Chained, flogged and starved: report reveals ‘unimaginable’ treatment of Nigeria’s mentally ill

Thousands of mental health patients in Nigeria are kept in chains and subjected to “unimaginable hardship” as relatives turn to a murky world of faith healers and poorly-regulated rehabilitation centres, a leading human rights agency said yesterday.

Human Rights Watch said in its report documenting mistreatment of mentally-ill patients that it had uncovered chaining at 27 or the 28 centres that it visited, as well as “terrible abuse” including flogging, starvation and sexual assault.

“People with mental health conditions should be supported and provided with effective services in their communities, not chained and abused,” said EminaĆerimović, senior disability rights researcher at Human Rights Watch.

Nigeria, with a population of 200 million, has just 300 psychiatrists, and the sector remains highly stigmatised, and woefully underfunded, particularly at a local level where psychiatric care is sometimes not accessible at all. Where there is formal mental health care in Nigeria, it is in the larger cities, and often unaffordable to all but a wealthy few.

According to the authors of the report, patients as young as 10 were found manacled to heavy objects, or to other detainees, and sometimes forced to eat, sleep and defecate where they lay. Patients were often placed in facilities against their will, and given medication and electroconvulsive therapy without consent. Among the facilities HRW visited were government-run and funded institutions.

“In a case that will remain forever etched in my mind, we came across one woman completely naked and incoherent. It was clear she needed immediate care,” said Anietie Ewang, one of the report's authors. “She was tied to her bed, had a bucket in which to defecate and urinate. She had no personal belongings – it was just a metal bed and a threadbare mattress.”

Staff, when questioned, claimed they were acting in their patients’ best interests. There remains a widely-held belief that mental illness is caused by evil spirits, and that only traditional methods can cure them.

The Nigerian government has in recent months led a crackdown on Islamic rehabilitation centres accused of committing some of the worst abuses, where mentally-ill captives are held alongside those being disciplined for behaviours such as stealing or drug use. Last month, President Muhammadu Buhari said he would not “tolerate the existence of the torture chambers and physical abuses of inmates in the name of rehabilitation.”

But critics accuse the government of lacking commitment to long-term reform of the sector. “Mental health is a very, very low priority,” said Dr Julian Eaton of the London School of Hygiene and Tropical Medicine and Christian development body, CBM International. “We need to have a radical shift of the entire budget [from] being spent on centralised services to broader community care.”

Eaton, who lived for several years in rural Nigeria, said that families with relatives gripped by psychosis turned to healers and religious centres in desperation after all other avenues had failed either through lack of money or the absence of long-term follow-up care.

“I don’t think I met a single family happy about the situation but they were really in an impossible place,” he said. “If they didn’t keep them [their relatives] locked up, they would be killed.”

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