Mental Health in the Developing World: In Chains
By: Joseph Leonard O Neill
Tags: Human Rights, Pandemic, Discrimination, Kenya, Mental Health

Photo published in The Economist

On November 21, 2020, The Economist published a disturbing article about the way people with mental health issues are treated in Kenya.

Father John Pesa at the Holy Ghost Coptic Church of Africa in Kisuma, Kenya, keeps at least 60 “patients” shackled in chains, according to Human Rights Watch.

This even happens with the consent of families. One 17-year old boy was sent to the priest by his own father after he began hallucinating and behaving oddly. He was locked in chains and soon became thin, as the church was not paid enough to feed him.

Such treatment is not limited to Kenya. According to The Economist, Human Rights Watch found “evidence of shackling in 60 countries, from Brazil to Indonesia.”

The Economist reports that in Kenya, traditional or spiritual healers, such as priests who say they can dispel the demons causing mental health problems, are called in before qualified medical professionals. “It is hard to shake off such deep-rooted beliefs,” the paper laments.

The tone of the report implies that such treatment of the mentally ill is limited to developing countries.

“In Africa, on average, there is less than one mental-health worker per 100,000 people, compared with 50 in Europe. Kenya has 0.19 psychiatrists per 100,000 people and one psychiatric hospital.”

But is the “developed world” really doing that much better when it comes to mental health? Many of the causes the article cites for the mistreatment of the mentally ill in Kenya could be equally applied more or less the world over, even in Europe, with its apparently generous supply of mental health workers:

“good care is expensive and patients are expected to recover in their community. Often people are ignorant of mental health issues, or fearful that the afflicted person may harm others.”

In the United States, the advent of anti-psychotic medications led to most psychiatric hospitals being closed and people with mental health issues being expected to recover in the community, while remaining “compliant” with medication.

People affected by mental health are more likely to be the victims of violence than the perpetrators of it, yet global stereotypes, fueled by sensationalized and skewed media reports, fuel a widespread misconception that people with mental health issues are more likely to be violent.

“…hundreds of thousands of people who suffer from mental illness have at some point been chained or locked up. In countries where such illnesses are poorly understood, many sufferers never see doctors.”

In the United States, 15 to 20 percent of inmates in prisons and jails have a serious mental illness. In the United Kingdom, “mental health detention,” or forcibly sectioning people, is standard and accepted practice. Chains may not be used in British mental health facilities, but seclusion is.

Readers of The Economist’s report may be tempted to believe mistreatment of the mentally ill only happens in the developing world, and that things will get better once developing countries advance economically. That is a dangerous fallacy.

Where “developing” countries have shackles and chains, “developed” countries have jails or psychiatric hospitals that are even more dangerous than prisons. Mistreatment of the mentally ill is not a malady that can be medicated with rising GDP. It is a pandemic of prejudice, fear, and discrimination. A re-evaluation of the way we treat mental illness, and the way we treat each other, must be part of the cure.