• The United Nations adopted a robust set of global development goals in 2015 that included promoting mental health and well-being for the first time. The plan is to also reduce premature deaths from noncommunicable diseases, including metal disorders. In 2006, the World Health Organisation launched The Chain Free Initiative which was a response to an urgent need to provide technical and financial support for hospital reform, improve domestic conditions for people with mental illness, develop community care programmes, raise mental health literacy in the community and among health workers, and ensure basic rights are guaranteed and monitored. 

    These are no small objectives. Mental illness is largely stigmatised in African countries and one needs to go no further than Kenyan comedian, Ted Malanda’s article: How depression has never been an African disease. It was a response to Robin Williams’ suicide because he had been suffering from depression. His article read, “As a Kenyan who watches NGOs tinkering with jiggered feet, I can’t wrap my mind around the fact that depression is an illness. We are stressed and depressed at the same time! In fact, it is such a non-issue that African languages never bothered to create a word for it.”

    The hope is it was a tongue in cheek article, but it did not help matters in a society where a fourth of the population suffers from a range of mental diseases, including schizophrenia and other psychotic disorders. Kenya has not made mental health a priority, like many other African countries because mental illness “is not an African illness”. Malanda’s article, might have just been a comic expression of his country’s policy or lack thereof but the jokes fall flat when the realities of mental illness confront us. Various psychotic conditions and manifestations of mental illness are being dismissed and underestimated while they silently ravage populations. The responses to these issues have been a fuel to the proliferation of the problem.

    Chained in Western Africa

    In 2015, The New York Times published an expose of religious retreats in West Africa where people suffering from mental illness were chained. Most of the population in this area views mental illness as nothing but demonic possession and with no formal options in their countries, many resort to religious retreats. Treatment not chains says, “In these centers, patients are chained to a tree and deprived of food and water for days to get the devil to leave their body. Some men and women remain chained for many years and often until death.”

    It is not entirely the fault of the relatives as they are left in a corner. States are simply not funding this “non-issue” and most are devoting less than 1 percent of health spending to mental health.

    Robin Hammond, a New Zealand born photojournalist published a book titled Condemned which carries photographs he took of the mentally ill in Eastern Congo, Mogadishu, Northern Uganda and Liberia. Time says, “Broken, largely forgotten, the mentally ill suffer abominable degradations, literally chained and caged throughout their days.”

    Hammond himself said, “I discovered an entire section of communities abandoned by their governments, forgotten by the aid community, neglected and abused by entire societies. This is not just a document of what shouldn’t be. This work is my protest.”

    While conditions like depression are dismissed as “White men diseases”, acute, psychotic conditions are dismissed as witchcraft and evil spirits. There is always an argument to avoid facing the reality of the day that people are unwell and need help. Governments rest in the shade of the ignorance of populations who do not view mental health as a priority yet more and more of their friends and relatives are being ravaged by this silent killer. 

    A BioMed Central paper on mental illness in rural Ghana largely summarise the position in all African states that, “Psychiatric services were difficult to access, particularly in rural communities, and also seen to have limitations in their effectiveness. Traditional and faith healers remained highly popular despite the routine maltreatment of the mentally ill in their facilities.”

    Mental illness is silent. It is silent largely because it is being hushed by communities which feel there are more pressing issues to be addressed. However, is it not possible to prioritise it along with other problems that need to be dealt with? The chains need to be broken.