Chained and neglected: the dehumanizing plight of Africans with mental health conditions

For five years, Paul was chained in a small room with seven men under dehumanizing conditions.

“[The] chain is so heavy. It doesn’t feel right; it makes me sad. I stay in a small room with seven men. I’m not allowed to wear clothes, only underwear. I have to go to the toilet in a bucket. I eat porridge in the morning and if I’m lucky, I find bread at night, but not every night…. It’s not how a human being is supposed to be. A human being should be free,” he told Human Rights Watch.

Mudinat, a woman with a psychosocial disability in Nigeria chained at a church in Abeokuta, also recounts how she goes to the toilet in nylon bags and eats at the same spot during the day.

“I go to the toilet in nylon bags, until they take it away at night. I last took a bath days ago. I eat here once a day. I am not free to walk about. At night I sleep inside the house. I stay in a different place from the men. I hate the shackles. I want to move about, I have asked the baba [faith healer] to take them off, but he won’t.”

Chaining or confiding people with mental health conditions remains a widespread practice in Africa. Some, as young as 10, are chained or locked in confined spaces for weeks, months, and even years, the Human Rights Watch said in a new comprehensive report.

The 56-page report, “Living in Chains: Shackling of People with Psychosocial Disabilities Worldwide,” examines how people with mental health conditions are often shackled by families in their own homes or in overcrowded and unsanitary institutions, against their will, due to widespread stigma and a lack of mental health services.

Human Rights Watch said many of those affected are forced to eat, sleep, urinate, and defecate in the same tiny area. In state-run or private institutions, as well as traditional or religious healing centers, they are often forced to fast, take medications or herbal concoctions, and face physical and sexual violence, the report noted.

The report includes field research and testimonies from Burkina Faso, Ghana, Kenya, Liberia, Mozambique, Nigeria, Sierra Leone, the self-declared independent state of Somaliland and South Sudan.

“Shackling people with mental health conditions is a widespread brutal practice that is an open secret in many communities,” said Kriti Sharma, senior disability rights researcher at Human Rights Watch and author of the report. “People can spend years chained to a tree, locked in a cage or sheep shed because families struggle to cope and governments fail to provide adequate mental health services.”

Globally, an estimated 792 million people, or 1 in 10, including 1 in 5 children, have a mental health condition. Yet, governments spend less than two percent of their health budgets on mental health.

Human Rights Watch said more than two-thirds of countries do not reimburse people for mental health services in national health insurance systems. Even when mental health services are free or subsidized, distance and transport costs are a significant barrier.

For many families, the absence of proper mental health support leaves them with no option but to shackle their relatives as they worry the person may run away or hurt others.

Shackling is typically practiced by families who believe that mental health conditions are the result of evil spirits or having sinned. People often first consult faith or traditional healers and only seek mental health services as a last resort.

One man from Kenya who is currently living in chains said, “It’s not how a human being is supposed to be. A human being should be free.”

“In many of these institutions, the level of personal hygiene is atrocious because people are not allowed to bathe or change their clothes, and live in a two-meter radius,” Sharma said. “Dignity is denied.”