By Felix Dela Klutse
Detention, violent treatment and chaining of mental health patients like dogs continous to be pervasive in many faith-based prayer camps in Ghana despite calls from human rights activists to ban the inhumane practices.
Imagine being taken to a prayer camp by a family member, chained to a tree or a concrete structure, sometimes without cover, and forced to urinate, sleep, defecate in the spot where you are chained and deprived of food and water, with no access to adequate health care. This is the reality for hundreds of people with real or perceived mental health conditions whom this reporter met or saw in a number of prayer camps across Ghana during a two-month investigations.
Mental health patient like Victoria Mensah, a 10-year old girl who lived in the Nyakumasi Prayer Camp in the Central Region of Ghana, was covered in dirt, chained to a tree and subjected to the same fasting regime as the adults. She had a serious skin condition with crusting and bumps on her arms, but it was left untreated. “The leader of the Prayer Camp told me the Lord will heal me through fasting,” she stated with tears in her eyes.
During the investigation, this reporter came across Ms. Umama Belakoba, who does not know her age. She has schizophrenia and is cared for by her mother at Nyinbunya prayer camp in northern Ghana, where she has been chained for a year to a shea tree. Umama Belakoba’s condition is possibly caused by trauma. Chained by her ankle to a shea tree, she has two hollows in the earth which serve as her toilet and to hold drinking water. Her mother, also called Umama, says: “my daughter has four children aged from eight to two. Her husband went to jail for stealing yams and the madness came.”
The Prayer Camp has 150 patients, and about 20 are chained to trees around the grounds. Umama Belakoba’s mother says the treatment of her daughter can be “only prayer. Pastor Isaiah Mensah, the leader of the camp, says he sometimes asks the mentally ill to fast with him, adding that, chaining is necessary for those who “can frighten people and even cause injury or make noise.”
“People with psychosocial disabilities are still chained like animals,” Shantha Rau Barriga, disability rights director at Human Rights Watch.
Barriga said if the government wants its ban on chaining to be more than empty words, it needs to ensure that the chains come off and also develop local mental health services that respect the rights of people with mental health conditions.
Emegence of Prayer Camps in Ghana
Ghana has several hundred of prayer camps, which are believed to have emerged in the 1920s, although little is known about their history, numbers, or operations since they are not state-regulated. While prayer camps in Ghana often serve as a refuge for people seeking spiritual healing and peace of mind, some of these camps place people with mental disabilities in an inhumane and degrading environment.
Spread throughout the country, prayer camps are privately owned Christian religious institutions with roots in the Pentecostal denominations established for purposes of prayer, counseling, and spiritual healing. The camps are run by prophets, many of them self-proclaimed. Some of these camps have units where persons with mental disabilities are admitted, and the prophets seek to heal persons with mental disabilities with prayer and traditional methods such as the application of various herbs. The prophets, or pastors, and staff at these camps have virtually no mental health care training.
In Ghana and other countries around the world, it is widely believed that mental disabilities stem from being cursed or possessed by demons, not from a psychiatric condition. With such a view comes the notion that people with mental disabilities such as schizophrenia or depression are sub-human, worthless and violent. The World Health Organization (WHO) estimates that one in four people in the world will be affected by mental health or neurological conditions at some point in their lives.
According to WHO, an estimated 2.8 million persons in Ghana have mental disabilities. Of these, 650,000 are thought to have severe mental disabilities. The UN Agency responsible for international public health further estimateed that only two percent of the 2.8 million Ghanaians suffering from mental disorders are receiving care at medical facilities. That leaves hundreds of thousands of people without access to sanctioned treatments – a great many of whom seek help at spiritual camps operating without government oversight.
It is intersting to note that Ghana’s 2012 Mental Health Act creates a system through which people with disabilities can challenge their detention in psychiatric hospitals. However, the law does not apply to prayer camps, leaving people with mental disabilities without legal remedies to seek release. In most prayer camps, people with real or perceived mental disabilities may only leave when the prophet deems them healed.
Between January and February 2020, this reporter visited eight prayer camps in the Greater Accra, Central, Eastern and Northern Regions of Ghana, interviewing more than 30 people and the results were astonishing. At Mount Horeb Prayer Camp in the Eastern Region of Ghana, Ms. Jenifer Aisha, a woman in her mid-50s, was only allowed to bathe twice a week and had to defecate in a bucket in a room full of other women. She said she would have preferred treatment in a psychiatric hospital, but camp administrators refused to let her leave.
During the investigations, extremely disturbing practices were observed in the prayer camps visited. The reporter observed shackling and forced fasting for people with psychosocial disabilities or in some cases neurological problems, including children. Men, women and children in Edumfa Prayer Camp in the Central Region of Ghana, for instance, were shackled to the walls or floors of their cells. The building holding adult males contained 16 concrete cells laid out like cattle stalls. There was a separate building for women and juveniles, with 10 people chained to the floor, including a 14-year-old girl and a 7-year-old boy, who exhibited symptoms not of a psychosocial disability, but of a neurological disease that required specialized treatment and medication.
“Chaining someone to a tree is not the kind of refuge anyone would seek,” a United Nations Expert on torture, Mr. Ofori Atiemo, has stated.
Steps taken by government
In recent years, the Ghanaian Government has taken some steps to improve the care of people with mental disabilities, including reducing overcrowding in state psychiatric hospitals and passing the Mental Health Act in June 2012. The Mental Health Act, for the first time, laid out a clear procedure for persons with mental disabilities to challenge continued detention.
However, even with the passage of the Mental Health Act, there is no system in place in Ghana to effectively and routinely monitor prayer camps, meaning that the hundreds of individuals housed in them may still be subject to the grave human rights abuses documented in this report. Checks from the Finance Ministry reveals that less than one percent of the national budget was dedicated to mental health care in the country.
Variety of Human Reights Abuses
During the investigation, it was observed that people with mental disabilities in Ghana endured a variety of human rights abuses in prayer camps. These include, but are not limited to: involuntary admission and arbitrary detention, prolonged detention, poor hygiene, chaining, lack of shelter, denial of food, denial of adequate health care, involuntary treatment, stigma and its consequences, and violations against children with mental disabilities.
Involuntary Admission and Arbitrary Detention
Most people with mental disabilities interviewed by this reporter said they were placed at the prayer camps without their consent because they had exhibited restless, confused, or aggressive behaviour. Some had not known where they were being taken until they got to a camp.
Prolonged Detention
Interviewees lamented that that they wanted to leave the camps, but that some administrators would not permit them because family members did not approve their discharge. In some prayer camps, they were unable to leave because, they were told, the prophet was still awaiting a message from God. Some remained even after discharge because their families had abandoned them, and they could not return to their home communities.
Poor Hygiene
Poor hygiene is a serious problem at the prayer camps. Facilities stank of urine and faeces, and there was inadequate water for drinking or bathing. Toilets facilities were broken, overflowed, or nonexistent. The nation could only boast of only 12 practicing psychiatrists and 600 psychiatric nurses and this has created terrible living conditions for persons with mental disabilities. In two prayer camps, urine, flies, and cockroaches competed for space in the toilets and there was inadequate cleaning equipment. Some patients were forced to clean toilets, including removing other patients’ faeces without gloves. At Mount Horeb Prayer Camp in the Eastern Region of Ghana and Edumfa Prayer Camp in the Central Region, individuals urinated and defecated in buckets in rooms that residents said were emptied only once a day.
Chaining
In four prayer camps visited, patients were seen either locked in chains inside fully built and semi-permanent structures, or chained to a tree or concrete floor until the pastor or prophet declared them “healed.” Movement was impossible beyond the length of the constraint—usually about two meters. People had to bathe, defecate, urinate, change sanitary towels, eat, and sleep on the spot where they were chained.
“In Ghana’s prayer camps, people with mental health problems are chained, beaten, starved, and prevented from leaving,” human rights campaigners, Ms. Jocelyn Edwards has disclosed.
Mr. Baba Agunga, a mentally ill man in his twenties, is held by chains to a tree at a prayer camp at Zorko in the northen part of Ghana. Baba sits naked on a cloth, with his thin legs hunging. He has been there for three years says his mother, Aniah Agunga. Through winter and summer, rainy seasons and drought, Baba has been tied outside the main camp within sight of the family hut. His father, who put on the chains has since died. All the while, Baba Agunga hasn’t moved beyond the earthen circle allowed by his four feet of chain.
His mother tries to explain why: “He was a good boy. He travelled down south and was fine, he was making bracelets and selling them. He came home with friends who smoked marijuana. I don’t know if it was this weed that caused his sickness,” she wept uncontrollably.
She continues: “Baba tried to attack me with a cutlass. My husband ordered chains from the chain maker and this is how he has been for three years at the prayer camp. The rain disturbs him and he is calmer in the dry season. I feed him when I can but there are days when there is no food.”
Another patient, Doris Appiah, 57 years from Greater Accra, has bipolar disorder. In her early twenties, she was sent to an overcrowded psychiatric hospital followed by a “prayer camp” to be treated. She stayed in the prayer camp for five years and tied to a wall or forced to fast.
Lack of Shelter
Shelter was a major concern in all the eight prayer camps visited. Over one-third of patients slept outside. Others sat in the sun all day or crowded in corners where shade provided temporary relief from the blistering heat from the sun, and with constant exposure to mosquitoes.
Denial of Food
Many interviewees spoke of persistent gnawing hunger from forced fasting in prayer camps or inadequate food. Many looked hungry. Administrators and pastors of seven of the eight prayer camps visited said fasting was a key component of curing mental disability and would help to starve evil spirits, “making it easier for the spirit of God to enter and do the healing.” People interviewed said there was too little food, sometimes only one meal a day. Some patients in Mount Horeb, Edumfa, and Nyakumasi Prayer Camps had to fast for 36 hours over three consecutive days in 12-hour stints from morning until dusk. Others, mainly the elderly, fasted from 6:00am until noon. Such fasting regimes ranged from seven to 40 days, and meant that people could not take prescribed medication in camps that allowed the use of such medication.
Denial of Adequate Health Care
Access to health care, including drugs was a major challenge for persons with mental disabilities. Some patients were responsible for buying their own drugs, especially to treat illnesses such as malaria, although some had no relatives to send to buy the drugs or money to do so. In some prayer camps, such as Nyakumasi, the prophet and the camp staff did not allow persons with mental disabilities to use medicine even when you get malaria.
Mr. John Elijah, a 25-year-old man who had been chained to a tree at Nyakumasi prayer camp for five months prior to the visit, said, “they give us palm oil instaed of medicine because angels here don’t allow taking medication.” Only one out of the eight camps visited allowed any medical care for mental health disabilities.
Involuntary Treatment
During the investigations, it was found out that persons with mental disabilities living in prayer camps were subjected to involuntary treatment through the use of force, coercion, and sedation. Some individuals said they were forced to take treatment against their will. In some prayer camps, patients were forced to take local herbs against their will, sometimes through their noses.
“The drugs cause my legs to swell, eye pains, and insomnia,” a 55-year old Florence Nsarful has disclosed.
A nurse who works at Tetteh Quarshie Regional Hospital in the Eatern Region of Ghana, who pleaded anomity said, “Mental health is not just about taking medication. Trying to force medication is not right. There is more to it.”
Stigma and Its Consequences
Persons with mental disabilities endure stigma and discrimination in the community. Some of the religious leaders interviewed described persons with mental disabilities as incapable, hostile, demonic, evil, controlled by spirits, useless, and anti-social. Such stigma in turn causes family members to abandon persons with mental disabilities in prayer camps, neither visiting them nor picking them up after discharge. Some give a false address so they cannot be traced.
Violations against Children with Mental Disabilities
Children with mental disabilities experienced similar conditions to adults in prayer camps. This reporter saw filthy living conditions. In some cases, children and adults were lying down naked next to their faeces. The situation was even worse in three of the eight prayer camps visited where children were subjected to restraints and other abuses. Solomon Boakye, nine years, who lived in Edumfa Prayer Camp and was often chained in the same room with about 20 other males said, “I have been fasting for 21 days. I feel pains in my stomach, my head, and my whole body.”
Wayforward
The UN Expert on torture, Mr Ofori said, it is about time inter-religious councils, faith-based organizations and the Ministry of Culture and Chieftaincy begin to play an important role in addressing these abuses in prayer camps.
“They should create guidelines to monitor operations of prayer camps and sensitize traditional healers and religious leaders on the manifestations of mental disability, and the rights of people with mental disabilities,” he admonished.
The Government of Ghana, along with community leaders, he added, should lead the charge to ensure that no one with a mental disability is mistreated in any one of these prayer camps.
“It is not about religion. It is about humanity,” The UN Expert on torture has stated.
Chief Psychiatrist and the Chief Executive Officer of the Mental Health Authority in Ghana, Dr Akwasi Osei, has condemned the practice of chaining mental health patients in traditional and faith-based camps for treatment. He said his outfit met with groups representing people with disabilities, other nongovernmental groups, mental health professionals, human rights experts, religious leaders, and traditional healers to discuss proposed guidelines in mental health care for traditional and faith-based healers.
“These efforts will include adopting guidelines and setting up regular monitoring visits to Ghana’s prayer camps,” Dr Osei added.
Contributing, Ghana’s Deputy Health Minister, Ms. Tina Mensah, stressed that, “the chaining of people with mental health conditions needs to stop – it needs to stop.”
Some experts have also suggested that intersectoral partnerships between prayer camps and biomedical care providers may be an effective strategy to address the overwhelming shortage of mental health care workers in Africa and other low-income settings.
