GHANA'S MENTAL HEALTH PATIENTS CONFINED TO PRAYER CAMPS
Jocelyn Edwards
In Ghana's prayer camps, people with mental health problems are chained, beaten, starved, and prevented from leaving, say human rights campaigners. Jocelyn Edwards reports.
Nestled in a verdant valley just outside of the small town of Mamfe, in Eastern Ghana, is Mount Horeb Prayer Centre. Established by the self-proclaimed prophet, Paul NiiOkai, the centre bills itself as a Christian centre of healing—a “deliverance and prophetic ministry”.
People with ailments both physical and psychological come to Mount Horeb because they have greater faith in God than in doctors, Reverend Betty Okai, the wife of Prophet Okai, tells The Lancet. “They believe that the power of God can work more than medicine.”
Of the hundreds of people that have come to the camp over the past 20 years for healing from physical and psychological ailments “just a few cases” have not been healed, she claims. Treatment for patients includes Bible reading, prayer, and voluntary fasting, according to Okai. “We pray in the healing name and blood of Jesus.”
Yet for the 80 patients with mental health problems that staff say are currently housed at the centre, the regime of the camp might actually harm more than heal.
Sitting outside a modern concrete house with a sign labelled “Prophet's Villa”, Reverend Okai insists that the patients, who have ailments ranging from drug addiction to depression, are well-treated and that the centre has not used chains to restrain patients for several years. However, a team from Human Rights Watch (HRW), who visited the camp in 2012, reported that patients were chained up, forced to fast for up to 36 hours, and prevented from leaving the camp by staff.
Mount Horeb is one of what is estimated to be hundreds of prayer camps across the Christian south of Ghana. 650000 people in Ghana are thought to have severe mental disabilities, according to WHO estimates. According to local advocates for people with mental illnesses, hundreds, if not thousands of these people are languishing in spiritual centres, where they are often subjected to inhumane conditions.
Established by self-proclaimed prophets, usually without any medical training, human rights abuses are rife in these camps. Often sent to these spiritual centres by their families, people with mental health problems can spend months there and may experience physical abuse, forced starvation, chaining, and other rights violations.
Supernatural forces
With 96% of the population professing some faith, according to a 2012 Gallup poll, Ghana is the most religious society in the world. Mental illness is seen as a spiritual problem, driving the families of those with mental problems to seek spiritual solutions.
Peter Yaro is the director of Basic Needs, a non-profit which assists people with mental disabilities in Ghana. “Mental illness is believed by most people to be supernatural. It is evil and therefore it needs to be addressed by similarly supernatural forces”, he says.
Prayer camps have proliferated in Ghana along with the growth of Charismatic and Pentecostal sects in the country. Today, there are 100 Charismatic and Pentecostal churches in the country and 28% of people in the country belong to one of these church denominations.
Although the exact number of camps in the country is unknown, it is estimated that the number reaches up into the hundreds. Often located outside of towns and cities, prayer camps are referred to as such because visitors spend time in residence. Ranging in size and sophistication, these spiritual centres can consist of one self-appointed leader and a few followers, or they can be more elaborate, with a hierarchical leadership structure and hundreds of people in residence. Patients may be charged a fee for residence, as at Mount Horeb, where patients are charged 50 cedis per month (about US$25) for food and lodging.
The philosophy espoused by these camps is often a hybrid of Christian teachings and traditional religious beliefs. Thus prayer and Bible reading can be combined with incantations, dances, and people falling into trances. “They combine both use of the Bible and some fetish [voodoo] approach”, says Yaro.
Prayer camps do not exclusively treat patients with mental health problems. Instead, they function as centres for general prayer and counselling and often attract people with physical ailments as well as other needs. However, their ministry to people with mental health problems is particularly subject to abuse since patients are kept in the camps against their will and are often unable to advocate for themselves due to the nature of their illnesses.
Chained and beaten
The 2012 report by HRW found instances of arbitrary detention, overcrowding and poor hygiene, chaining, denial of food, and lack of adequate shelter at eight prayer camps surveyed across the country. “Nearly all residents were chained by their ankles to trees in the compound, where they slept, urinated and defecated and bathed”, said the report. “As part of the ‘healing process’, people with mental disabilities in these camps—including children under 10—are routinely forced to fast for weeks, usually starting with 36 hours of so-called dry-fasting, denied even water.”
Full-size image (39K) Jocelyn Edwards
Doris Appiah has bipolar disorder and is a survivor of several prayer camps
Basic Needs' Yaro, who says almost all of the patients he works with have consulted some spiritual leader, recounts the stories he has heard from survivors of prayer camps. “I've heard stories of having been chained and being left at the mercy of the weather for days. I've heard stories of sleep deprivation because they wake them up in the middle of the night to pray. I've heard stories of issues of sexual advances”, he says.
Doris Appiah was a 23-year-old medical student when she first developed bipolar disorder. Over the next decade, she would visit a series of self-styled prophets who tried to “heal” her. “I was beaten, tied up, and left in the rain”, she says. “I still have scars.”
Staff at the prayer camp poured perfume down her nose in a water board-like treatment and doused her with hot water. “They hit me with it [the water] to [expel] the witchcraft from me.”
She finally ran away from the last camp in 1989. Now 58 years old, Appiah is outspoken about her experience, advocating for other people with mental illnesses. However, the taboo of mental illness is so great that other survivors of prayer camps are often afraid to be identified.
In Ghana, mental illness carries with it a special kind of stigma, explains Appiah. “People think that you are mentally ill because you have done a terrible sin and that is the punishment”, she says. “When somebody goes to the mental hospital, by the time they return their room is let out. When the family has a meeting they don't want you to talk; nobody wants to marry you; nobody wants to employ you.”
Possible solution
Ghana's mental health sector is severely under resourced with only 12 practicing psychiatrists and three psychiatric hospitals nationwide.
As a result, prayer camps have long functioned with no government oversight. According to AkwasiOsei, the medical director of Ghana's main psychiatric referral hospital, Accra Psychiatric, that should change when the country's mental health act is implemented. “Until now we really didn't have any solution”, says Osei. “Now for once we have the opportunity to handle it if we are able to implement the mental health law.”
The 2012 law provides for the registration of prayer camps and training of staff as informal frontline community workers. Staff will be trained on when to refer cases to the hospital and the proper treatment of patients.
“That is the main reason why the act was passed, to see to the regulation of some of those camps”, says Tony Goodman, public relations officer for the Ghana Ministry of Health.
Osei says he believes that this approach will be more effective than shutting down these spiritual centres. “If we shut them down it won't work …people will go underground and [the problem] will be even more serious”, he says. “Making sure that if people go there no harm is done to them, that is the way forward.”
But a year and a half after the passage of the act in March, 2012, the government has yet to appoint the board established by the law that is charged with implementing it. And even once the authority is put in place, the regulation and training of prayer camp staff is likely to happen slowly.
Culture change
Max Vardon, head of the National Council on Persons with Disability, says he believes a more effective approach is to tackle the belief system that has led to the mistreatment of people with mental disabilities in the first place. “We have a culture where some of these things that are seen as abuses elsewhere are not seen as abuses, in part because of cultural tradition and superstition. [People] see [what they do] as protecting the individual from the evil spirit that inhabits them.”
To counter this attitude, the Council is planning a campaign to change the perceptions of people with disabilities in Ghana, both mental and physical. Called Imago Dei, the campaign aims to engage religious people in Ghana by letting them know that even people with disabilities are made in the image of God.
“Until the population as a whole is disabused of these beliefs [that disabilities are caused by the supernatural], there will continue to be a demand for prayer camps rather than scientific solutions”, says Vardon.