People with mental disabilities suffer severe abuses in psychiatric institutions and spiritual healing centers in Ghana, Human Rights Watch said in a report released today. The Ghanaian government has done little to combat such abuse or to ensure that these people can live in the community, as is their right under international law.

The 84-page report, “‘Like a Death Sentence’: Abuses against Persons with Mental Disabilities in Ghana,” describes how thousands of people with mental disabilities are forced to live in these institutions, often against their will and with little possibility of challenging their confinement. In psychiatric hospitals, people with mental disabilities face overcrowding and unsanitary conditions. In some of the spiritual healing centers, popularly known as prayer camps, they are often chained to trees, frequently in the baking sun, and forced to fast for weeks as part of a “healing process,” while being denied access to medications.

The report also highlights the challenges of people with mental disabilities who live in the community, who face stigma and discrimination and often lack adequate shelter, food, and healthcare.

“The government needs to take immediate steps to end abuses against people with mental disabilities in institutions, prayer camps, and the community,” said Medi Ssengooba, Finberg fellow at Human Rights Watch. “The conditions in which many people with mental disabilities live in Ghana are inhuman and degrading.” The report is based on more than 170 interviews with people with mental disabilities in the country’s three public psychiatric hospitals, and in eight prayer camps and the community; family members; healthcare providers; administrators and staff of prayer camps; government officials; and staff members of both local and international organizations working in Ghana.

The World Health Organization estimates that close to 3 million Ghanaians live with mental disabilities and 600,000 of these have very severe mental conditions.

Ghana’s three public psychiatric hospitals – in Accra, Pantang, and Ankaful – house an estimated 1,000 people with mental disabilities. In all three institutions, Human Rights Watch found filthy conditions, with foul odors in some wards or even feces on the floors due to broken sewage systems. The hospital in Accra was severely overcrowded and many people spent all day outside the hospital building in the hot sun, with little or no shade.

Human Rights Watch found that at least hundreds – and possibly thousands – of people with mental disabilities are institutionalized in prayer camps associated with Pentecostal churches. Managed by self-proclaimed prophets, these camps operate completely outside of government control. People with mental disabilities at these camps do not receive any medical treatment – in some, such treatment is prohibited even when prescribed by a medical doctor. Instead, the prophets seek to “cure” residents through miracles, consultation with “angels,” and spiritual healing.

The report found even worse conditions in prayer camps than in psychiatric institutions. At the eight prayer camps inspected, nearly all residents were chained by their ankles to trees in open compounds, where they slept, urinated, and defecated and bathed. Some had been at the prayer camps for as long as five months. As part of the “healing process,” people with mental disabilities in these camps – including children under age 10 – are routinely forced to fast for weeks, usually starting with 36 hours of so-called dry-fasting, denied even water.

Doris Appiah lived both in prayer camps and psychiatric hospitals for a total of over 10 years, but is now living in the community. While in prayer camps, Appiah was tied with ropes for over two months, and forced to take harmful local herbs, which caused side effects to her tongue.

“As soon as you get a mental disability, you nearly lose all your rights, even to give your opinion,” she told Human Rights Watch. “We call on government to ensure that services are available to persons with mental disabilities as close as possible and that prayer camps are monitored to guard against abuse of those admitted.”

Ghana ratified the Convention on the Rights of Persons with Disabilities in July 2012. Under this convention, countries must undertake steps to ensure that people with mental disabilities can make important life decisions for themselves, including choosing their place of residence and with whom they live, and that they are not forced to live in institutions.

Ghana’s 2012 Mental Health Act, which went into effect in June, creates a system through which people with disabilities can challenge their detention in psychiatric hospitals. However, the law does not apply to prayer camps, leaving residents without legal remedies to seek release. In most prayer camps, residents may only leave when the prophet deems them healed.

The act also allows forced admission and treatment in psychiatric hospitals and promotes guardianship as opposed to supported decision-making, which limits people with mental disabilities from making their own decisions. Both are inconsistent with the Disability Rights Convention.

The government should create community-based support services, including housing and healthcare that enable people with mental disabilities to live in the community, Human Rights Watch said. Facilities where people with mental disabilities are admitted or treated, including prayer camps, should be carefully regulated. The government should also ensure that people are not forcefully detained in these facilities or in psychiatric hospitals and that they have access to mechanisms to challenge any violations of their rights.

“Ghana deserves credit for ratifying the Disability Rights Convention,” Ssengooba said. “Now it’s time for some real changes to both policy and practice for people with mental disabilities in Ghana.”