The Federal Executive Council’s decision to approve an amendment to decriminalise attempted suicide is an important moment in Nigeria’s mental health journey. For decades, a person who survived a suicide attempt could find themselves treated not only as someone in distress, but also as someone who had committed an offence. Moving away from punishment and towards care represents a significant shift in how we understand suicide, mental illness and the responsibility of the health system. Yet, while the decision deserves recognition, we should be careful not to confuse a change in the law with a solution to the problem.

The more difficult question is what happens next. If a person survives a suicide attempt today, can our health system provide the psychological assessment, crisis intervention, treatment and follow-up that they need? Can someone experiencing severe depression or suicidal thoughts access care before they reach a crisis point? Can a teenager struggling with anxiety, trauma or hopelessness find help without being labelled, stigmatised or dismissed? These are the questions that should define Nigeria’s next chapter in mental health, because decriminalisation is meaningful only when it is accompanied by a health system capable of offering people a genuine alternative to despair.

Evidence suggests that Nigeria’s mental-health challenge is considerably larger than the number of reported suicides. A 2026 systematic review and meta-analysis of Nigerian studies estimated the prevalence of suicidal ideation at 7.9 per cent, suicidal planning at 1.9 per cent and suicide attempts at 1.3 per cent. The researchers also highlighted an important limitation: Nigeria still lacks sufficiently robust national suicide surveillance, meaning that the true burden is difficult to establish. This uncertainty itself is a public-health concern because we cannot design effective interventions, allocate resources appropriately or measure progress when our understanding of the problem remains incomplete.







More importantly, suicide rarely emerges in isolation. It can be the final manifestation of a much longer trajectory involving depression, substance use, trauma, violence, social isolation, financial distress, relationship breakdown, displacement, chronic illness or other social determinants of mental health. This is why Nigeria cannot approach suicide prevention solely through the lens of psychiatry, nor can we wait until someone reaches the point of attempting suicide before the health system intervenes. Effective prevention requires us to move upstream, identify risk earlier and create multiple opportunities for people to enter care before distress becomes a crisis.

That means integrating mental health into primary health care. Nigeria has spent years strengthening PHC as the foundation of its health system, yet mental health is still too often treated as a specialised service that exists somewhere beyond the ordinary health system, usually in psychiatric hospitals or specialist clinics. For many Nigerians, particularly those living in rural and underserved communities, that model is simply not realistic. The first point of contact for someone experiencing psychological distress may be a primary healthcare worker, midwife, nurse, community health extension worker, teacher, community or religious leader. Our health system should therefore be designed to recognise distress wherever people enter the system and provide an appropriate pathway to care.

This is where PHC integration, task-sharing and task-shifting become particularly important. Nigeria does not have enough psychiatrists, psychologists and other specialised mental-health professionals to meet the country’s needs through a specialist-only model. The answer cannot simply be to wait until we have enough specialists. We need a tiered, stepped-care system in which appropriately trained non-specialist health workers can identify common mental-health conditions, recognise suicide risk, provide basic psychosocial interventions and make appropriate referrals, while specialists manage more complex cases. WHO’s Mental Health Gap Action Programme provides an important framework for this kind of approach, particularly in settings where specialist resources are limited.

However, integration cannot simply mean adding another screening form to an already overstretched PHC worker’s desk. It requires training, supportive supervision, appropriate medicines where indicated, functional referral pathways, specialist support and continuity of care. It also requires financing. Otherwise, we risk creating a system that identifies people in distress but has nowhere to send them.

Surviving an attempt should trigger more than emergency treatment for the immediate physical consequences. It should prompt a comprehensive psychosocial and suicide-risk assessment, safety planning, appropriate treatment, family engagement and structured follow-up. Continuity of care is essential because the period following an attempt can remain one of significant vulnerability. The objective should not simply be to stabilise the patient and discharge them, but to establish a pathway that reduces the likelihood of another crisis.

Our health information systems also need strengthening. Nigeria cannot effectively prevent what it cannot adequately measure. Suicide and suicide attempts should form part of a stronger public-health surveillance architecture, with appropriate safeguards for confidentiality, dignity and data protection. Better data would allow us to understand who is most at risk, where the burden is concentrated, which risk factors are changing and whether interventions are actually reducing suicidal behaviour. It would also help governments move away from reactive responses to individual tragedies towards evidence-based population-level prevention strategies.

But data alone will not solve the problem. We must also confront the stigma surrounding mental illness. In many Nigerian communities, depression may be dismissed as weakness, psychological distress may be interpreted exclusively through spiritual explanations, and someone expressing suicidal thoughts may be told to pray harder, be more grateful or simply “snap out of it”. Families may conceal mental illness because of concerns about marriage or social reputation. Religion and spirituality can provide enormous sources of resilience and social support, and they should not be positioned in opposition to mental-health care. The challenge is to build partnerships in which religious and traditional institutions can recognise warning signs, respond safely and facilitate referral rather than inadvertently delaying professional care.

The same principle applies to schools and workplaces. A comprehensive suicide-prevention strategy must include adolescents and young people, who are navigating academic pressure, unemployment, family difficulties, social media exposure and other stressors alongside the broader uncertainties of growing up in Nigeria. Schools can become important platforms for mental-health literacy, early identification and referral, while workplaces need to recognise that mental health is part of occupational health. Economic insecurity, job loss, excessive workload and burnout do not become less important to public health simply because they may not appear on a clinical diagnosis sheet.

This is why the conversation must ultimately move beyond suicide. Nigeria’s mental-health agenda should encompass prevention, early intervention, treatment, rehabilitation and social reintegration, while addressing the social determinants that increase vulnerability. Mental-health services must be affordable, accessible, acceptable and of sufficient quality, particularly for populations that are already underserved. This will require stronger collaboration between health, education, social protection, labour, justice and other sectors because the determinants of mental health do not sit within the health sector alone.

Nigeria has already established an important policy foundation through the National Mental Health Act and the broader mental-health policy framework. The challenge now is implementation. We need sustained domestic financing for mental health, stronger community-based services, integration into PHC, functional referral systems, workforce development, suicide surveillance and evidence-based psychosocial interventions. We also need to ensure that mental-health services are incorporated into broader health-system strengthening efforts rather than treated as a separate programme competing for attention and resources.

The decriminalisation of attempted suicide therefore presents Nigeria with an opportunity much larger than a legal amendment. It gives us a chance to reconsider what we mean when we say that mental health is part of health. A person who attempts suicide should not first encounter the state as a criminal. They should encounter a health system capable of recognising that they are in crisis and responding with dignity, safety and appropriate care. But the ultimate measure of success should be even more ambitious. It should not simply be that fewer people are prosecuted after attempting suicide; it should be that fewer people reach the point of attempting suicide in the first place.

Nigeria must move from criminalisation to care, and from care to prevention. The Federal Executive Council has opened the door to a more compassionate and public-health-oriented approach to suicide. The responsibility now is to ensure that behind that door is a health system that Nigerians can actually turn to when they are struggling. Decriminalisation may change what happens after an attempt, but prevention requires us to change what happens long before one occurs.

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