For a region plagued by deadly threats such as malaria and H.I.V., mental health and disability have historically “lingered near the bottom” of African priorities.

In Ghana, the consequences of this neglect are staggering. Out of 26 million people who live in Ghana, there are 2.8 million suffering from mental disability but there are only three public psychiatric hospitals. Poor and rural living Ghanaians have one alternative: prayer camps scattered throughout the country where they are involuntarily chained in place, forced to fast, and receive minimal treatment. These “traditional healers’ in Ghana are far more accessible than trained psychiatrists, and around eighty percent of the population utilizes them as the only source of treatment. According to Human Rights Watch (HRW), one prophet admitted to the illegality of chaining, but cited a lack of alternatives: “[I]f a person comes and he is very wild. . .we have to chain them.”

According to a report by the HRW, each of Ghana’s public psychiatric hospitals have capacity ranging from 200-500 patients, yet one of the three hospitals, Accra Psychiatric Hospital, usually keeps 900-1200 patients. Just over three percent of Ghana’s total health expenditure is spent on public psychiatric hospitals,  accounting for the overcrowding and staff shortages that have kept some patients sleeping outside. Researchers from HRW visited Ghana’s public hospitals, interviewing both patients and caregivers. They noted that nurses force patients to clean their own wards, “including removing other patients’ feces, without gloves.” Patients are involuntarily medicated, threatened or beaten when protesting. In one instance a nurse told a patient, “If you shout again, I will put the needle in your mouth.”

Most Ghanaians with mental health concerns turn to the hundreds of prayer camps because of these shortages. Family members, sometimes utilizing police arrest, often abandon their relatives. According to HRW, one man described how his mother “told the police to arrest me while I was sleeping. I was handcuffed at 5 a.m.” Many patients are handcuffed upon arrival, a practice deemed a form of torture by the UN Special Rapporteur on Torture, Juan Méndez, who visited Ghana’s psychiatric hospitals in 2013 at the invitation of the government. Méndez criticized the use of electroshock therapy, which is administered without proper anesthesia, and recommended that the Mental Health Act be amended to more directly apply the standards set forth in the Convention on the Rights of Persons with Disabilities (CRPD). Additionally, patients can spend months or years chained in place to trees, forced to bathe, defecate, and sleep in one small space. Patients are often required to fast for days at a time, which a pastor described as a way to “starve” evil spirits, “making it easier for the spirit of God to enter and do the healing.” Stigma remains a major hindrance to progress in implementing sustainable mental health care — religious leaders at prayer camps often label patients “demonic” and nurses who work with patients in hospitals are called “mentally ill” themselves.

Ghana’s treatment of mental disability is in violation of numerous domestic and international laws and agreements. Ghana’s constitution forbids treatment that “detracts [from a person’s] dignity and worth as a human being.” Before Ghana passed its Mental Health Act in 2012, the Mental Health Decree of 1972 was Ghana’s guiding mental health framework, with a complete focus on institutional care. While Ghana’s Mental Health Act requires hospitals to be monitored, the law does not cover prayer camps. Additionally, the legislature has not passed an implementation instrument, leaving the Act with zero impact.

Internationally, Ghana’s practices are in violation of the CRPD (passed in 2012), and the Convention Against Torture (CAT, passed in 2000). The CRPD requires Ghana to train professionals working with disabilities, which Ghana is fundamentally failing to do. It is vital that Ghana’s government takes steps to regulate mental health care, especially at prayer camps where most Ghanaians turn to first for treatment, and where the most severe human rights abuses are occurring. While the CAT requires states to educate law enforcement and medical personnel about torture, it is often Ghana’s law enforcement who abandon the mentally disabled at hospitals or prayer camps, and it is Ghana’s medical staff who are committing human rights abuses by engaging in electroshock treatment and coerced medication. Civil society within Ghana has taken impactful steps to fill the gaps left by government inaction. One organization, Basic Needs, has supported over 140,000 Ghanaians by targeting stigma, aiming to make mental health a “topical public discourse issue,” always with the goal of reintegrating Ghanaians with their families. Until the government prioritizes mental health, commits to fulfilling its international obligations, and implements its own laws, Ghanaians with mental disabilities will continue being treated as “less than human.”