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The Mistreatment of The Mentally Ill


In Developing Countries
Ashton Aylesworth
Rob Ruttan

Preface

The World Health Organisation (WHO) estimates that mental and


neurological disorders are the leading cause of ill health and disability
globally. The mistreatment of the mentally ill has been a global issue for
centuries, religious and cultural stigmas have been at the root of this
problem in most cases but the lack of adequate treatment and care of the
mentally ill has also contributed to this issue. Three quarters of those with a
form of mental illness live in developing countries (Kanellis, 2011). With this
said it is reasonable to assume that the countries should adapt and
accommodate for the abundance of mentally ill by properly treating them.
Unfortunately this is not the case and the subjection of the mentally ill to
inhumane living conditions, physical abuse and torture is very prominent.
The mentally ill are, in most cases, incapable of acquiring a consistent
job and properly caring for themselves. They have done nothing wrong, and
it is humanitys duty to provide aid and protection for those who cannot
acquire it themselves. These people are in need of care and that demand is
met with negativity and abuse. In Mexico , an increasing number of people
who are living with mental illness, a population that is largely mocked and
ignored there, have stood up and taken it upon themselves to care for each
other. The mental health system is really so poor that the only ones who can
sympathize and properly care for the mentally ill are the mentally ill. A
human rights activist group called the Disability Rights International, or DRI,
issued a report displaying the evidence of torture and other methods of
inhumane treatment in Mexican psychiatric hospitals. Not only are the
mentally ill being mistreated in public but also in places that they are
designated to go to receive treatment.
The Mayo clinic refers to mental illness as:
A wide range of mental health conditions disorders that affect your mood,
thinking and behavior. Examples of mental illness include depression, anxiety
disorders, schizophrenia, eating disorders and addictive behaviors.(Mayo
Clinic 2015)

When referring to the mentally ill in this report it will include: schizophrenia,
depression, Post traumatic stress disorder (PTSD), bipolar disorder and/or
trauma. The case studies discussed in this report will outline the
accessibility to treatment, ignorance or lack of understanding about mental
illness, as well as the religious and cultural stigmas surrounding mental
illness in Afghanistan, Kenya and Mexico.

Table of Contents
Preface

2
Background

5
Expert
p7
Role of Control

The Logic of Evil

11
Religion and Spirituality

Case Study: Afghanistan

Case Study: Kenya

Case Study: Mexico

13

14

17

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International Organizations
Canadian Connection

p 21
p

23
Solutions
25

Works Cited

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Background
The mistreatment of the mentally ill can be traced back as far as 5000
BCE, evidenced by the discovery of trephined skulls in areas that were once
a home to ancient world cultures. Early man believed mental illness was a
direct result of supernatural phenomena such as spiritual or demonic
possession and so they responded with equally mystical and sometimes
brutal treatments. (Foerschner, 2010) Trephining is a procedure in which a
hole was drilled into the skull in order to free the so called spirits inside. The
success rate of this method very low and the only positive thing that it
resulted it in was to incidentally relieve pressure on the brain. In most if not
all ancient civilizations the mistreatment of the mentally ill stems from
religious stigmas. The only ancient civilization that properly cared for the
mentally ill was the Egyptians. The Egyptians encouraged the mentally ill to
participate in recreational activities and to attend social gatherings.
(Foerschner, 2010) During the Middle Ages the most common treatment for
mental illnesses was bloodletting. Bloodletting involved extracting blood
from different parts of the body and sometimes involved the use of leeches.
Due to the shame of giving birth to someone with mental illness, most
families would hide them in cellars, attics, or put them in caged pig pens.

Asylums contributed to a line that some people believe to exist between the
mentally ill and those who are not. The first were established during the 16th
century. Asylums were not set up as places to care and treat the mentally ill
but rather as a place for families to drop off their mentally ill relatives. In
1784, in Vienna, an asylum of sorts was built and named the Lunatics tower.
The mentally ill were placed in small rooms and were put on display for the
public.
The mentally ill werent treated as humans but rather as useless
animals; however some people believed otherwise and wanted to break this
cycle of abuse and ignorance. One of those who broke the cycle was Phillippe
Pinel who was a French physician. In 1772, Pinel traveled to an asylum to test
his hypothesis that the mentally ill would respond better if they were treated
with respect and compassion just like anyone else would be. His methods
produced positive results and afterwards abuse, filth and noise were
reduced. Around the same time that Pinel was testing his hypothesis an
English Quaker by the name of William Tuke founded a psychiatric hospital
called the York retreat. The hospital was run by Tuke and other Quakers who
shared the same ideals. The hospital was a farm house that encouraged
patients to work and play in an environment that emphasized reason and
humanity. These two cases created a humanitarian movement that spread to
the United States of America in the early 1800s. The treatment of the
mentally ill gradually became more humane across the world throughout the
1800s. However this treatment failed to continue through the last quarter of
the 1800s as biomedical breakthroughs and advancements occurred and
people started to believe that medicine was the cure for everything.
Lobotomies were soon adopted across the world as a quick, cheap and
somewhat effective method for curing some mental health conditions such
as schizophrenia. Lobotomies involved severing the brains frontal lobe which
reduced the symptoms of mental illness at the cost of a persons intellect

and personality. The patients who underwent this surgery often ended up as
lifeless almost zombie-like beings.
Electro Convulsive Therapy was introduced in the 1930s (Montgomery,
2007) to treat atypical mental disorders. Along with this, and the
development of pharmaceuticals used to treat the symptoms of many mental
disorders, these still remain the most common treatments for the mentally ill
today.

Expert
Arthur Kleinman is a physician and anthropologist. He is also a
professor in the department of Anthropology, Medical Anthropology in Global
Health and Social Medicine at Harvard Medical School.
Dr. Arthur Kleinman is a graduate of Stanford University and Stanford
Medical School. He was trained in psychiatry at the Massachusetts General
Hospital. Kleinman is also a key figure in several medical fields including
medical anthropology, social medicine and medical humanities. He was the
chair of the Department of Social Medicine at Harvard Medical School for a

decade, and he is a member of the Institute of Medicine of the National


Academies. In 1973 he taught Harvards first course in medical anthropology.
He also introduced Harvards PhD program in medical anthropology. He has
supervised more than 75 PhD students and more than 200 postdoctoral
fellows. In 2001 he was the winner of the Franz Boas Award of the American
Anthropological Association, which is its highest award.
Arthur Kleinman has written six books, co-authored two others, written
over 300 articles, book chapters, reviews, and introductions, and has also coedited 30 volumes and seven special issues of journals. Kleinman is the
author of multiple articles in The Lancet on care giving and global mental
health and has edited a forthcoming volume titled Mental illness and
Substance Abuse in Africa. He has co- authored several articles on stigma
and mental illness and the appropriate use of culture in clinical practice. He
has delivered lectures at Yale University, Stanford University, and Harvard
University. He has carried out research in China since 1978 and also in
Taiwan from 1969 until 1978. Recently he completed a collaborative study
with professor Sing Lee of Hong Kong on Stigma in China.

An article he co-authored claims One major problem with the idea of


cultural competency is that it suggests culture can be reduced to a technical
skill for which clinicians can be trained to develop expertise,
(Kleinman,2006)

Role of Control

The mistreatment of the mentally ill in most developing countries is


ultimately controlled by the government. The government of the respective
developing countries is in charge of allocating the percentage of the health

budget toward mental health, and in most cases this percentage is very low.
In the majority of African countries the current accessibility of mental health
services is deficient. The psychiatrist to patient ratio is lower than 1 to
100,000 and its reported that 70% of African countries allocate less than 1%
of the total health budget to mental health. This results in the families of the
mentally ill not being able to know how to access treatment or care for their
ill children. Most of the time those with a form of mental illness are locked in
sheds and kept separate from their families. In Kenya this reality is described
by the editor David Mckenzie.
The tin shack looks like any other in a patch of small plots on the
dusty outskirts of Nairobi. It's the haunting sound that grabs you, the awful
moaning and cries coming from within. It's Thomas Matoke's home. But it's
more like a cell. Matoke, 33, is tied to a steel bedframe with a piece of blue
rope. He's surrounded by pools of his urine, his mattress soiled and ripped to
shreds. His moans are interrupted when he chews his hand or the bedframe.
He can't speak to tell his mother what he wants or feels. He's alone in his
world of screams and agony. He's been like this for 30 years. (Mckenzie,
2011)
The case of Thomas Matoke is one of many within Kenya, and of all of the
African countries Kenya is one of the better off in terms of mental health
care. If the governments of these developing countries allocated more, even
a percentage more, of the total health budget to mental health treatment it
would drastically cut down the absurd patient to psychiatrist ratio and save
the lives of those with mental illness.
Economic status is a factor in the control of the mistreatment of the
mentally ill. In Kenya various studies have shown that those with a lower
class socio-economic status are more prone to suffer from mental health
disorders than those who are wealthy. Now on top of the cultural and
religious stigmas, these family members become a burden. This could

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contribute to the abuse of those with mental illness. The fact that they also
earn little to no money and cant hold a consistent job, makes the upper
middle class and the wealthy feel far more superior to those who are
mentally ill.
The cultural and religious stigmas attached to mental illness in
developing countries have a similar if not equal impact as the governments
lack of funding. Stigma is associated with negative stereotypes that have
been nurtured by ignorance, religious/traditional teachings and community
class structure. Education or lack of knowledge and awareness of mental
illness greatly affects the treatment and recovery of a mentally ill person. A
patient from Zambia explains the effects of stigmas:
So I came in contact with stigma and discrimination and that
introduced me to life of misery, you know you cant get a job you cant be
accepted. I couldnt see hope and my future was chopped off. I live a life of
loneliness. (From a patient report from Zambia, Kapungwe et al., 2010, p.
195)
Living with a form of mental illness can reflect poorly on ones family
and affect their chances of getting a job and retaining social relationships. In
Mexico mental illness is such a taboo that the mentally ill have taken it upon
themselves to care for each other in psychiatric hospitals. Throughout history
religions have deemed mentally ill people as possessed. In Malaysian
culture the mentally ill are labeled as sakitjiwa which translates to the
illness of the soul and are not regarded as sick but rather possessed or being
socially punished. When people are uncertain of things, they look for an
explanation and when they cant find a logical one they often find a spiritual
one, and unfortunately that is the case for mental illness. This social stigma
has caused the shunning and discrimination of those who are in the greatest
need of societal interaction and support.

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The Logic of Evil


To most, the mistreatment of the mentally ill is justifiable because of a
cultures religious beliefs they simply just do not know how to properly care
for them and these patients pose a great economic burden.

After all these many years of war and all these deaths, with the
government spending money on bullets and bombs rather than social
welfare and development, the people who are most vulnerable in society,
theres nothing for them other than to put them in prison and shackle them
to the floor.(Hammond, 2014)
Governments must prioritize the treatment of diseases that pose the
greatest risk to the masses. Mental illness is not a communicable disease
and therefore is not near the top of their priority list of funded treatments.
For example, HIV/AIDS, Ebola and other infectious diseases pose a greater
threat. Another reason the mistreatment of the mentally ill occurs is because
of fear. People can learn of someone who was in an accident and came out
brain- injured as well as mentally ill and think that it could happen to them,
so they justify their abuse and harassment of the mentally ill because of their
fear. In many religions the mentally ill are considered possessed, and the
brutal and inhumane treatments people put them through are believed to rid
them of evil spirits or demons. Yayasan Galuh, a mental health facility in
Indonesia is a prime example of this. 260 patients spend their days chained
to cold hard tile floor bordered by an open sewage system. American
journalist Ray Suarez describes Yayasan Galuh:
The conditions may seem cruel, but employees at the foundation see
themselves as healers who give these much-neglected patients ancient and
what they say are effective therapies. Many of the patients have been left

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here by family members at wits end, not sure where to turn for help, when
the choices are so few. (Suarez)
The healers use herbs and other natural ingredients to create medicine that
has little to no effect on the patients. But they stick with these primitive
methods because they are convinced that it is the only way to banish the
demons within the mentally ill. Jajat Sudrajat, one of the head nurses at
Yayasan, says these traditional healing medicines treat people who suffer
from dark spirits. (Sudarajat). These religious stigmas have created a
barrier, causing those who believe in the stigmas to close their minds to any
contradictory ideas or methods of treatment. They have solidified the idea
that the mentally ill are harbouring evil spirits over the decades, and have
refused to change their ways. The lack of health care in general as well as
the lack of education in developing countries results in families having no
clue as to how to care for their ill family members. Most of the time the
families separate the mentally ill from the others by tying them to poles or
locking them in sheds at the border of their properties. In most cultures it is
also shameful to have given birth to someone with a mental illness, so even
if there were health care in the area of a family who is caring for someone
with mental illness, chances are they will not seek out treatment because
they would be too embarrassed to do so. In Indonesia a 29-year old man has
been kept in a cage by his brother and sister for 10 years. They say it is to
prevent him from running off and harassing the neighbours. This is just one
of the many cases of the families of mentally ill who havent been properly
cared for. Often, people are blatantly afraid of the mentally ill, this could be
because they act much differently from those without mental disorders or
simply because they think that mental illness could happen to them. They
attempt to overcome their fear by isolating the mentally ill, abusing them or
just bullying them.

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Religion and Spirituality


If ignorance is bliss, demon chasers must be in nirvana. (Caroll)
Religion has played a very big part in the mistreatmenst of the mentally ill. A
few of the world religions such as Christianity and more specifically Roman
Catholicism, have and/or used to have uneducated views on mental illness.
This has played a huge role in influencing people to stigmatize and even
discriminate in some cases the mentally ill as religious teachings often
influence beliefs about the origins and nature of mental illness.
Christianity which is the second most practiced religion in Africa has a
history of harboring a social stigma towards the mentally ill. According to a
recent LifeWay poll, nearly half of adult evangelical Christians believe that
mental illnesses such as depression and schizophrenia can be cured solely
through prayer and the Bible. (Riley, 2014)
Today, the Roman Catholic Church still believes in diabolic possession
and its priests still practice what is called "real exorcism," a 27-page ritual to
drive out evil spirits. The ritual involves the use of holy water, incantations,
various prayers, incense, relics, and Christian symbols such as the cross. The
Catholic Church has at least ten official exorcists in America today. (Cuneo)

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In other cases, some religious organizations attempt to help the


mentally ill and put them through rituals or treatments that often worsen not
only their mental health but physical health as well. For example, Native
Doctor, Lekwe Deezia claims to treat mental illness with traditional herbs and
medicine as well as through the power of prayer. His treatments can
sometimes take months during which the patients are strapped to trees and
not given any protection from the elements. The patients also say they are
only fed once a day and sometimes only once every three days.
In contrast to these examples of how religion negatively affects those with
mental illnesses Buddhism as well as Hinduism both objectively understand
affliction as a natural process of human life.
The Buddhas original concern with the sufferings involved in human
life became the focus for his teaching. In particular they provide the core of
the key teaching, known as the Four Noble Truths. This teaching consists of
four statements, the first of which emphasised the reality of affliction. The
noble truth of dukkha, affliction, is this: birth, old age, sickness, death, grief,
lamentation, pain, depression, and agitation are dukkha. Dukkha is being
associated with what you do not like, being separated from what you do like,
and not being able to get what you want. (Samyutta Nikaya 61.11.5) In other
words, human life is unavoidably linked to situations which are distressing.
(Brazier, 2006)
Today, much of the stigma around mental illness is due to
misunderstanding. This misunderstanding can often be linked to religious
and/or spiritual beliefs that try to explain the causes of mental illness. These
causes can be construed to be evil, other, possession by the devil and
instills fear and loathing in people. Hiding, shunning and the mistreatment of
the mentally ill seems justified in order to keep the sane people safe.

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Case Study: Afghanistan


Years of war, poverty and social problems have greatly affected the
mental health of Afghani citizens. Mental illness is prevalent in Afghanistan
more than most countries in the world. More than sixty percent of Afghans
are afflicted by mental illness. (WHO,2009) Afghanistans population is 30.5
million (World bank, 2010) and only two psychiatrists are in the country
caring for that population.
Forty-three percent of the population is under the age of fifteen years,
seventy-five percent of the population is rural and the healthy life
expectancy rate at birth is thirty-five years for men. (WHO 2005)
Afghanistan established a mental health plan and policy in 1987 which
handles the main mental health issues. There is no consistent budget
allocation for mental health, but in 2004 $100,000 out of a 289.4 million
dollar total health budget was allocated towards mental health. Female
patients account for forty-seven percent of the patients in mental health

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facilities in all of the country. The percentage of adolescents and children are
relatively low in all mental health facilities. In mental hospitals substance
abuse and schizophrenia are seen most frequently. Inpatient units and
mental hospitals both see schizophrenia as their most common disorder.
(WHO,2005)
Less than one percent of training for medical doctors is used for mental
health. There are only two psychiatrists in the country and neither of them
are working in mental health facilities. Coupled with this staggering deficit of
professionals the Afghanis have only an additional forty mental health
workers. There is no financial or legislative support for people with
psychiatric problems in Afghanistan. The majority of mental health facilities
are in the major cities. In the rural areas of Afghanistan the healthcare staff
has little to no training to treat or care for the mental ill.
Twenty-five percent of all in-patient psychiatric clinics and forty percent
of all admissions to mental hospitals are involuntary. Of all the patients
admitted, over twenty percent are restrained. Some non-governmental
organizations have established intervention centres in 2005 in the capital
city of Kabul but not in rural areas. (WHO, 2005) The most serious cases of
mental illness, such as, schizophrenia would lead the patients family or
community to have them committed to a treatment or containment facility.
However, the thousands of Afghanis that suffer from PTSD from the after
effects of war go untreated.
The conditions in the rural areas are similar to those in developing
countries such as Kenya. Wali Sultani has been brought out to Mia Ali Saeb
Shrine in Samar khel, a rural area outside the eastern city of Jalalabad. He
was chained to a wall and provided with only bread, black pepper and water.
He wears the same dirty clothes every day of his forty day long treatment
which is supposed to rid his bodies of bad spirits. (Barker 2008) Admission to
this shrine can cost as much as $200 which is a large sum of money in

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Afghanistan. The guardians of the shrine called The Mias speak of miracles
that have occurred at the shrine.
"There are lots of scorpions and snakes here, but the scorpions do not
sting the sick people, and the snakes do not bite them. A bomb hit here in
the middle of the courtyard during the Soviet invasion, but it didn't
explode."(Mia Osman, 2008)
It is obvious that they regard these patients as other and these
superstitions surrounding the mentally ill help them craft these types of
myths. Regardless of The Mias statements on the miracles of the shrine, it
is obvious the conditions of the shrine are inexcusable. The cells are made of
concrete and smell of human excrement said Kim Barker, a Tribune
Correspondent who visited the shrine.
This specific case is just one of the results of Afghanistans
misunderstanding of mental illness. Afghanistans health ministry would like
to shutdown such institutes as the Mia Ali Saeb Shrine, however given all the
alternative health crises the ministry face, places like the shrine are not of
high priority.
There is only one mental hospital in the country and it technically only
has forty beds, as sixty of them are designated for substance abusers. This
leaves the population without a place to go to properly treat their mentally ill
family members or friends. The lack of adequate health care leaves people
with little choice other than shrines and other unofficial, most likely
unregulated inhumane conditions and ineffective methods of treatment.

Case Study: Kenya

Where there is war, famine, displacement, it is the most vulnerable


that suffer the greatest. Abandonedby governments, forgotten by the aid
community, neglected and abused by entire societies. Africans with mental

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illness in regions in crisis are resigned to the dark corners of churches,


chained to rusted hospital beds, locked away to live behind the bars of filthy
prisons. Some have suffered trauma leading to illness. Others were born
with mental disability. In countries where infrastructure has collapsed and
mental health professionals have fled, treatment is often the same a life in
chains. (Hammond 2011)
Kenya is a developing country located in East Africa. It has a life
expectancy rate of fifty-four years and a population of foty-three million. The
health service for the mentally ill is inefficient and lacking in both manpower
and finances. The health service in Kenya is separated into six levels;
volunteer community health workers, dispensaries, health centres, district
general hospitals, provincial general hospitals, and the national referral
hospitals. The majority of the health investment in Kenya focuses on
communicable diseases despite the negative impact that the lack of
treatment and abuse of the mentally ill leaves on the country. There are only
seventy-five psychiatrists that work in the public sector in the country to
serve a population of thirty-eight million. The remaining psychiatrists in the
country work exclusively with private patients at a high cost. There are also
only 500 psychiatric nurses of which only 250 work in mental health which
means that for each district there are only one or two psychiatric nurses.
(WHO atlas 2011)
Kenya only has one Psychiatric hospital, called the Mathari psychiatric
hospital, which houses 675 patients and abuses the rights of the mentally ill
frequently. Many of the patients are confined, chained to beds and poles, or
over- medicated so much that they are put in a comatose-like state. When
the mentally ill arent accepted into the hospital they are most likely chained
up to poles by their own families according to Edah Maina, who is the chief
executive officer of the Kenya Society for the Mentally Handicapped. The
hospital is extremely understaffed and lacking in resources. The service is so
inhumane that forty patients conspired and actually escaped their

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treatment facility. The patients overpowered guards and fled through the
slums of Nairobi. WHO states that the conditions in the Mathari psychiatric
hospital are not unique, and that the treatment is equally poor or even
worse. Joyce Kingori who manages Britains mental health NGO BasicNeeds
visits the clinic regularly. He commented on the conditions on the state of the
clinic, Not even our prisons look like that. The conditions outside of the
clinics arent any better than inside them.

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Case Study: Mexico


In 2008 the amount of neuropsychiatric disorders contributed to
nineteen percent of the global burden of disease. (WHO 2008) The
population of Mexico is 110,645,154. Mexico has an official mental health
policy and was most recently revised in 2007(WHO 2007) and the General
Health Law establishes Mental Health as a basic service and as a health
priority. The government health department allocates 0.65% of the total
health budget towards mental health. Even though manpower and financial
funding is low towards mental health there is still a strong mental health
policy in Mexico. With this said, it is clear that the problem lies within the
social and religious stigmas in the country as well as the treatment of
patients by psychologists.
Social stigmas dont just influence those without mental illnesses it
also prevents those with mental illnesses to mistreat them in a way by not
seeking out proper treatment. Especially adolescents whom rarely seek out
help for their mental illnesses. In 2001-2002 less than one in seven
adolescents with any type of mental illness used any form of mental health
care.
Eunice Diaz de La Vega suffers from schizophrenia and was delighted
to be pregnant. She was concerned about the challenges she would face as a
schizophrenic sufferer and went with her mother to see her doctor in Mexico
City to discuss the challenges she would face raising a child while suffering
from schizophrenia. My mum said, 'Do you think it's OK that my daughter
has this child?' The psychiatrist said, 'No she has to abort.' No one asked me
or even looked at me."(Vega). In Mexico it is not uncommon for psychiatrists
tor recommend this route to their patients. Colectivo Chuhcan , a support
group made up of people with psychiatric disabilities who stand for the rights
of their fellow sufferers, has gathered testimonies from fifty-one women

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living in Mexico who suffered from some form of mental illness. Forty-two
percent of the surveyed women said they had been either forced or coerced
into sterilisation by their family members or their doctors. Another fortythree percent of women who visited a gynaecologist were abused either
physically or sexually. One student doctor described the process of
convincing them to abort as Bombardment. Disability Rights International
was allowed into an institution in which the staff is appointed as the legal
guardians of abandoned woman and have total control over them. The
director of this institution told DRI that all of these women need to be
sterilised. This could be to avoid pregnancies that are caused by sexual
abuse.
The only immediate solution for this issue would be for psychiatrists to
respect their patients and treat them as equals. Natalia Santos, a member of
Colectivo Chuhcan says They think they can simply take the possibility of a
child away from someone with just a couple of words they just see us as
robots. (Santos) Doctors also see abortion or sterilisation as a simple
solution for an issue they dont understand. Another solution for this issue
would be for there to be a policy as well as training on patients rights. This
solution would not only reduce the amount of psychiatrists that coerce
women into sterilisation but also psychiatrists that abuse patients rights.
Eunice Diaz de La Vega ended up keeping her child and she now has a
five-year-old daughter but she said she was clearly still frustrated as she
described her experience to John Holman, who recorded and reported her
experience five years after the incident.

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International Organizations

World Health Organization


WHO Mental Health Atlas 2011The WHO Mental Health Atlas 2011
represents the latest estimate of global mental health resources available to
prevent and treat mental disorders and help protect the human rights of
people living with these conditions. It presents data from 184 WHO Member
States, covering 98% of the worlds population. Facts and figures presented
in Atlas indicate that resources for mental health remain inadequate.
The distribution of resources across regions and income groups is
substantially uneven and in many countries resources are extremely scarce.
Results from Atlas reinforce the urgent need to scale up resources and care
for mental health within countries. (WHO 2011)
During the five year time period between 2005 and 2010, 3000 of the
5000 of the health care staff in the public health care system of Kenya
received basic training using a sustainable general health system approach.
The training was provided by a collaboration between WHO (World Health
Organization), the ministry of health, and the Kenya Psychiatric Association.
The result of this program was an enhanced set of health worker skills that
was responsible for a noticeable improvement in the intervention clinics,
regardless of the lack of medicine and manpower.
World Federation of Mental Health (WFMH)
The World Federation for Mental Health (WFMH) is an international,
multi-professional non-governmental organization (NGO), including citizen
volunteers and former patients. It was founded in 1948 in the same era as
the United Nations (UN) and the World Health Organization (WHO).

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Founded in 1948, the mission of our international organization


includes:
The prevention of mental and emotional disorders;
The proper treatment and care of those with such disorders;
And the promotion of mental health. (WFMH 2014)
The Federation, through its members and contacts in many countries,
has responded to international mental health crises through its role as the
only worldwide grassroots advocacy and public education organization in the
mental health field. Its organizational and individual membership includes
mental health workers of all disciplines, consumers of mental health services,
family members, and concerned citizens. WFMHs broad and diverse
membership makes possible collaboration among governments and nongovernmental organizations to advance the cause of mental health services,
research, and policy advocacy worldwide. (WFMH 2014)

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Canadian Connection

Canada has a population of almost 36 million and it is estimated that


nearly one in five Canadian adults will personally experience a mental illness
during a one year period. Canadians suffering from mental illnesses undergo
mistreatment the same way that people living in developing countries would,
although not to such extreme extents. Stigma and discrimination as well as
abuse, and lack of treatment are prominent in Canada. Stigma and
discrimination associated with mental illnesses very much affect Canadians
the same way it does in developing countries. Superstition, fear and lack of
knowledge are the root of discrimination towards Canadians with mental
illness. CAMIMH (The Canadian Alliance for Mental Illness and Mental Health)
has stated that reducing discrimination and stigmas is the first priority for
improving the mental health of Canadians. Educating people about mental
illness and policies that address discrimination provides incentives for
change. Another very large issue with the mental health care in Canada is
the two-tiered mental health system for children and youth. Canadas youth
suicide rate is higher than most other industrialized countries, including the
UK and the United States. The government provided health care only
encompasses the psychological support services provided by psychiatrists.
The waiting period to acquire an appointment with psychiatrists can be a
year long. During this year the youths mental health will most likely
deteriorate dramatically. The alternative to waiting a year for an appointment
with a psychiatrist is for the family to pay for access to a social worker or a
psychologist. Or, familys are desperate to seek help for their child, and learn

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how to work the system. They will visit their local emergency room in order
to have their sick child assessed or will also resort to calling the police in
order to have their child formed in order to seek assessment and much
needed treatment. However if the family cant afford the fee for a
psychiatrist their child will be forced to wait for a year in most cases to get
better. This can be solved by the government investing in a new National
Youth Suicide Prevention Fund that would go towards implementing youth
suicide prevention programs and initiatives across the country. There is also
a Canadian charitable program called Bell Lets Talk which has donated $73.6
million to a wide variety of mental health organizations across the world. The
program has four main goals, ending stigma, care and access, research, and
workplace health. Clara Hughes, a famous Canadian Olympic athlete who
has suffered from depression is Bell Lets Talk spokesperson.
In 2010, Bell announced the launch of an unprecedented multi-year
charitable program dedicated to the promotion and support of mental health
across Canada. Over the next several years, this multi-million dollar initiative
will support a wide range of programs that will enhance awareness,
understanding and treatment of mental illness and promote access to care
and research across the country. (Bell Lets Talk 2012)
The government has provided funding to an organization, Reconnect, which
supports mentally ill patients and their families in the community. Health
care workers, social workers, psychiatrists, and nurses make up several casespecific teams to treat and support the mentally ill client in their own home
or group facility. Reconnect began in 1981 as a project to serve discharged
psychiatric patients in Etobicoke, following the closure of Lakeshore
Psychiatric Hospital in 1979. A Community based Day Treatment program,
funded by the Community Mental Health Branch of the Ministry of Health,
was established in early in 1984. Reconnect is governed by a Board of
Directors which includes consumers, family members, mental health and

26

business professionals, and other interested community members.


(Reconnect 2014)
CMHA-CANADIAN MENTAL HEALTH ASSOCIATION influences public policy and
health system planning to promote mental health. (CMHA 2014)

Solutions
There are a few possible solutions to the mistreatment of the mentally
ill, but the most effective one would be education. The root of this problem is
the lack of understanding that comes with it. People dont know how to treat
the mentally ill, or they dont know what mental illness is in the first place.
Educating people on not only what mental illness is but how to seek out
proper care and personally care for the mentally ill would cut down on the
abuse that the mentally ill suffer. Religious and Cultural Stigmas would also
be obliterated because they are the result of lack of education. In order for
this to happen Non-Governmental Organizations would have to provide
funding and other resources. It is already difficult for ordinary public schools
to be built in developing countries, it wouldnt be possible for the
government to fund a separate education program for mental illness.
Another effective solution to this issue would be for there to be more
effective training methods implemented as well as an increased amount of

27

psychiatric nurses and doctors. The psychiatrist to patient ratio in Africa is


less than 1 to 100,000. This would require the collaboration between the
universities in the developing nations to open up training facilities for those
who would volunteer to become a psychiatrist or a psychiatric nurse. This
method worked quite efficiently when the World Health Organization
partnered with multiple other NGOs and universities to provide training for
psychiatrists and psychiatric nurses. Their enhanced set of skills was
responsible for a noticeable improvement in the intervention centres.

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Appendix

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31

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33

34

Photos from Robert Hammonds Condemned


Severely mentally disabled men and women are shackled and locked away
in Juba Central Prison for years on end. The new nation of South Sudan
faces a tremendous challenge to build a modern country capable of caring
for all of its citizens. Juba, Sudan

35

Abdi Rahman Shukri Ali, 26, has lived in a locked tin shack for two
years. He stays with his family in Dadaab in Eastern Kenya, the
worlds largest refugee camp, where Somalis fleeing conflict and
famine have sought safety. Dadaab Refugee Camp, Kenya (Hammond
2011)

36

Due to insufficient staff numbers, family members are encouraged to


stay with patients at Brothers of Charity Sante Mental. This relative
would often beat, tie up and drag the patient when she did not obey
his instructions. Goma, The Democratic Republic of Congo(Hammond
2011)

37

Native Doctor Lekwe Deezia as mentioned in religion and spirituality.