Governance and Leadership in Mental Health Service Delivery: A Multi-Centre Study of the Implementation of Nigeria’s Mental Health Act (2021) in Nigeria’s Federal Hospitals

Abstract

Nigeria’s Mental Health Act (2021) represents a pivotal shift toward rights-based, integrated mental health care, yet its implementation in federal hospitals remains fragmented due to governance challenges, resource constraints, and leadership gaps. This qualitative multi-site qualitative study evaluated the Act’s operationalization in four tertiary federal hospitals (University College Hospital Ibadan, Ahmadu Bello Teaching Hospital Zaria, University of Benin Teaching Hospital Benin City, and Federal Neuropsychiatric Hospital Enugu) through in-depth interviews with 20 mental health practitioners. We employed a tri-pillar compliance lens that integrated governance structures, ethical frameworks, and implementation capacity for the interviews. The study revealed partial compliance, with strengths in policy advocacy by the Chief Medical Directors (CMDs), but persistent barriers included workforce shortages, stigma, and inadequate resource allocation. Thematic analysis highlighted opportunities for CMD-led reforms, such as integrating mental health into primary care and fostering ethical training. Our findings highlight the need for strategic leadership to bridge demand-resource gaps, promoting equitable access and recovery-oriented services. This research offers actionable pathways for CMDs and policymakers to institutionalize the Mental Health Act 2021, enhance mental well-being, and align with global standards