![]() Such establishments are not inspected by any independent body, despite Nigeria’s commitments under Article 16(3) of the UN Convention on the Rights of Persons with Disabilities, which sets out that the state needs to ensure that an independent monitoring body inspects all facilities and services designed for people with disabilities. From what I know from workshop participants, these hospitals ain’t pleasant places. According to a 2006 World Health Organization report 91% of mental health expenditure is directed to hospitals. Primary healthcare services do not deliver mental health care, despite a policy from 1991 which sets out that they should. A psychiatrist at the main hospital in Lagos told workshop participants that the country has around 160 psychiatrists, roughly one psychiatrist for a million potential patients ( WHO data from 2011 doesn’t give the actual number but says there are 0.06 psychiatrists for every 100,000 people, and data from 2005 puts it at 0.09). Services for people with psycho-social disabilities in Nigeria are few and far between. For more on this epidemic of child abuse, watch this video and read this article. If the child’s parents are convinced that their child is demonised the child is abandoned by their family and at risk of being beaten, starved and killed by the community. I heard in Lagos stories of five year old children with disability who was believed to be a witch, a popular belief pedalled (and cured – for money!) by the church for many children, not just those with disabilities or behavioural problems. Beatings are expensive: families spend significant amounts of money on the services of traditional healers. The fact that this practice involves inflicting physical and mental violence on another human being is seen, at best, as a minor inconvenience.Ī 2008 article in the African Journal of Psychiatry gives some examples of how traditional healers treat people in Nigeria, claiming that in one church 40% of the ‘treatment’ for mental illness constitutes beating. Spiritual healers therefore beat the affected person to drive out the evil spirit, or shackle the person and deprive them of food or water. ![]() People who have mad thoughts or exhibit mad behaviour are thought to be possessed by evil spirits, and thus the cure is to ensure that the spirits leave the possessed person’s body. Workshop participants were unanimous in their view that even educated people in Nigeria believe that madness is caused by the devil (I use the term ‘mad’ rather than using illness or disability terms to avoid either the suggestion that madness is viewed by the average Nigerian as a medical defect or a social phenomenon). In this piece I want to share my thoughts on the duel challenges of traditional beliefs to madness and a defective mental health system. Participants of the workshop gave numerous examples of how people with disabilities are discriminated against in various settings, including by their own families at home, in healthcare facilities, on the streets, in police lock-ups and in prisons. The workshop was part of an EU-funded project coordinated by the London-based Equal Rights Trust in conjunction with the Legal Defence and Assistance Project, a Nigerian NGO. On day three I participated in a roundtable with disability activists, representatives from the prison service, the attorney general’s office, the ministry of justice and others. With Krassimir Kanev, esteemed colleague from the Bulgarian Helsinki Committee, I was co-delivered a two-day workshop to NGOs and lawyers on how to combat torture and ill-treatment against people with disabilities. This is the context in which I spent three days in humid and car-jammed Lagos, the second city of Nigeria. Nearly two thirds of the population live on under $1.25 per day, according to the 2011 UN Human Development Index. Its 162 million people live in a land-mass nearly four times the size of the UK. Ill-treatment is carried out with impunity because perpetrators are never punished. Both the psychiatric and the traditional healing industries are unregulated, unmonitored and susceptible to corruption. Mental health services are largely absent from primary healthcare, save in some EU-funded pilot projects. The tiny amount of psychiatrists are hospital-based and overstretched. The colonial lunacy law provides precisely zero protections against arbitrary internment, chemical and physical restraints, and non-consensual electroshock in psychiatric hospitals. Within this delusional belief system, beatings, lashings, burnings and rapes drive out the evil spirits. They profit from the populist belief that madness is caused by demonic possession. As a result people labelled as mad are hyper-stigmatised and families urgently want to rid the devil from their afflicted relative. Traditional and spiritual healers deliver the bulk of mental health ‘services’ in Nigeria, Africa’s most populous country.
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