Out of the Shadows: Overcoming Mental Illness

Of the half a billion people worldwide currently suffering from mental illness, three quarters live in the developing world.

In the poorest countries, governments spend very little on mental healthcare, leaving their citizens disproportionately affected by this crippling disease. And where access to appropriate healthcare is extremely limited, more often than not the communities surrounding sufferers fail to understand their condition. Sick people are left isolated, or worse: forced to undergo tortuous, humiliating and terrifying treatment at the hands of relatives or community and religious leaders.

In rural West Africa, this treatment takes its most violent form with those suffering from mental disorders often left outdoors in the elements, chained to trees for years on end and regularly whipped to force “evil spirits” to leave their bodies.

In India, economic and social exclusion has led to a spate of suicides by subsistence farmers. Meanwhile, Syrian children suffering from trauma after witnessing the atrocities of war in their homeland receive little or no medical attention, even after reaching the relative safety of refugee camps in Jordan, Lebanon and Turkey.

But as governments turn a blind eye, a vanguard of innovators is leading the fight back to inform communities and provide appropriate care. In 2015, People & Power filmed with some of these mental health activists working in India, rural West Africa and the Zaatari refugee camp for Syrian refugees in Jordan, hoping that governments, donors and aid agencies will eventually get behind their work.

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FILMMAKERS’ VIEW

Maura Forrest and Linda Givetash interview Gregoire Ahongbonon, founder of the mental health organisation Saint Camille de Lellis, which runs eight assistance centres in the Ivory Coast, Benin and Burkina Faso [Gian-Paolo Mendoza/Al Jazeera]

While diseases such as HIV/Aids, Ebola and Malaria grab most of the world’s global health headlines, mental illness is actually the leading cause of disability worldwide. 

Given its prevalence, this issue ought to be at the top of government agendas, particularly in the developing world where citizens are disproportionately likely to be affected. But instead, where little is understood about mental illness and resources are scarce, sick individuals often suffer human rights abuses. Some even attempt to hide their condition, never seeking care for fear of being stigmatised and left excluded and isolated from their communities. 

Farmer suicides in India

The ongoing epidemic of farmer suicides throughout the rural regions of India is a case in point and typifies the challenges of addressing mental health crises in resource-depleted societies. Hundreds of thousands of Indian farmers have killed themselves in the past 20 years.

Economic and social pressures combine with the lack of mental health infrastructure to create a deadly mix: farmers who are deep in debt often view suicide as their only option. Shubham Kitukale, a farmer living in India’s rural Vidarbha region was one of those who tried to kill himself when his failing farm and growing debt became too much to handle. Kitukale took a bottle of pesticide to a nearby bus station and drank it. He woke up in hospital the next day, lucky to be alive.

While the discourse around farmer suicides in India has focused predominantly on economic and social issues, Dr Vikram Patel, considered one of the world’s foremost experts on global mental health, says the strategy to combat those suicides must include healthcare.

In the absence of such provision by the Indian government, Dr Patel and his team have launched a pilot mental health programme in a handful of local villages, relying on community-based mental health interventions to stem the tide of suicides. One of his programs, VISHRAM, works with locals to increase awareness of mental illness and provide a form of psychological first aid to rural communities.

Janrao Haware is one of the locals trained to provide psychological first response for those suffering mental health complications. A couple of weeks after Kitukale attempted suicide, Haware paid him a visit. Through a series of counselling sessions, the pair unpicked Kitukale’s entire story, his struggle with debt, and the feelings that drove him to attempt suicide. Through something as simple as being afforded a regular opportunity to discuss his problems in confidence, Kitukale has been returned to full health. Now back living with his family, the young farmer recently got married and is expecting a baby. He says that when things get tough, he no longer considers suicide as a way out. 

Urban challenges

Providing mental health in India’s cities has its own set of challenges too. The Indian government spends less than 1 percent of the national health budget on mental illness, and there are fewer than 5,000 psychiatrists to care for a population of 1.2 billion.

That means most people in need of care don’t get any help, including people like Munda, who lives in one of the slums of Pune, a city two hours away from Mumbai.

She has made friends in the area, some of whom are outreach workers from a local NGO called Bapu Trust. When Munda first came to them she was mute. The abuse she received daily because of her mental disability at home, in the temples she frequented and on the streets, had led this woman to internalise her suffering to such an extent that her mind appeared to have simply given up on communicating with others.

Bapu Trust workers used art and music therapy to open up dialogue with Munda, slowly gaining her trust. The organisation also delegated community members to keep an eye on the sick woman to make sure she was comfortable and her condition improving. Today, she has a support network, something that would have been inconceivable only a few years previously.

If Munda had not received this care in the community, she might have ended up in a mental hospital, one of the few options for families struggling to care for relatives living with mental illness. However, not all mental hospitals in India have the capacity to help their patients; some appear to actually harm them further.

A recent report from Human Rights Watch documented widespread abuse in some of these local hospitals, where “women and girls constantly pulled lice from their hair”, faced unsanitary conditions, neglect and abuse. 

Dr Bhargavi Davar, founder of the Bapu Trust, was inspired to take action after seeing her own mother suffering in one such institution. Dr Davar’s organisation is now treating about  200 patients at a cost of $100 per patient per year; a small fraction of the cost to treat them in hospitals and clinics.

Week after week, Bapu Trust outreach workers knock on doors, hold community meetings and recruit local people to seek out and counsel those living with all forms of mental illness, from depression through to psychosis. Once someone in need of help has been identified, Bapu provides them with basic counselling, arts-based therapies and psychosocial interventions. The organisation currently receives no financial support from the government and, like many other similar programmes, relies heavily on private donations and grants to keep it afloat.

The worst place in the world to suffer mental illness

For sufferers of mental illness, Togo is one of the worst places in the world to live.

The country is so severely under-resourced and so little is understood about this form of disease that many desperate families see no option but to take sick relatives to so-called prayer camps.

The local religious leaders who run these camps claim they can cure the mentally ill by encouraging  “evil spirits” to leave their bodies. Usually this is attempted by chaining the sick person to a tree and prescribing them a series of beatings with canes, occasionally punctuated by prayer rituals. Those subjected to this treatment often stay chained outside in all weather for weeks, months, even years, waiting for a sign that they are healed – so that they can finally be released from their shackles and allowed to reintegrate into the community.

Pastor Paul Noumonvi runs one such prayer camp in Togo, known as “Jesus is the Solution”, where he conducts “divine healing” in return for donations from the families of those exhibiting mental illness. When we visited the camp earlier this year, more than 150 people were chained up behind his church. They were tied to trees, to concrete blocks on the ground or kept in small cells. No trained medical professionals were present at the prayer camp, and Noumonvi’s methods of patient evaluation are questionable at best.

Gregoire Ahongbonon, a mental health advocate working in West Africa, often visits camps like Jesus is the Solution as he seeks to bring an end to the tradition of prayer centres by providing a viable alternative for those families who have no way to care for relatives suffering from mental illness. His organisation, Saint-Camille-de-Lellis, runs eight assistance centres in Ivory Coast, Benin and Burkina Faso.

At Saint Camille’s centres in Benin hundreds of patients are fed, given shelter and a proper medical diagnosis. They receive regular medical tests for a small fee, doses of medication at reduced prices and even learn practical skills such as sewing and baking. It is hoped this will make it easier for them to earn money, support themselves and have a more stable life in the future.

Trauma and mental illness

Community-based care is crucial not only in the context of treating psychiatric illnesses, but also to help those who have experienced trauma. Conflict in the world today has resulted in more than 60 million forcibly displaced people, including 19 million refugees – the highest number since World War II. Among the flood of people entering Europe from the Middle East are many adults and children who suffer under the burden of the enormous stress that comes with living through war and displacement.

Fourteen-year-old Ahmed saw a young girl shot dead by a sniper, just outside his school in Syria. His mother said the boy refused to speak for days afterwards and would hide under a table whenever he heard loud noises.

Disturbed and depressed, Ahmed couldn’t eat or sleep and would frequently lose his temper. Things started to improve when Syrian psychiatrist Dr Mohammad Abo-Hilal began treating him at the Zaatari Refugee Camp in Jordan. Using counselling and art therapy, Dr Abo-Hilal helped Ahmed gradually deal with his trauma.

The Zaatari Refugee Camp is the largest in the Middle East and Ahmed is far from the only inhabitant suffering from post-traumatic stress. Many of the children here have witnessed terrible atrocities and are especially vulnerable to mental health problems. Without official sanction from the Jordanian authorities, Dr Abo-Hilal operates here under the radar, using the few resources he can scrounge together to try and treat those most in need of his help.

The doctor and his team use counselling, visualisation techniques and art therapy in an effort to communicate with the children and get them to open up about their experiences. His work has been so successful in Jordan that Dr Abo-Hilal is now also expanding his efforts to another Syrian refugee camp, this time in southern Turkey.

Looking into the future

This year marked the first time that governments of the United Nations included mental health as part of their new sustainable development goals. Other global institutions such as the World Bank and the World Health Organization have also acknowledged the need to make mental health a central focus of the global health agenda.

But for now, in places like India, West Africa and the Middle East, it’s left to a small coterie of humane innovators to make a difference. Together, they are using every resource they can to provide actual care to people, helping to bring mental illness out of the shadows. 

Current and former students and faculty of the University of British Columbia’s Graduate School of Journalism International Reporting Program contributed to the production of Out of the Shadows.

This film was first broadcast on Al Jazeera English in October 2015.