Bouake – In Côte d’Ivoire, popular beliefs often associate mental illness with paranormal events or spiritual manifestations. Most people seek care for mental health conditions in prayer camps set up by pastors. However, the “care” provided does not conform to standards and protocols for appropriate mental health services. 

Across the country, there are more than 500 unconventional facilities, including the prayer camps, that offer some care to people with mental health condition, yet over 98% of these facilities have no mental health services at all, a 2021 World Health Organization (WHO) survey found.

Sabrina*, who took her son to one of the prayer camps says she saw little improvement after seeking the services. “My son hasn't been well for six years. When he was evicted from the family home, I brought him here so that the pastor could cure him … he got a little better, but I wasn’t satisfied.”

Côte d’Ivoire has fewer than 100 mental health specialists, including psychiatrists, psychiatric nurses and midwives, for a population estimated at over 29 million. The African region has a severe shortage of mental health professionals, with 0.9 mental health workers per 100 000 people. 

In 2023, Cote d’Ivoire piloted CAMPPSY (Psychological Camp) project in collaboration with the Mindful Change Foundation through the National Mental Health Programme (PNSM) to provide appropriate mental health care in the prayer camps where many people seek help. Through the initiative mental health professionals are deployed to provide quality care and to uphold and protect the rights of people with mental illness.

About 30 health care workers have been deployed to 10 prayer camps in two health regions, benefiting 104 people with disorders including depression, bipolar disorder, epilepsy and psychosis. In camps not yet included in the programme, mobile teams provide appropriate services. A psychologist is available to provide monthly monitoring of patients, and on request.

With the support of WHO, the clinical psychologists, social workers and nurses deployed to these camps have been trained to provide even better care.  

“At first, some parents are opposed to medicating their children. For them, they rate prayer above treatment,” explains Ferrala Tuo, a pharmacy assistant with the CAMPPSY project. “One patient really made an impression on me. On our first visit, he was chained up, and his father was discouraged because his son had been living in this state for nearly three years. After three months of treatment, his condition improved dramatically. Thanks to his example, many people have accepted the treatment, especially as it’s free.” 

For Michel Amani, who heads the CAMPPSY project, human rights remain a priority. “As well as providing medical treatment, we are focusing on promoting human rights. In the past, patients were chained up in the camps and lived in very difficult conditions. Now, their living conditions have improved considerably. They are well-dressed and clean.”  

This focus on mental health is a key priority for WHO. The Organization supports affordable, effective and feasible strategies to promote, protect and restore mental health. 

“The human rights-based approach enables an appropriate response focused on the patient's needs, and not just on the illness or disability,” stresses Dr Ambroise Ané, Noncommunicable Diseases Programme Officer at WHO Côte d'Ivoire. “We emphasize a holistic approach, because people with mental disorders have other health needs.”

WHO is supporting the national strategic plan for mental health, which also includes a focus on neurodevelopmental disorders in children. As such, the Organization is supporting the training of primary health care staff in surveillance, detection and timely care in cases of neurodevelopmental disorders in children and adolescents. In line with WHO guidelines on integrating developmental care into primary health care, Côte d’Ivoire is promoting a community-based approach. 

“The community-based approach is an effective way of combating prejudices and practices that impede appropriate care, such as shackling, confinement and family rejection,” explains Professor Asseman Médard Koua, Coordinating Director of the PNSM. “It aims to mobilize resources to meet the needs of patients, and to involve communities in raising awareness and referring patients to mental health facilities and professionals.”

Just five months of care and adherence to medication, more than 70 people under the CAMPSY pilot mental health care project have seen their condition stabilize. Life in the CAMPPSY centres resembles an ordinary community, with the residents take care of their surroundings and even engaging in subsistence farming. This boosts their self-esteem and integration. 

“Since he started taking the medication, things have changed. His behaviour is no longer the same. My son is calmer and more stable,” says Sabrina. “It's like a rebirth, and I'm hopeful for the future.”

*Name changed to protect identity