In the United States, our prisons remain our largest mental-health system. Rates of anxiety, depression, and other social ills continue to rise across the country, mirroring trends across the developed world. But left out of many discussions of our global mental-health crisis is the profound impact it is having on the Global South, where over 80 percent of the people suffering mental disorders actually live.
In Ghana today, treating mental illness means chaining people indoors, where they are shunned and rendered pariahs by their communities. Misunderstood or misdiagnosed, youth and adults are denied opportunities to live independently, work, or attend school, and stigmatized families seek either to treat or to protect their loved ones by keeping them locked up at home—a method known as “shackling.” Some end up locked in isolated “prayer camps,” often forced to live in squalid conditions and fed concoctions thought to offer a spiritual remedy. Voluntary, appropriate treatment, meanwhile, is virtually nonexistent, and many communities lack awareness of, or misinterpret the symptoms of, mental illness.
Across the Global South, treating mental illness is less than a priority in communities that are often struggling just to provide adequate vaccination coverage, or to contain HIV infection. In poorer countries, threadbare health-care systems are failing to stay staffed with general-practice physicians, and mental-health clinicians are seen as a rare commodity.
Amid these structural barriers, where traditional religious beliefs dominate and public healthcare infrastructure is weak, isolation may be seen as a last resort for recovery, or perhaps a way to conceal a family’s shame. But the underlying culprit is the inability of the mainstream mental healthcare field to promote a diverse, culturally nuanced appreciation of mental illness and neurological disease, and shortcomings of global public health agencies to integrate mental health into a broader long-term development agenda. But solutions must be rooted in local institutions and indigenous cultures as well. Mental health must be confronted by local initiatives that empower the most impacted communities.
Systematic imprisonment of the mentally ill has also plagued Indonesia, where, despite the abolition of such practices in the 1970s, some 18,000 have faced forced confinement in recent years, tied down to their beds, warehoused in animal pens, and branded with public shame. However, under public pressure, the Indonesian government has begun to reform, vowing to provide more psychiatric-treatment resources.