Sick and Chained: Plight of Countless Africans With Mental Health Conditions

For nearly a year, Benjamin Billal was chained to a rock.“I was taken to a faith healing center by my grandmother and my mother,” Billal told journalists by video link from Monrovia, Liberia on Tuesday. “There, I was shackled. I was chained to a rock, where I stayed for about 11 months. There, there was no food. They gave us food at will — when they feel like giving you food, they gave you food. And there, we had no freedom moving around. You want to move around, you move around with chains.”What did he do to get this treatment? According to doctors at Liberia’s only mental health facility — where he was finally taken after 11 months of being shackled — he was suffering from depression.Shackling, restraining and detaining patients with mental health conditions is a sadly common practice in Africa, with some children as young as 10 being chained and locked in small spaces by their families, a new report by Human Rights Watch has found.The World Health Organization estimates that as many as 1 in 5 Liberians suffer a mild to moderate mental disorder. But in 2016, according to WHO data, the West African country had only one registered psychiatrist. Additionally, poverty and lack of awareness usually put mental health low on the list of priorities for many struggling families.Shackling is a global problem, said Kriti Sharma, a Human Rights Watch researcher on disability rights. She authored this year’s report on the degrading practice and shared some of her experiences.“What we found is, frankly, horrific,” she said. “People can spend years tied to tree, locked in a cage or sheep shed, or in overcrowded and unsanitary institutions. And why? Because families are struggling to cope, because governments are failing to provide adequate support and services in the community, particularly mental health care.”Shackled people live in extremely unsanitary and degrading conditions, Sharma said.“Many are forced to eat, sleep, urinate, defecate in a very small space, sometimes no larger than a one- to two-meter radius,” she said. “Simply put, dignity is being denied. One man in Kenya told me, ‘I’ve been chained for five years. The chain is so heavy it makes me sad.’ He stays in his room with seven people, seven men. He’s not allowed to wear clothes. He only wears an underwear, and he has to go to the toilet in a bucket. He told me, ‘it’s not how a human being is supposed to be. A human being should be free.’”Michael Njenga, Kenya-based chairman of the Pan African Network for Persons with Psychosocial Disabilities, says he has two recommendations for governments.“We need absolute prohibition, in terms of shackling,” he said.He said governemnts also need to address systematic shortcomings when it comes to dealing with mental health.  “I think for me, most important… is looking at the intersection between availability of mental health services within the community.  It is important to ensure that we develop a wide range of community-based mental health services that respond to the needs of persons with psychosocial disabilities.”And, Sharma, the report’s author, said the global pandemic has made the problem even more dire.“People go in and out of chains depending on the support that’s available in these communities,” she said. “We are closely documenting a case who was shackled for eight years in a shed. He was freed, he went back to the community because he had access to support. He had a job. He did the local call to prayer at his mosque. And then, four years later, when COVID-19 hit, he was shackled once again by his family because there was a disruption in government services.”Billal’s story, however, has a better ending. After his older brother fished him out of the faith healing center and took him to a mental health facility in Monrovia, he was able to complete his education.He is now a schoolteacher, and a mental health activist, working to make sure what happened to him does not happen to anyone else. 

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