Written by: Malcolm Akatinga Ali, Mental Health Nurse and Mental Health Advocate
The belief of mental illness having a spiritual cause dates back to medieval times, and has since been a challenge to scientific knowledge and biomedical care providers in modern times.
In the historical development of the care and treatment of the mental illness, during the periods of Demonology and the Dark Ages, the causes of mental illness were believed to be caused by spirits and demons. Various forms of inhuman treatments were meted out to the mentally ill such as flogging, starving, purging with emetics as treatments and in some cases as punishment when the patients were believed to be demon possessed.
Today despite the enlightenment in scientific knowledge and medicine, some of these ancient practices and beliefs are still being carried out on people with mental illness especially in Ghana where people give spiritual meaning to almost everything that happens in their lives than it having a natural cause. For instance, exorcisms, a practice where demons and spirits are driven out of a person believed to be possessed are still practice in this modern era but have been metamorphosed to what is now known as spiritual deliverance.
Over spiritualisation of life circumstances, including our health is undoubtedly a deeply ingrained phenomenon that has permeated and influences almost every aspect of our life, from eating food, choosing relationships, joining associations, finding a partner for life to seeking health care. One’s religious doctrine and belief greatly influence his need for health care. Even at a point of life and death in the hospital, some people still turn down blood transfusion in the name of their religious doctrines.
A professor once said “Africans are notoriously religious.” Indeed Ghanaians are notoriously religious and spiritual. Everything that happens in their lives is given a spiritual meaning other than it having a natural cause. Some people are quick to confide their health problems to their pastors and spiritual leaders more than they do to their doctors.
The understanding of mental illness and mental health in our part of the world is a worrisome situation that needs much attention just as mental illness itself. When even the educated ones who are supposed to know better troop to the prayer camps to seek answers to their psychological and mental health problems, then you know there is a challenge for mental healthcare providers in Ghana.
Apparently, education on mental illness in Ghana is low as many people still associate mental illness with witchcraft and superstition. Many are ignorant about mental illness and mental health and hence are not able to differentiate between behaviour of mental patients from sheer criminal behaviour. This has led to many mental patients being attacked and in some instances lynched for displaying inappropriate behaviour in the public such attempting to steal, unlawful entry to houses and attacking people for no apparent reason. Others have also been thrown to jail for things they did as a result of their mental illnesses.
In May 2015, an old woman by name Madam Barbara Boakye-Yiadom, who was suffering from mental illness and found her way onto the streets of Madina in Accra, was accused as a transgender witch and was nearly lynched by a mob who had surrounded her and taking pictures of her nakedness. She was said to have crushed with an electricity poll and landed when flying in the night. Social media was ladened with the naked pictures of this innocent woman who instead of getting help from the society for her unfortunate illness was rather subjected to global shame. She clearly appeared confused and helpless with obvious signs of mental health problem but that eluded the Ghanaian society who was enjoining her antics. Even journalists, who by virtue of their educational enlightenment, should have known better could not also resist the whims but carried the story as a hot cake.
It later emerged that the woman has been staying in Canada for most of her life and had returned from Canada to seek treatment for her mental condition in Ghana.
Faith leaders are the first point of contact to most people and their families when they are experiencing mental health problems in Ghana. They do so because they belief mental illness is a spiritual problem so they will rather beseech their spiritual leaders first for help than seeking biomedical care. The activities and the role these prayer camps and other spiritual homes play therefore cannot be ruled out from the equation of mental health care in Ghana.
There are rampant human right abuses of persons with mental illness at most prayer camps in Ghana. Mental patients at some prayer camps are housed in poor and unsafe environment. The care givers at the prayer camps lack the requisite knowledge to professionally handle the patients. Their patients are subjected to beating and canning, mishandling, chaining them in the sun and rains and to the mercy of mosquito bites and harsh weather conditions at night. In some cases where the patients are believed to be possessed by demons as in the era of demonological and Dark Ages, severe beatings are meted out on them to drive out the demon from the person. These practices at the prayer camps in the long run worsens the plights of these innocent patients and do not help patients to recover early. Faith healers in some prayer camps, after struggling with their patients for months or even years to no avail then direct them to go to the psychiatric hospital, claiming they have done with the spiritual realm of the condition, leaving the physical aspect.
This poses a great challenge for mental healthcare providers as many end up with complicated physical conditions at the prayer camps thereby making their medical prognosis poor.
In contrast, in a mental healthcare setting, be it a psychiatric hospital or psychiatric unit at the general hospital, mental healthcare providers together with other biomedical care givers provide a serene and a humane environment for their patients and this helps in their early recovery process. The professional training acquired by the biomedical care providers at the psychiatric hospitals helps them to understand the behavior of their patients as part of their conditions and relate well with them. The rights of patients are respected. The psychiatric hospital is therefore a family home for both healthcare providers and patients and their relatives.
Faith healers and their activities at the prayer camps preach spiritual cause of mental illness, they do not believe in physical cause. This, they are able to assuage the average Ghanaian who already has a predilection to spiritual meaning of life circumstances to patronize their outfit than attending psychiatric hospital when faced with mental health problem. This has given rise to the proliferation of prayer camps and other spiritual homes across the length and breadth of the country.
Biomedical care providers are constantly faced with the challenge of having to discharge patients against medical advice since most of the patients and relatives belief their problem is spiritual and always demand taking patients to prayer camps. They support their action with a quotation in the bible, Ephesians 6:12. “For we wrestle not against flesh and blood, but against religious principalities, against powers, against the rulers of the darkness of this world, against spiritual wickedness in high places.”
Biomedical care providers are not are happy with the situation where demand to discharge their patients against medical advice because it interrupts medical treatment of patients and challenges mental health care providers and other stakeholders to intensify the education on mental illness to demystify the myths surrounding mental illness. However the limited resources in the sector are a major hindrance to accomplishing this mission.
Prayer camps and other spiritual homes do not believe in long term taking of psychiatric medication and have therefore been preaching against that. Whiles mental healthcare providers recognise the importance of patients’ faith in the treatment process and thus respect patients’ belief; some faith healers on other hand are completely against long term taking and adherence to psychiatric medication. They argue that taking medication for spiritual problems is tantamount to lack of faith and would rather depend on God for healing through prayers. Psychiatric Patients who insist on going to prayer camps and other spiritual homes to continue treatment are advised by mental healthcare providers to continue taking their medications alongside the spiritual prayers but most patients end up abandoning their drugs because their pastors preach against it as lack of faith. This has seen patients relapsed on many occasions and are brought back to the hospital for treatment, a worrying trend of vicious cycle in the metal health care in Ghana and in most African countries.
Fasting and prayers, especially ‘dry fasting’ at some prayer camps is hindering and retrogression mental health care in Ghana. Psychiatric patients who find their way to prayer camps to exercise their religious faith and in a desperate quest to get healed stop taking their medication whiles they go into fasting. After stopping the medication for sometimes they relapsed and are either being chained at the prayer camps or send back to the psychiatric hospital. Mental healthcare providers often advise their patients never to stop taking their drugs in the name of fasting or any other reason. They are further advised to confide in their caregivers at the hospital any concerns they have regarding their treatments and fasting. But in a country where over 90% of the population identify themselves as religious, many tend to heed to the word of their pastors or spiritual leaders than what biomedical care providers would tell them. It is therefore not surprising that a patient’ relative would call his or her pastor on phone to complain about a patient’ odd behaviour on a hospital bed instead of reporting to the healthcare providers.
When some prayer camps are unable to control and manage their aggressive patients, they send them to psychiatric hospital to take injections to calm them and return to the camps, and indeed their caregivers go to the psychiatric hospital and insist on going back when they are told by healthcare providers to stay for further management. Mental healthcare providers, through the psychiatric social work department and the community psychiatric nurses are not able to effectively track and monitor patients at home because of the activities of prayer camps and spiritual homes. Most of these faith healers are on the media landscape touting triumphantly of having the best cure for all mental health problems, quoting biblical verses and scenarios to back their claims.
It is important to state, however that some of the prayer camps are collaborating with mental health care providers to give care to their client whiles upholding and maintaining their philosophy of spiritual causes of mental illness. Community psychiatric nurses pay regular visits to these camps to give health education and management of aggressive patients and also give education on the need to continue taking psychiatric drugs whiles at the prayer camps.
However, some other prayer camps resist attempts by mental healthcare providers to give them guidelines on how to attend to their clients, including humane treatments and respecting the fundamental human rights of their patients. The Ankaful Psychiatric Hospital in collaboration with the Mental Health Authority, in June this year rescued some patients from the shackles of welded chains in a prayer camp in Nyankomase called Jesus Divine Prayer Centre in the central region. The patients were anchored to trees with chains for many years with no intention of releasing them in the near future. The chains were released with the help of hacksaws and the patients were sent to Ankaful Psychiatric Hospital for treatment. Most of them have since been treated and discharged home. The exercise was taken after several failed attempts by healthcare providers for the owner of the camp to improve the condition of the camp and care of the patients.
It is apparent that faith healers and their activities at their homes are first respondents to persons and families facing mental health problems in our belief system, their roles and impacts on mental health care, therefore cannot be underestimated. It is important for mental healthcare providers and spiritual leaders or faith healers to synergise their efforts towards ensuring optimal care for persons facing mental health problems. Whiles faith healers belief in the spiritual causes of mental health illness, it is imperative to collaborate with mental health care providers for guidelines and guidance on acceptable standard of mental healthcare.
Faith healers and other religious leaders can play a crucial role in mental health care when giving guidelines and training in mental health on treatment of mental illness. They can help to reduce the stigma associated with mental illness.
In the light this, the mental health Act 846 (Act 2012) has made provisions to regularise the activities of prayer camps and faith healers in Ghana, including the protection of the right of persons with mental illness. The Act in its current stage is however financially crippled to meet this exercise. Stakeholders in the mental healthcare sector, including the Mental Health Authority are pushing for a legislative instrument (LI) for the Act to financially stand the test of time.
The legislative instrument is currently before parliament, appealing to the conscience of the law makers to give it a thumb up. When done, the LI will determine a levy for mental health care in Ghana and this will help mitigate the challenges in the mental health sector including the activities of prayer camps and spiritual homes. Until that is done, the myriad challenges facing the mental health care sector in Ghana, including the impact of prayer camps and spiritual homes will continue to glare.
Malcolm Akatinga Ali, Mental Health Nurse and Mental Health Advocate,
Ankaful Psychiatric Hospital