In January, a security officer at one of Ghana’s prayer camps told an AFP reporter something that should have ended our national argument about mental health legislation. Patients, he said, are still chained. The camp simply hides them when NGOs or journalists come.

Read that again, because it contains the whole problem. The people running these camps know that chaining is illegal. They know precisely who might catch them. And they have learned, over nine years, that almost nobody is coming.

Ghana does not have a law problem. Parliament passed the Mental Health Act, Act 846, in 2012, outlawing inhumane and degrading treatment of people with mental health conditions. In 2017, the Mental Health Authority went further and issued an explicit ban on shackling, and the country was praised internationally for it. On paper, we are a model. A person chained to a tree in a prayer camp this morning is protected by as much law as anyone reading this.

What we never built was the machinery that turns a ban into a consequence.

Act 846 required Visiting Committees in all sixteen regions to inspect facilities and protect the rights of the people held in them, and a Mental Health Tribunal to hear complaints. A decade after the law passed, Human Rights Watch found that only five regions had committees at all, and that two of those had managed a single monitoring visit each. Not one visit a year. One visit, total. In 2023, an international organization had to step in and secure the release of more than thirty chained patients in the Eastern Region alone. That is a foreign NGO performing an inspection function Ghanaian law assigns to Ghanaian institutions.

A ban that is never inspected is not a ban. It is a press release.

But suppose the state arrived at every camp tomorrow with bolt cutters. We would still face the harder question, the one we keep declining to answer. Where would those patients go?

Ghana has roughly 39 psychiatrists, about 0.13 for every 100,000 people, and more Ghanaian psychiatrists practising outside the country than inside it. Around 2 percent of Ghanaians with a diagnosable disorder receive formal care. An estimated seven in ten of those seeking help go to a traditional or faith healer, and most go there first, because that is where family, pastor and their own understanding of the illness send them.

So let us be honest about what prayer camps are. They are not a fringe competing with our mental health system. For most Ghanaians, they are the mental health system. And the chains are not evidence that faith healers are uniquely cruel. They are evidence that we handed an entire category of medical care to people we never trained, and then expressed shock at what they improvised.

A pastor who sincerely believes a psychotic episode is a spiritual affliction, and who has been given no other tool, will restrain. He will prescribe fasting. He will isolate. He is not choosing the fourth-best option after medication, therapy and referral. He is reaching for the only one he has. Dr Abigail Harding, a psychiatrist at Korle Bu, has been blunt about the cost: chaining, forced fasting and isolation can traumatize patients further, delay effective treatment, and in some cases kill them.

That is a knowledge gap producing a human rights violation. And unlike the psychiatrist shortage, it is fixable inside a single budget cycle.

What makes the omission harder to defend is that Ghana’s own policy already leans on these healers. Act 846 gave the Mental Health Authority a mandate to partner with traditional and faith-based practitioners. The Authority has issued guidelines for negotiating care with them and distributed registers so health workers can track who passes through their doors. Community mental health workers trained at Kintampo learn to sensitize healers as part of the job. We have decided, correctly, that faith leaders are part of the delivery model. We have simply declined to fund the part where we equip them.

The evidence that equipping them works is not speculative. The COSIMPO trial, published in The Lancet in 2020, ran a cluster-randomized study in Kumasi and Ibadan in which traditional and faith healers were trained to work alongside primary health care workers. At six months, patients in the collaborative arm did better on psychotic symptoms and disability than those receiving enhanced care as usual. Harmful practices, chaining among them, fell once healers were engaged and observed at all.

The counter-example is just as instructive. Angela Ofori-Atta’s team ran a randomised trial at the Mount Horeb Prayer Centre in Mamfe, published in the British Journal of Psychiatry, adding psychiatric medication to the normal camp routine. The medicated residents improved meaningfully. They were not unchained any sooner. You cannot deliver drugs into a camp and expect the chains to fall off by themselves. Practice changes only when the healer’s understanding changes and when somebody is checking.

Which is the point. Enforcement and training are not competing strategies here. They are the same strategy. Inspection without a training and referral relationship produces a raid, a news cycle, and a camp that gets better at hiding people. Training without inspection produces goodwill and no accountability. Ghana has attempted each half separately, and we have the results.

Three things would change this. Resource the Visiting Committees in all sixteen regions and give them the mandate, the vehicles and the fuel to arrive unannounced. Fund it with the levy that Act 846 instructed the Finance Minister to prescribe and that no government, across four administrations, has ever laid before Parliament. And attach to every registered camp a trained community mental health officer whose job is not to shut it down but to teach, screen, refer and return.

We have spent nine years treating faith healers as the obstacle to mental health care in Ghana. They are the largest workforce we have. The chains will come off when we finally decide to train them, supervise them, and show up.

By Noah Boakye-Yiadom | [email protected]

The writer is a Ghanaian-Canadian mental health promotion researcher with the University of Calgary.