Unbound: mentally ill people can end up shackled in rural Ghana. Releasing them also involves liberating entire communities from their prejudice

A story of a metally ill teacher in rural Ghana

When Francis, a 48-year-old teacher, had the misfortune of becoming mentally ill, his aggressive behaviour as he increasingly lost touch with reality drew him into conflict with his neighbours. Francis’s brother sought help from traditional healers, who performed numerous rituals to try to appease family ancestors for any wrong-doing the family might have committed. When nothing worked, one of the healers pinned Francis’s foot through a heavy length of tree trunk to restrain him.

For two long years Francis remained thus restrained, in an empty windowless room, naked on a bare concrete floor upon which he ate, slept and relieved himself. People lost sight of the intelligent and articulate man who had taught at the local school and saw only his mental imbalance. As Francis remembers: ‘Even though I did not know or care where I was, I really felt I should not be kept in this room. I protested angrily and shouted to be allowed out but that did not help. Either I would be ignored, or they would guard me even more firmly as they feared I may do something untoward.’

Situations like this remain a reality in rural Ghana for many people like Francis whose families are unable to think how else to deal with erratic behaviour. Often, families will have spent considerable sums of money asking local healers to help, and restraining by force may well be a last resort.unbound

For families living in poor rural communities, life is tough and they need to maximize their own productive time in the field, at market, or working at a trade. Caring for another family member, especially an adult, constitutes considerable responsibility and a heavy burden. But this practical aspect of the problem is far from the worst of it. It is actually much harder to contend with the stigma and fear surrounding mental illness. ‘What is wrong with him?’ ‘Will I catch it?’ ‘I am frightened of him.’ Fellow villagers start to shun the whole family, blaming them for other troubles in the area and urging them to move out. Such social exclusion starts a cyclical relationship with the mental illness, with one exacerbating the other.

Francis’s wife could not bear the terrible situation he was going through and left. She had little say in the treatment he received as that was considered the preserve of Francis’s brothers. The family had heard there was a hospital for people with mental illness in Accra, the capital, but they did not have the money to travel that far and, anyway, felt there were spiritual forces at work. So sticking to traditional treatment was the best solution for them.

The way out

  • Providing┬áchemical drug: Simply providing a chemical drug to treat an illness can only ever address a part of the problem–if, indeed, it helps at all. Drugs only help a percentage of people with mental illnesses.
  • Tackling the issue holistically: It is vital to tackle the issue holistically, to tackle: the illness; the ignorance and negative attitudes; the exclusion; and the poverty. Though it sounds like a large task, it is possible–even in the most resource-poor areas.

When BasicNeeds Ghana, the mental health charity I work for, chanced on Francis, we were shooting photos of the living conditions and experiences of people with mental illness or epilepsy, as part of documenting the lives of people with psychosocial illnesses. After a short meeting with Francis, it was clear he could easily be helped clinically. A Community Psychiatric Nurse was called in, diagnosed Francis with psychosis and administered medication. On the next visit, four weeks after the first treatment, Francis was a changed man. We then persuaded his brother that the medication had stabilized Francis’s condition sufficiently and he should be released from the log. Now it was time to persuade the healer, who had the final say. He agreed, provided some rituals were performed, which Francis’s brother carried out.

Had Francis been set free from the log by a well-meaning community worker instead, the chances are he would have been pinned back into position very soon afterwards. But because we took time to demonstrate his stabilized condition to those who had put him there, the healer was able to share the credit for releasing Francis and so save face. Moreover, by passing on basic information about common symptoms to traditional and faith-based healers, the attitudes of a large number of people in a community can be properly shifted.

The clincher for the wider community is, of course, when they see a person with previously erratic behaviour doing productive work again. When someone transforms from being a burden to being a burden-sharer, it counts for a great deal.

For that reason, contact was made with the education authorities, who were glad to know Francis was still interested in teaching and reinstated him in his job. His wife, Yaa, returned with hopes of rebuilding their family.unbound 2

Conclusion

Francis himself is hopeful. ‘I feel great that my family easily interact with me. I relate with my neighbours and members of the community quite well, even though a few times I have noticed one or two people look at me in a queer manner. [Now that I am working again] I should soon regain my rightful place as one of the educated members of the village, with an opinion on its affairs.’

But what about the others still shackled and chained? There is a vital need for stories like this to be told and passed on to address deeply held stigma and fear. Community plays and radio drama are making an impact, as are newspaper articles produced by self-help groups of people who have been directly affected.

These small local groups have together created a national membership association of users–MEHSOG (Mental Health Society of Ghana)–that’s taking their stories to a much higher level. They were instrumental in campaigning for the Mental Health Bill of Ghana which became an act this March. The new law will ensure the integration of mental health in all health services and policy initiatives, so that it is not just an afterthought. It will encourage civil society organizations that have shied away from mental health to come on board. It provides the legal and moral backing for people dealing with mental illness to pursue their basic rights. I now dare to be hopeful of truly significant social change in the future.

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