Ethiopia's mentally ill stay in the shadows

By Seleshi Tessema

ADDIS ABABA, Ethiopia

An intimidating man with a muscular build was standing on a roadside in Piazza, one of the oldest shopping centers in Ethiopia’s capital of Addis Ababa.

The half-naked man, talking loudly while glaring at the sky, was holding a rock.

Screaming and threatening to stone motorists, he walked to the center of the two-lane road and blocked the busy midday traffic until he was taken away by police officers.

‘One of them’

Dereje Assefa, a psychiatrist and head of the mental health department at the Ethiopian Health Ministry, told Anadolu Agency that the man was among those in Ethiopia suffering from extreme mental health problems.

“Those men and women are among the nearly one percent of Ethiopia’s population that are mentally ill,” Assefa said. “Some of them are violent, others are passive, and all of them live in the streets in lamentable self-neglect.”

In addition to the chronically mentally ill, he said, at some stage in their lives, one in five people in Ethiopia will be affected by mental and/or neurological disorders, including depression, anxiety, schizophrenia, dementia, and substance abuse disorders.

“Mental illness pervades all sectors of society, but in our case, the people most affected by mental disorders are the poor, the unemployed, the uneducated and victims of violence,’’ Assefa noted, adding that people addicted to khat, an edible green leaf known for its narcotic effects widely consumed in Ethiopia, and cannabis are vulnerable to mental disorders.

Multiple causes

The Ethiopian Health Ministry's National Mental Health Strategy states that multiple factors are to blame for the increasing prevalence of mental illness.

“In addition to physical illnesses which negatively impact mental health, national policies that effect the well-being of communities, human rights violations, violence and cultural and environmental factors are among the causes,” the paper says.

Assefa said the provision of modern treatments and care for the mentally ill had been swayed by a deeply entrenched public perception of the causes of such illnesses, which has far-reaching consequences.

“This belief is that severe mental illnesses are attributed to supernatural causes like punishment by God, possession by evil spirits, and bewitchment,” he said.

“Due to this, families often take the sick to religious and traditional healers instead of modern health facilities.”

According to Assefa, families tend to seek modern treatments after it is virtually too late, and the public’s view of the mentally ill has also led to the ill facing discrimination and stigma.

Exorcism

On a bright windy morning, many men and women chained by the ankle were quietly sitting in the compound of St. Urael, one of the Ethiopian Orthodox churches that provide holy water.

Followers of the church strongly believe the water heals every disease and exorcises demons. The water is blessed by priests clutching crosses and given to the sick, who drink it as a tonic.

Inside a small room, dozens of men and women were being rinsed in the water. Some were wailing, while others were speaking in many local dialects.

Father Kinfe Michael, who administers the water, told Anadolu Agency that most of the mentally ill who had been receiving it had been treated at mental health hospitals for some time.

“When their conditions don’t change, families bring their loved ones to us, and many had been freed of demons and the state of being bewitched,” he claimed.

Human rights violations

After undergoing a long recovery in churches and hospitals, patients often encounter a hostile domestic environment that denies them their basic rights.

“They are ... discriminated against in employment, promotion, education, and housing, and some are denied the opportunity to vote, get married, and have a family. They also don’t find appropriate treatments,” said the mental health strategy paper.

Ethiopian health officials, who pride themselves on having helped integrate mental health treatment and care into 266 hospitals nationwide over the last two decades, have the mammoth task of transforming the collective culture.

“The government of Ethiopia will make sure that the rights of people with mental health conditions are observed through raising awareness and the development of health policies and laws,” Assefa said.

But for now, those who aimlessly walk and live on the streets of Addis Ababa often remain neglected by their families and health officials alike.