When Dror Ben-Zeev read a New York Times story on how people with mental illness were being chained in parts of Africa, he couldn’t stop thinking about it.
The professor of psychiatry and behavioral sciences is a mobile health researcher and co-director of the Behavioral Research in Technology and Engineering (BRiTE) Center at UW, which seeks digital solutions for mental health problems. He came to UW from Dartmouth, in part, to find collaborators in global health. He wants to bring novel resources to people with little to no access to mental healthcare, individuals in dire need of help.
So he chose Ghana.
Ghana is a West African country of 27 million people and just three psychiatric hospitals. Most Ghanaians with mental health challenges will consult with local religious leaders and healers before they seek the services of mental health professionals.
We sat down with Ben-Zeev for a Q&A about the mHealth for Mental Health Program.
How common is chaining people with mental illness?
Various mechanical restraints are a pervasive problem in low- and middle-income countries. This appears in one form or another in many sub-Saharan countries.
Why did you choose Ghana?
Why not Ghana? You have to start somewhere. Ghana is English speaking, politically stable and has robust cellular infrastructure. You see mobile phones and strong 3G signals everywhere. Ghana also has prayer camps that restrain some mentally ill people by chaining them to trees or concrete slabs on to the floor for months or years at a time. So it’s systematic. I learned that family members and even the local police drop off people with mental illness at these camps. Seems like the perfect place to start.
What did you find in the prayer camp you visited?
Everyone I met throughout my visit seemed very open to the ideas of digital health. Even the traditional healers, prophets and staff working at the prayer camps expressed a willingness to try new approaches. No one is happy about having to restrain people with chains, but they feel they don’t have another solution. But they do. The patients we met at prayer camps didn’t seem to pose any threat. That’s true about the majority of people with severe mental illness worldwide. They are much more likely to be the victims of violence than the perpetrators. Some were people with developmental disabilities or epilepsy. Most were quite calm and were just happy to talk with us. It is heartbreaking to see people just waste away like that.
Who are some of the people you met in Ghana?
I met with psychiatrists, psychologists, nurses, healthcare trainees, patients with mental illness and their families, telecommunication company officials, the minister of health and NGO workers. I also met with traditional healers, pastors and prophets.
What are you hoping to accomplish in Ghana?
We want to see people with severe mental illness treated humanely and get supportive, helpful services. Whether we like it or not, prayer camps and traditional and faith healers are likely to continue seeing the majority of these individuals. We hope to work with them to consider shifting their practices. I would like to see these camps become safe sanctuaries for the mentally ill. Perhaps they can engage in some form of employment—a cottage industry of sorts that would give people dignity and sense of purpose and contribution. We want to help provide tools that empower healers and others with options. To do this, we want to explore the integration of evidence-based intervention strategies with currently used spiritual and religious approaches through content that can be accessed via mobile device.
What are you proposing?
We would like to develop culturally informed digital tools for the faith healers, caretakers, NGO workers and others who serve as conduits to patients. These could include audio and video content for guided relaxation, aggression management, meditation, or guidance on how to conduct a compassionate conversation with someone who might look, talk, or act…differently. Things that may divert the use of chains, forced fasting, forced confinement and the like as the go-to approaches.
This isn’t a pipe dream; we’ve already developed tools like this for the U.S. Patients with severe mental illnesses use them in our studies all the time! With the right approach—thoughtful adaptation and consideration of the local context, dialects, beliefs—I have no reason to think they can’t be put to good use in Ghana.
If you are interested in learning more about Dr. Ben-Zeev’s work in Ghana, visit the mHealth for Mental Health Program site.
