It helps them to express their desire and willingness to be bound by the outcome of that relationship. In legal practice it is known as consensus ad idem i. e agreement of two minds. But is it possible for two to agree where the other mind has deficiency of reasoning? Is it possible for two to tangle where one is unaware of the terms of their engagement? Would there be an equal bargaining power where a doctor and mentally ill patient agreed over a treatment? Can a third party give consent on behalf of mental patients with respect to their treatment? Is the rule of informed consent an absolute practice in case of the mentally challenged patients in Nigeria?

The response to the above posers implies the conflict between autonomy and paternalism within the prism of medical law in Nigeria. In exploring this discourse, this paper shall:

• Embark on conceptual clarifications of certain terms.
• Examine the legal frame work for the protection of mentally health patients.
• Examine the legal frame work of informed consent of mental health patients in Nigeria.
• Discussed the scope and limitation of informed consent of mental patient in Nigeria.
• The way forward.

The prospect of this work is to further develop on the understanding of the concept of autonomy of mental patients in Nigeria. It is the hope of this writer that this work will be of immense contribution to medical jurisprudence and research.

• CONCEPTUAL CLARIFICATIONS OF TERMS

1. AUTONOMY

This is a principle that states the right of a person to make a decision about the nature of treatment that will be carried out on him. It also refers to the respect accorded to a patient before treatment or information about him is relay to others. It cuts across issues like consent and confidentiality. It is also known as self-rule.[1]

1. INFORMED CONSENT

This is a principle which requires the right of patient to know the nature and extent of treatment carried out on him. It involves the patients’ right to agree to a particular treatment, to be informed of the nature of treatment, the benefits and the risks associated with the treatment. It is the duty of a doctor to give informed consent on the treatment he intends to carry out on a patient.[2]

1. MENTAL ILLNESS

This refers to disorder of one or more of the minds such as emotion, perception, memory or thought.[3] It also includes a situation of both mental and psychological disorder that affect how persons relate to others in their environment.[4]

1. LUNANCY

This is a severe mental illness that exposed someone to violence and wild behaviour that deprived a patient of reasoning capacity. It is an obsolete term to describe a mental illness because it is no longer available in used.[5] It is rarely used in medical literatures because of its obsolete nature.

1. MINOR

This is person who is below the age of 10 years and incapable of reasoning well. He is incapable of making decisions that will be legally binding on him. Any decision made by him will be unenforceable, except he is matured to know the consequences of his decision.

1. ADULT

This refers to any person who is above the age of 18 years and capable of given consent on any form of treatment. An adult in the eyes of law is someone who is capable to be bound by the outcome of his decision. An adult is a legally recognized person in the eyes of the law.

• LEGAL FRAMEWORK REGULATING MENTAL HEALTH PATIENTS IN NIGERIA.

The laws governing mental health patient in Nigeria can be classified into two: the specific laws and the general laws. The specific law that governed mental health patient is the Lunacy Act of 1958.[6] This law regulates the practice and regulations of mentally-ill patients in Nigeria as well as institutions that have the custody of mentally-ill patients.

The other laws that are complimentary to Lunacy Act of 1958 are the general categories of law. They include the 1999 Constitution of the Federal Republic of Nigeria, CAP C23, LFN, 2004, Code of Medical Ethics, 2008, Penal Code, Child Rights Act, 2003, 1993 Nigerians with Disability Decree, Violence against Person (Prohibition) Act, 2015, Rights of Persons with Disabilities Act, 2018 and other international instruments.[7]

3.0. EXAMINATION OF CRITICAL LEGAL ISSUES UNDER THE LUNACY ACT OF 1958

This is a specific law that regulates and governs the treatment and welfare of mentally challenged patients. It is also governs the authorities who are in charge of the custodies of the mental patients, and how these patients are been treated. However, the Lunacy Act 1958 falls short of its statutory expectations in terms of the protection of the rights of mental patients. This position will be examined in detail at the subsequent paragraphs.

The first point to note is that autonomy of a minor is not respected under the Lunacy Act.[8] This is despite the fact that respect for the autonomy of minor is an integral part of Nigerian medical jurisprudence.[9]  This is coupled with the fact that respect of the autonomy of mental patients is an internationally recognized practice.[10] This right can also be exercised through their proxies after their consent has been obtained or where there are unconscious. At such, the parents or guardians of the minor patient have the right to determine the nature and the manner of the treatment that will be carried out on the patients.

However, Lunacy Act violates the concept of mature-minor or Gillick – Competence test.[11] This is more apposite where a minor is in lucid intervals and is capable of making decisions. Lucid interval is usually considered a window of sanity to any mentally challenged patients. It is a special instance that accrues a temporary right for patients to act as persons with sanity.[12] Once a person is under his lucid interval he can enter into valid contract and enforced it. This also qualifies him to make and execute valid documents.[13] In Nigeria, the law recognizes the rights of a person who developed mental issues to give advanced directives on where he will be treated.[14]

Again, the definition negates the dignity of adult persons who are in their lucid interval. These are people who have temporary mental impartment and can resume to state of sanity after a while. During these temporary intervals, the law permits them to give consent and enter valid contractual agreements.[15]

Apart from the crisis of given consent, the mentally impaired persons also suffer stigmatization and injustice. Stigmatization occurs in instances when they are “dubbed” as “madmen” “idiots” and psychiatric patients. This labeling sometimes rationalized their detention for several days with or without treatment or observations. [16]

A further impact of detention of mental patients in prisons chain is that it violates their rights to personal dignity and freedom from torture.[17] This is worse where the case of the patient is within the window of lucid interval, and posed no threat of violence to others. Nigerian laws accord respect to human dignity without discrimination on ground of any circumstances.[18] However, in some cases of mental illness the patients are not the architect of their misfortune but social challenges could have led to their predicaments.[19] Therefore, it is within the province of wisdom that, state should cater for it citizens who are victims of special circumstances- like mental patients.

The Lunacy Act of 1958 deprived mentally ill-patients of dignity and sense of honour. This starts with the definitional problems. The Act under section 1 defines lunacy as idiocy and regards any person of unsound mind to be a lunatic.[20] The act further defines Lunatic to include idiots and any persons with unsound mind. However, the medical limitation of this definition is that person may be of unsound mind but may not be affected by mental disorder.[21] Also, the provision is generously mischievous because mental illness includes cases of depression and other psycho-social crises which do not require such persons to be labeled as lunatic.[22] Even normal people sometimes have instances of depression and other psychological crisis.

Also, the law[23] does not provide for consent to be obtained either by the relatives or guardians of the lunatic. This contravenes principle of the proxy consent. Proxy consent is a permissible practice of obtaining consent for a treatment of patients through a third party such as spouse, parents, guardians or the state. By proxy consent, it is the relatives or guardians of minor or mentally challenged persons that can give consent or act on their behalf. This is because proxy autonomy of the patients will further promote dignity and respect of mental patients.

The above practice applicable in Nigeria is in sharp contrast with what is obtainable in other jurisdiction. For example, section 7 of the English Mental Health Act, 1983 provides that:

“In the case of mentally ill-patients, however, a spouse or relative may appoint a guardian and he or she could give effective consent on behalf of the patient.”[24]

In Australia, mentally ill patients have the rights to nominate certain persons that can act on their behalf during treatment. Such persons may include close relatives, close friends, neighbours or care-givers. These nominated persons are meant to protect and promote the interest of mental patients during treatment.[25]

The India law also recognizes the rights of mental patients to exercise proxy rights of representation. The Indian law provides for nominated representative for both adult mental patients and minor mental patients.[26] For the adult patients the law provides for the patients right to nominate their relatives, care-giver or any person appointed by the Board of the mental health institution. In the case of the minors, any competent person who is not a minor may be nominated as representative.[27] However, where the legal guardian is not acting in the interest of the minor or is not capable of doing so, the board of the institution may appoint certain individual it deems fit.[28]

Another critique of the mentally impaired patients in Nigeria relates to the use of authorities to determine what constitutes Lunacy? The Lunacy Act, 1958 provides for two conditions precedents before a person can be adjudged and declared a lunatic. These are:

• The magistrate must find that the person is lunatic, and
• A medical practitioner must examine and certify the person a lunatic.[29]

While the legal recognition and competence of a medical doctor is not in doubt because of his expertise and training, but that of a magistrate is highly questionable. This is because the magistrates are not trained personnel in medical province. Therefore, the yardstick, expertise or basis upon which he arrived at a conclusion is not rational and objective. The arrangement of the section wherein the verdict of a magistrate in paragraph (a) above, precedes that of medical doctor in paragraph (b) above, implies the priority of the former’s verdict over the later.  Thus, making it appears as if the opinion of the doctor on what constitutes insanity is subject to that of a magistrate.

It is the firm opinion of this work that the opinion of the magistrate on what constitute insanity should be dispense with because he is not a trained expert in mental health. There is no basis of including a magistrate to be an assessor of a patient’s sanity or insanity.[30]All that is ideal for him is to grant order or authorization for detention or released of such patients.

Again, the admission of patients into asylum is mostly involuntary.[31] While it may be excused on the ground that it is a paternalistic approach, it will be more justified if the consent of the relatives were obtained.

Also, mentally-challenged persons are not supposed to be accommodated in prisons, either as prisoners or as Awaiting Trial Persons (ATP).[32] This is common trend in Nigeria where pre-trial detention is high and persons with mental health challenges have been in detention.[33] This development sometimes led the detainees to develop mental problems as a result of depression due to frustration. Thus, the precarious plights of pre-trial detainees in Nigeria sometimes lead them to become mentally challenge.

Perhaps, the greatest odd of the Lunacy Act of 1958 is its archaic and obsolete posture as well as its disregards for the rights of mental health patients. This is reflected in the words of Onyeama JCA (as he then was) that:

“All the old judicial authorities for compulsory treatment is retained and…the procedure themselves are ponderous, inflexible and hedged around with the sort of archaic terminology and obsolete judicial formulation that have long since been abandoned in modern Mental Health Acts adopted in other countries.” [34]

These are some of the legal critique examined of the Lunacy Act with respect to the rights and plights of the mentally -ill patients in Nigeria. A further critique of the autonomy of the mentally ill patients will be examined at the subsequent section of this work; where references will be made to other general laws that protect the rights of the mental health persons.

4.00 OTHER COMPLIMENTARY LAWS ON THE RIGHTS AND AUTONOMY OF MENTAL PATIENTS IN NIGERIA.

This section highlights some of the legal frameworks that protect the rights of mental patients in Nigeria. Some of these laws are Constitution of the Federal Republic of Nigeria, Code of Medical Ethics, 2008, Penal Code, Violence against Persons (Prohibition) Act, 2015, Child Rights Act, 2003 and Persons with Disability Decree 1993.

4.01. CONSTITUTION

The constitution of the federal republic of Nigeria provides for the rights and dignity of persons. It accord them freedom from torture. Therefore, it is within the spirit of the constitution of the Federal Republic of Nigeria that rights of mentally-ill patients shall be respected.[35] It also provides for their rights to safe custody and decent treatment.[36] This includes their proxy rights to give consent.

4.02. CODE OF MEDICAL ETHICS, 2008

Under this code, doctors are enjoined to eschew psychological and biological torture of patients.[37] This include mentally-ill patient. By stating the need for doctors to abhor torture, the code is in consonance with the Constitution of the Federal Republic of Nigeria which deals with freedom from torture and right to personal and human dignity. The code also provides for the for their proxy consent in section 19.

4.03. PENAL CODE

This is a piece of legislation that punishes any crime committed in northern part of Nigeria. Its scope of application covers the whole of Northern Nigeria. The Penal Code upholds the right of mentally challenged persons, especially within the province of right to life. It criminalizes any act of assisted suicide on an insane person.[38] This assisted suicide could be medically or socially induced. Thus, doctors are not permitted to assist a mentally challenge patient to commit suicide under Nigerian law.[39]

4.04. VIOLENCE AGAINST PERSONS (PROHIBITION) ACT, 2015

The Violence against Persons (Prohibition Act,) 2015, equally provides for the protection of the mentally retarded persons. Section 28(4) empowers a complainant to apply for protection of mentally retarded person or any person who is unable to give consent for the protection against the violence meted out on him. This section of the law really shielded the mentally retarded patients again violence or brutality. Thus, it is in tandem with the International Principles for the Protection of Persons with Mental Illness and Improvement of Mental Health Care Facilities (subsequently referred to as “Protection Principles”). Principles 8 of the ‘protection principles’ provides for the protection of the plights of mentally ill-offenders. It ensures that they are protected from torture and other inhuman treatment.

Protection of mentally challenged persons from brutality and respect for their dignity is also recognized in the American case of Ford Vs Wainwright.[40] In this case, condemned prisoner petitioned the state that he was not competent to face execution because of insanity. Justice Marshal delivered the opinion of the court held that the Eight Amendment prohibits states from inflicting death penalty upon a prisoner who is insane. The reasons for not condoning the execution of insane, is that such an execution has questionable retributive value, as it presents no example to others. Thus, it simply offends humanity and has no less logical, moral, and practical force at present.

4.05. CHILD RIGHTS ACT, 2003

This is legislation that accords dignity to mental health patients. It seeks to protect the welfare and rights of children who are mentally deranged. Section 64 (4) (a) provides that

“a scientific sample may be taken from a child who:

• Is suffering from mental disorder within the meaning of any relevant law in Nigeria”.

The only exception to the above provision is where he does not know the purpose and consequences of the treatment on him. At this juncture, it is the doctor or his guardian who can give consent on his behalf.[41] The provision of the Child Rights Act on the right of a child to give consent relating to his treatment is upheld in the recent case of Esabunor V Faweya.[42]

Other categories of generic laws that protect, the rights of mental patients include Discriminations against Persons with Disability (Prohibition) Act, 2018[43] and 1993 Nigerians with Disability Decree.[44]

5.00. THE LIMITATIONS OF THE RIGHT OF MENTAL HEALTH PATIENTS IN NIGERIA

While the concept of right is personal and inalienable, the restrictions to these rights are mostly inspired by public interest and utilitarian value. This principle is termed as “best interest” of the patient in medical law. It is known as paternalism.

Paternalism is a policy that overrides individual rights to give consent in pursuit of the patients’ best interest. Paternalism is justified by philosophers John Stuart Mill (1806-1873). He argued that paternalism is a justified intervention for the benefit of the patient or when the intervention is to prevent the harm to others.[45] It is from this proposition that most constitutions of the world provide a claw-back clauses” or “derogatory clauses” to restrict the rights as ascribed to individuals in the interest of public health, public safety, public morality etc.

Limitation of the autonomy of patients in Nigeria is reflected in section 45 (a) and (b) of the 1999 Constitution of the Federal Republic of Nigeria. The section provides that:

• Nothing in sections 37, 38, 39, 40 and 41 of this constitution shall invalidate any law that is reasonably justifiable in democratic society
• For the purpose of protecting the rights and freedom of other persons.

The import of the above provision is that autonomy of the mental patients will be restricted where it will posed risks to himself. For example, autonomy will not be respected where a mental health patient contemplates committing suicide, take harmful drugs such as poison or attempts to hang himself. In the same vein, the autonomy of mental patients can be restricted where the legal rights of others will be drastically affected.

In further consolidating the limitations of the rights of mental patients, this work will examined the role of state in circumscribing those rights. In the course of examining the role of state this work will center on the roles play by the legislature, executive and judiciary. The detail discussion of these issues is examined in the subsequent paragraphs.

The state is the ultimate custodian and protector of individual rights. It sometimes determined the extent and scope of the enforcement of those rights. The power of state to restrict individual rights to give medical consent by patients (both by sound and unsound mind patient) is approved. The institutions of the state can restrict the autonomy of mentally deranged persons are executive, legislative and judiciary.

1. EXECUTIVE

The heads of executives here include minister of health, Police, Psychiatry Hospitals and others of similar status. They can issue directives or policies to be implemented in limiting the rights of mentally challenged persons in the general interest of the society. These executive institutions are sometime created by law. Also, there are they are meant to ensure the protection and interest of the mentally challenge persons, in discharging their functions.

1. LEGISLATURE

Through the instrumentality of legislation the rights of individual can be curtailed. They can be curtailed in the overriding public interest, specifically health concern. Examples of legislation that curtails the right of patient to give medical consents are 1999 Constitutions Child Rights Act 2003 and Lunacy Act 1958.

1. COURTS

Through judicial activism courts in various cases both foreign courts and Nigerian Courts have ruled against the rights of individual to give or withheld consent against the patients. These decisions are mostly paternalistic in nature- in the best interest of the patients. Nigerian courts enriched medical consents in many cases.[46] The recent decision is that of Fayewa Vs Esabunor (Supra).

5.00.   THE WAYS FORWARD

A good scholarly work is that which proffers solutions to the challenges identify during its discourse. It is on this premises that this work suggested the following measures as step forward to the plight of lunacy laws in Nigeria. These steps include the need for (a) good health infrastructure (b) review of Lunacy Act (c) judicial activism (d) capacity building, and (f) sensitization.

1. Good Health Facilities

Nigerian government should try and have good health care facilities in mental health institutions. This will benefit both the patients and the health care providers. The good facilities are capable of ensuring salubrious environment for the mental patients. Good environment also promotes the dignity of patients. Aside from the patients’ perspective, good health facilities will reduce the incidence of health workers been assaulted by the mental patients.

1. Review of Lunacy Act, 1958

The principal legislation on mental health is over 50 years old. It is lagging behind compared with other advanced countries. It is not in tune with the reality of time and current legal trend. The Nigerian legislation should re-visit the Mental Health Bill of 2013 to create a modern legal impact.

1. Judicial Activism

Courts should be more proactive in adjudicating on matters relating to autonomy of patients. They should imbibe the liberal approach to interpretations of statutes that seek to be harsh on patients.  Court should strive more on the substance and the heartbeat of the cases than the technicalities involved.

1. Capacity Building Training for Mental Health Workers

It’s a common sight to see that health workers usually applied brutal forces to curb the excesses of mental patients. This constitutes not only grave abuse of human rights but it ended up causing another health challenge to the body of the mental patients. The effects of such incidences include wounds, abrasions and other sorts of injuries. The health workers should apply more of psychological persuasions /threats than use of physical violence.

1. Sensitization

There is need for public enlightenment on path of Nigerian in order to understand that mental health patients may not necessarily be lunatic. They should be taught to appreciate that mental health patients could be suffering from depression and other psychological crises. And that it is not every psychological case that amount to a psychiatric issue to warrant detention of a person as mental patient.[47] People should also be taught to stop stigmatization against mental health patients.

6.00. CONCLUSION

This work started with theoretical interrogation of the concepts behind the autonomy of mental patients. It raised some fundamental questions which gave births to the examination of the laws governing the autonomy of patients in Nigeria. In examining the laws on autonomy, the work exposed the flaws of the Lunacy Act, 1958-being the principal legislation. The work further explored some national plus international instruments that compliment autonomy of patients in Nigeria. Limitations of the concepts of autonomy through the machineries of the state were also discussed. In progressive manner, the work concludes by recommending certain steps as way forward to compliments the rights and dignity of mental health patients in Nigeria.

1.”Oxford Concise Medical Dictionary”, 8th Edn( Oxford University Press, 2010) 66

2.n.377

3.n.453

4. Paulo Ugochukwu Ude, “Policy Analysis on Nigerian Lunacy Act (1958): The New for a New Legislation”P.1@ J. Psychiatry (19) (1)  (University of Texas, 20^{20) 205@https://www.researchgate.net>…<accessed}on26thNovember,2019>

^{5.lunacy@https://medical-dictionary.thefreedictionary.com><accessed on 25th February}, 2020>

6.This law has been the only special law governing mental patients in Nigeria. The Lunacy Act is adjudged to be outmoded and irrelevant to contemporary realities. The Association of Psychiatrists of Nigeria attempted to review the Lunacy Act 1958 by promoting  the  Mental Health Bill 2003 and the Mental Health Bill 2013. However, these attempts did not succeed. See  Comfort Chinyere, “Criminal Justice And the Mentally Disabled Offender” in Epiphany Azingye and Chinyere Ani, Rights of Persons With Disabilities (Edn., Nigerian Institute of Advanced Legal Studies) @297-300.

7. For purpose of clarity these instruments are classified into two; those that are specific to mental health patients and others that applied generally. These international instruments that specifically relates to the rights of mental patients include; United Nation Declaration on the Rights of Persons with Disability. This is made pursuant to UNGA Resolution 46/119 of 17th December, 1991. Also in this category is the UN Principles for the Protection of Persons with Mental illness and Improvement of Mental Health Care. This Resolution is made pursuant to UNGA-A/RES/46/119. Again, the UN Declaration on the Rights of Mentally Retarded Patients, proclaimed by the GA RES.2856(XXVI) fall under this category . However, instruments that are of general applications to mental patients and other persons include, UN Body of Principles for the Protection of All Persons Under any Form of Discrimination-UNGA resolution43/173.annex,43..UNDoc.A/43/49/(1988); UN Standard Minimum Rules for the Treatment of Prisoners; UN Body of Principles for the Protection of All Persons Under any Form of Detention or lmprisonment, UN Declaration on the Rights of Disabled Persons, UN Standard Minimum Rules for the treatment of Prisoners, Convention on the Rights of Persons with Disabilities and Universal Declaration of Human Rights of 1948.

8.The right of minor in mental  health  is  an  internationally recognized  norm.  Principle 2 of  UN Principles for the Protection of Persons with Mental illness and the Improvement of Mental Health Care,1991,  provides for the protection of minors. While Principle 11 provides the rights of patients to give consent to treatment.

9.In  the case of  Tanko V  Okekearo 12 (NWLR) PT.79. The Supreme Court of  Nigeria held to the effect that a child who though is minor, can give valid consent for his treatment provided he knows the consequences of  that  treatment.

10.World Atlas, 2011,  culled from Paula Ugochukwu Ude , n 1. See also World Atlas,2017, P.15 @https://www.who.int>handle PDF  <accessed on 27 November, 2019>

11.This principle espouses that children under the age of 16 years has a right to give medical consent to treatment provided that they know the consequences of his acts. The principle derived its authorship in the case of Gillick Vs West Norfolk and Wisbech AHA (1986). In this case  mother of a girl who was below 16 years, opposed medical examination and treatment on her children. She also objected to doctors’ advice to give contraceptive and immunization. However, it appears the children agreed to such terms. When the matter was referred to the House of Lords, their Lordships held  that a child under the age of 16 had the legal competence to consent to medical treatment provided they have sufficient maturity and  intelligence to understand the nature and implications of that treatment. See Richard Griffith, ‘What is Gillick-Competence?’-NCBI, @https://www.ncbi.nlm.nih.gov>pmc< accessed on  27th  November, 2019>

12. Richard Schulman, ‘Lucid Intervals and Testamentary Capacity’(2019)@https://www.allaboutestates.ca>luci…<accessed on the 28th December, 2019>
13. n.
14. AFENI V. SHEHU (1998) 7 N.W.L.R(PT.556)p.145-146 paras. H-C.
15. Richard Schulman. N.4

16 . Section 36(5) of Nigeria,1999 provides  that any person ( including mental patients) has the right to be presumed innocent until proven guilty. this principle is enunciated in the case of Adeniyi V F.R N (2012) 1 NWLR PT (1281) 284.

17.Section 34 (1) (a) prohibits subjection of human beings to torture or inhuman or degrading treatment. See Odiong V Asst. IGP (2013)LPELR-20698(CA)

18.See section 42 (1) of the 1999Constitution as Amended.

19.Adeoye Oyewole, How Change affects the Mental Health of Nigerians, Punch, 22nd, April, ^{2016@https://www.@https://punchng.com>how-change-…<accessed on 12} February,2020>

20. Andrew Hudson Westbrook, “Mental Health Legislation and Involuntary Commitment in Nigeria: A Call for Reform” Washington University Global Studies Law Review,Vol.10, 2 @403-404

21.N.14.

22..N.14.

23.Andrew Hudson Westbrook. N.14

24.See also T. V T (1988) (Fam 52).

25.Section 19(1) and section 20 (1) and (2) of Mental Health Act, 2015, Australia.

26. Sections 14 and 15 of the Mental Health Act of India, 2017.

27.Section 14(1) and  (3)  of the Mental Health Act of India, 2017.

28. Section 15(2) (a) and (b) of the Mental Health Act of India, 2017.
29. Sections 12 and 13 Lunacy Act,1958.
30. Paula Ugochuckwu Ude, n
31. Abdulwasiu Ojo Akorede, “The Rights of The Mentally Ill and the Nigerian Society: Enhancing Dignity in Mental Health Through Legislation”,  Journal of Law, Policy and Globalisation,Vol.52, 2016 @173
32. Rule 68 of Code of Medical Ethics,2008.
33. Muneer Yaqub, ‘Nigerian Prisons are Living Hell’, African Liberty (2019)@http://ww.africanliberty.org.< accessed on 30th November, 2019>
34. N. 31 @175

35.Section 34 (1) (a) prohibits subjection of human beings to torture or inhuman or degrading treatment  and provides for rights to dignity of persons.

36. Section 35(1) (e) states that “every person shall be entitled to his personal liberty and no person shall be deprived of such liberty save in the following cases of persons..of unsound mind..for the purpose of their care or treatment or the protection of the community” (emphasis added).

37.See Rule 67 Paragraphs  a, b and c of Code of  Medical  Ethics, 2008.

38. Section 227 of the Penal Code provides that “if any person under eighteen years of age, any insane person, any delirious person, any idiot or any person in state of intoxication commits suicide, whoever abets the commission of such suicide shall be punished with death.”This provision of the law is meant to protect the lives of mental health patients such as insane persons, idiots and those in delusion. This law aptly suits the classification of persons defined by the Proposed Mental Health Bill 2013, where it categorizes insanity, idiots, delirious, etc as a mental health patients. Reference to persons in state of intoxication in section 227 of the Penal Code, is an indication that the law categories person under intoxication to be mentally challenge persons. This also qualifies the international taxonomy of mental patients which includes persons under intoxication. See World Atlas, 2017, P.15 @https://www.who.int>handle PDF  <accessed on 27 November, 2019> n. 5.

39.This position becomes more cogent considering the fact that doctors are ethically and legally prohibited to assist in suicide. Also, Rule 68 of the Code of Medical Ethics, 2008 prohibits assisted suicide on patients, including mentally deranged patients. in the same vein, section 228 of the Penal Code.

39. 477 US- 399(1986)

41.Section 64(4) (b) of  the Child Rights Act, 2003.

42. (LPELR(2019)SC.97/2009 In this case it was held that a court can intervene in the case of a child lacks competence to make decisions for himself. See P.343 Paras F-G. of the case. This case further compliment the decision in of the supreme court in Tanko V. Okeararu(2002) LPELR-SC-73/1998 where it was held that a minor can give consent to treatment pertaining his health once he/she knows the implication of their decision.
43. Section 57 of the Act, defines disability to include long term physical, mental, intellectual or sensory impairment which in interaction with various barriers may hinder full and effective participation in society one equal basis. The import of this definition is that it includes mental ill-health among the long-term impairment that is a probable cause of discrimination. It is an attempt to cure this discrimination and anomaly that this Act was signed by President Muhammadu Buhari in 2018.See Queen-Esther Iroanusi, Ten Things To Know About Nigeria’s New Disability Law, Premium Times,24th January,2019@https://www.premiumtimesng.com>…<accessed on 30th November, 2019>

44.Section 14 of the Decree provides for the membership of the Commission to include a person from the mentally impaired Community.

45. Stanford Encyclopaedia of Philosophy, Mill’s Moral and Political Philosophy, section 3.7, ^{2018@Plato.stanford.edu/enteries/mil-moral-political/<accessed on 20th} February,2020>
46. Such cases are Faweya V Esabunor, Tanko V Okerearu,Airedale NHS Trust vs Bland(1993) A.C and other related case.

47.Cases  such as defect in speech, emotional crises and depression may be handled by Psychologists who are meant to study the scientific behaviour of individuals and their mental processes. However, it is when such psychological crises aggravated to a worse scenario that results into  mental impairment, that psychiatrists should  intervene. Psychiatrist will then  focused on the diagnois, treatment and prevention of mental, emotional and behavioral disorders of individual with such cases.