Nigeria: people with mental health conditions chained, abused

Thousands of people with mental health conditions across Nigeria are chained and locked up in various facilities where they face terrible abuse, Human Rights Watch said today.

Detention, chaining, and violent treatment are pervasive in many settings, including state hospitals, rehabilitation centers, traditional healing centers, and both Christian and Islamic faith-based facilities.

“People with mental health conditions should be supported and provided with effective services in their communities, not chained and abused,” said Emina Ćerimović, senior disability rights researcher at Human Rights Watch. “People with mental health conditions find themselves in chains in various places in Nigeria, subject to years of unimaginable hardship and abuse.”

President Muhammadu Buhari said in October 2019 of the Islamic rehabilitation centers that he would not “tolerate the existence of the torture chambers and physical abuses of inmates in the name of rehabilitation.” But the government has yet to acknowledge that this abuse is rife in government-run facilities too.

Between August 2018 and September 2019, Human Rights Watch visited 28 facilities ostensibly providing mental health care in 8 states and the Federal Capital Territory, including federal psychiatric hospitals, general state hospitals, state-owned rehabilitation centers, Islamic rehabilitation centers, traditional healing centers, and Christian churches. Human Rights Watch interviewed 124 people, including 49 chaining victims and their families, staff in various facilities, mental health professionals, and government officials. The names of the victims have been changed to protect their safety.

Deep-rooted problems in Nigeria’s healthcare and welfare systems leave most Nigerians unable to get adequate mental health care or support in their communities. Stigma and misunderstanding about mental health conditions, including the misperception that they are caused by evil spirits or supernatural forces, often prompt relatives to take their loved ones to religious or traditional healing places.

Human Rights Watch found that people with actual or perceived mental health conditions, including children, are placed in facilities without their consent, usually by relatives. In some cases, police arrest people with actual or perceived mental health conditions and send them to government-run rehabilitation centers.

Once there, many are shackled with iron chains, around one or both ankles, to heavy objects or to other detainees, in some cases for months or years. They cannot leave, are often confined in overcrowded, unhygienic conditions, and are sometimes forced to sleep, eat, and defecate within the same confined place. Many are physically and emotionally abused as well as forced to take treatments.

A nun in charge during a Human Rights Watch visit to a state-owned rehabilitation center in southeastern Nigeria said they chain people to their beds “so they do not run away.” The nun defended chaining a woman who had HIV “to stop her from going around the men.” Human Rights Watch found another woman at the same institution chained naked to her bed.

The staff, except one older guard, would leave at 6:30 p.m. each day, leaving residents, including children as young as 13, with no one to help them. The facility has no electricity, so people are chained to their beds in total darkness. The nun said that, “The patients are given flashlights to use at night.”

In a traditional healing center close to Abuja, Nigeria’s capital, Human Rights Watch met a woman who was pinned to a tree trunk with an iron ring. She had been restrained like this for three weeks with her upper body naked. She was unable to move and so she was forced to eat, urinate, and defecate where she sat.

Chaining can cause serious injuries and psychological distress. A 35-year-old woman chained for 10 months in an Islamic rehabilitation center in Kano, northern Nigeria, said, “Everything about this (chaining) is difficult. You feel like you want to commit suicide … regardless of how you felt before coming here, you will get worse.”

Adults and children in some Islamic rehabilitation centers reported being whipped, causing deep wounds. People in Christian healing centers and churches described being denied food for up to three days at a time, which staff characterized as “fasting” for “treatment” purposes.

In many of the traditional and religious rehabilitation centers visited, staff forced people with mental health conditions, including children, to eat or drink herbs, in some cases with staff pinning people down to make them swallow.

In psychiatric hospitals and government-run rehabilitation centers, staff forcibly administered medication, while some staff admitted to administering electroconvulsive therapy (ECT) to patients without their consent.

In some cases, families took their children – including young adults – to religious and traditional rehabilitation centers for actual or perceived drug use or “deviant” behavior, including skipping school, smoking tobacco or marijuana, or stealing from their parents. Some children in the facilities – some as young as 10 – have been abandoned by their families.

Nigeria ratified the Convention on the Rights of Persons with Disabilities (CRPD) in 2007. It has the obligation to ensure equal rights for people with disabilities, including the right to liberty and freedom from torture, ill-treatment, and forced treatment. While the Nigerian Constitution prohibits torture and other inhuman or degrading treatment, the government has not outlawed chaining. In a 2015 report, the United Nations special rapporteur on torture said that chaining “unequivocally amount(s) to torture.”

The Nigerian government should ban chaining and urgently investigate chaining in state-owned rehabilitation centers, psychiatric hospitals, and faith-based and traditional healing centers in all 36 states and the Federal Capital Territory. The government should also prioritize the development of quality, accessible, and affordable community-based mental health services.

“President Buhari denounced chaining as torture,” Ćerimović said. *“But it’s not enough to raid these centers and shut them down. People rescued from these desperate conditions and other Nigerians experiencing psychological distress should have access to proper psychosocial support and mental health services.” *

Mental Health in Nigeria

A mental health condition refers to a range of experiences that affect a person’s mood, thinking, and behavior. This includes depression, anxiety, schizophrenia, and bipolar condition. It can affect anyone, regardless of age, gender, race, ethnicity, religion, spirituality, sexual orientation, or any other background. The World Health Organization (WHO) says a mental health condition will affect one in four people globally at some point in their lives.

Nigeria has fewer than 300 psychiatrists for an estimated population of over 200 million. Several mental health professionals told Human Rights Watch that quality mental health services are available only to wealthier citizens who can afford it. The lack of quality mental health care and its prohibitive cost often drives people to consult traditional or faith-based healers.

Nigeria’s 1958 Lunacy Act allows the detaining of people with mental health conditions in mental health institutions, even without providing medical or therapeutic treatment. People spend years in institutions – sometimes decades – because Nigeria lacks adequate services to support them in the community. In all but one of the facilities Human Rights Watch visited, people were not allowed to leave or to challenge their detention.

Unlawful Detention

In 27 of 28 facilities Human Rights Watch visited, all residents had been unlawfully detained. They did not enter the facilities voluntarily and could not leave if they wished to do so.

Victor, a 29-year-old Christian man held in an Islamic rehabilitation center in Kano since June 2018, said:

“I heard that I would be here only for two weeks at first when I was brought here, then later that changed to one month, then two months. Now I am going on my third month here. Other people here say they were told the same thing, and they ended up staying here for years.”

Akanni, a 22-year-old woman who had a mental health crisis following the death of her mother and who had been detained in a church in Abeokuta for five months at the time of a March 2019 interview, said: “When my father brought me, I didn’t know that he would leave me here. I was not happy, but I don’t have a choice.”

Sometimes families pay healers to detain their relative at home and take them to a center. Shums, a 27-year-old man who said he had depression, was taken as he worked on his farm in early 2019:

“Two men approached me and asked if they could talk with me. I complied and started walking with them. They jumped on me, handcuffed me, and put shackles on my feet. Then they brought me here an Islamic rehabilitation center in Kano.”

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