(Accra) – Faith-based and traditional healing centers in Ghana continue to hold people with real or perceived mental health conditions – psychosocial disabilities – in chains in inhumane conditions despite a 2017 ban on such treatment, Human Rights Watch said today.

“People with psychosocial disabilities are still chained like animals,” said Shantha Rau Barriga, disability rights director at Human Rights Watch. “If the government wants its ban on chaining to be more than empty words, it needs to ensure that these chains come off and develop local mental health services that respect the rights of people with mental health conditions.”

A man with a real and perceived mental health condition held by a chain around his ankle at a traditional healing center in the Greater Accra Region in Ghana. 

© 2019 Shantha Rau Barriga/Human Rights Watch
From November 4 to 8, 2019, Human Rights Watch interviewed 25 people, including people with psychosocial disabilities, mental health professionals, staff at prayer camps and traditional healing centers, mental health advocates, religious leaders, and two senior government officials.

Of the six prayer camps or traditional healing centers across Ghana’s Greater Accra, Eastern, and Central regions Human Rights Watch visited, dozens of people were chained in two facilities. At both centers, men detained there called out to the Human Rights Watch researcher, begging to be released. In one traditional healing center, Human Rights Watch found 16 men in a dark, stifling room, all of them with short chains, no longer than half a meter, around their ankles. They called out: “We are suffering here. They are abusing our human rights. Please help us. Please help us.”

“The chaining of people with mental health conditions needs to stop – it needs to stop,” Ghana’s deputy health minister, Tina Mensah, told Human Rights Watch. Similarly, in a meeting with Human Rights Watch, the gender, children and social protection minister, Cynthia Morrison, said, “I give you my commitment right now, and I’m sure we’ll bring an end to it.”

These chains had been around the ankles of a woman with a real or perceived mental health condition through the night at a prayer camp in the Eastern Region of Ghana. She was released just before Human Rights Watch visited, but is still held at the prayer camp in a locked room, with the chain lying next to her mattress. 

© 2019 Shantha Rau Barriga/Human Rights Watch

At another prayer camp, people with real or perceived mental health conditions continue to be confined in cages that they are rarely allowed to leave, based on regular visits since 2011. They are forced to urinate or defecate in small buckets placed outside their cells. Most cages are so narrow that the men cannot even stretch out their arms. In two other facilities, people with mental health conditions are not chained, but the head of each camp explained that they are denied food for up to seven days, based on the belief that “fasting” will enable them to use worship and prayers to heal them.

The head of Ghana’s Mental Health Authority, Dr. Akwasi Osei, announced on World Mental Health Day in 2017 that the government would enforce the 2012 Mental Health Act provision that people with psychosocial disabilities “shall not be subjected to torture, cruelty, forced labour and any other inhuman treatment,” including shackling. In a video with Human Rights Watch, he said it was “illegal to put anyone in chains.”

Human Rights has found, based on its research since 2011, that families often take people with real or perceived mental health conditions to faith-based or traditional healers because of widely held beliefs that such disabilities are caused by a curse or evil spirits, and because their communities have limited, if any, mental health services. In some cases, the family member may  have been using drugs such as marijuana; in others, they were outcasts because of so-called deviant behavior.

“We need to talk to the families and make sure that they are ready to receive them because if the family refuses to receive them, where do they go?” Morrison said of the families of people in the spiritual or traditional healing centers.

Human Rights Watch confirmed that people remain unchained in Nyankumasi prayer camp, where officials from the Ghana Mental Health Authority sawed the chains off the 16 residents in 2017. They now refer anyone in a mental health crisis who comes to the camp to the nearby psychiatric hospital. The head of another center, Doctor Jesus Prayer Camp, told Human Rights Watch that they do not chain anyone because they are aware of the national ban.

In one traditional healing center, Human Rights Watch found 16 men in a dark, stifling room, all of them with short chains, no longer than half a meter, around their ankles. They called out: “We are suffering here. They are abusing our human rights. Please help us. Please help us.” 

© Shantha Rau Barriga/Human Rights Watch 2019

Deputy Minister Mensah said: “You can see that there have been improvements since the last time you were here. That means the people are taking up the challenge and improving some of the conditions. But we need to still do more. We have to sensitize the people, educate them on the rights of every individual. They cannot chain people in this way.”

In February 2019, the World Health Organization initiated, with the support of the UK’s development agency, its Quality Rights initiative in Ghana, an e-learning program aimed at training at least 5,000 people on ways to improve the quality of mental health services and ensure respect for human rights, including through obtaining informed consent from the person involved.

Based on interviews with seven mental health professionals and advocates in early November, most of whom had completed the training, Human Rights Watch believes that there has been a marked shift in the attitudes and practices of staff in Accra Psychiatric Hospital and among mental health professionals who administer medication to people in some prayer camps.

A nurse who works at Tetteh Quarshie Regional Hospital said, “Mental health is not just about taking medication. ‘Take your drug. Take your drug.’ Trying to force medication is not right. There is more to it.”

A nurse at Accra Psychiatric Hospital said: “Try to talk to the patient, to find out how you could help the patient – or what the patient thinks could be done to help them to get out of an aggressive mood. It’s possible to do without seclusion.”

A number of efforts led by local nongovernmental organizations, especially groups of people with psychosocial disabilities, are also underway. For example, MindFreedom Ghana has teamed up with the Human Rights Advocacy Center to conduct human rights training for psychiatric nurses and traditional healers. Another organization, Basic Needs Ghana, has been facilitating peer support groups. The Mental Health Society of Ghana is working with Time to Change in the UK to combat stigma and challenge stereotypes by highlighting the experiences of people with mental health conditions who have jobs, families, and are part of their communities, especially through social media.

Despite this progress, the government of Ghana should take further steps to end shackling by setting up the Visiting Committees outlined in the Mental Health Act to monitor prayer camps and traditional healing centers to enforce the ban, and by investing in community mental health services that respect human rights. The government should also ensure that people with psychosocial disabilities get adequate support for housing, independent living, and job training.

The government should follow through on commitments to sensitize the public and to combat the stigma associated with mental health conditions, Human Rights Watch said. Finally, the government needs to set up the levy envisaged under the 2012 Mental Health Act to fund mental health services as a matter of priority.

“It was promising to see that the ban is having its intended effect in some camps,” Barriga said. “But many people with real or perceived mental health conditions are still chained or locked up. Just as the minister said, ‘This needs to stop.’ The government needs to move from rhetoric to reality.”