Mental Health Laws Ignore Traditional Care In Africa: Insights From 5 Countries

When Idoko, a 23-year-old man living in rural Benue State, north central Nigeria, began hearing voices, withdrawing from family and speaking incoherently, his family’s first call was not to a psychiatrist. They took him to a local faith-based prayer group, where members pray over people believed to be afflicted by spiritual forces. When he showed no signs of recovery, the clan head advised them to take him to a renowned traditional healer.

Idoko was chained to a tree for the first six weeks, and was given doses of a herbal concoction prepared by the traditional healer. His condition improved, and by the fourth month, he was sent home with a long list of instructions. He relapsed after a couple of months and was eventually referred to a specialised psychiatric hospital more than 200km away. I met Idoko in Benue State more than a decade ago and have followed his story since. I have permission to use his story.

This is not an unusual story. Depression, anxiety, psychosis and substance use disorders affect nearly 150 million people on the continent. Yet the majority receive no formal care – partly because there is hardly any available. Millions of people are receiving care, or being held, in settings the law does not see. For many across Africa, prayer camps, traditional healers and community elders are the first port of call during a mental health crisis. Many patients have suffered serious human rights violations in these settings.

My colleagues and I are researchers specialising in law, policy and coercive practices in mental health care, working at the intersection of global mental health, human rights and health systems.

We recently conducted research looking at mental health legislation in five African countries: Cabo Verde, Egypt, Ghana, Kenya and Nigeria.

Our findings show that in all the five countries, mental health laws are being reformed to align with international human rights standards. This is important because colonial-era mental health laws across Africa treated people with mental health conditions primarily as subjects of detention, often with little regard for their dignity or wishes. Reform replaces this coercive approach with consent-based care that respects individual autonomy, creates legal accountability, reduces stigma and improves access to services.

However, we also found that the laws largely ignore how most Africans access care. Traditional healers and prayer camps remain outside formal legal frameworks despite serving millions, while poverty blocks access to voluntary psychiatric services.

We conclude from our findings that mental health laws need to reflect reality. Legal frameworks that only regulate formal psychiatric facilities are written for a system the majority will not use. When formal services are scarce and expensive, people go where care is available, familiar, and culturally meaningful. The law has very little to say about those places.

Read more: How indigenous and faith healers approach mental health in Ghana

What we did

Our research used comparative legal analysis, examining the texts of mental health legislation alongside policy documents across the five countries representing different regions, languages and colonial histories.

All, except Kenya, have repealed outdated colonial-era laws that treated psychiatric patients primarily as subjects of detention. The new laws include provisions that reflect international human rights standards, involuntary admission as a last resort, rights to appeal detention, and prohibitions on using restraints as punishment.

Nigeria’s new Mental Health Act requires 48 hours of prior medical care before implementing coercive measures. Ghana goes further by including people with lived experience of mental health problems on review panels that decide whether detention is justified.

However, these progressive laws are built around a model of care consisting of only formal, hospital-based psychiatric services delivered by trained clinicians. This barely exists in practice.

For example, Nigeria has roughly 306 psychiatrists for a population of over 200 million people. Ghana, Kenya and Cabo Verde face similar shortages with 39, 115 and 7 psychiatrists for 33 million, 55 million and half a million people respectively.

Over 25% of the population in four of the five countries live in extreme poverty. Cabo Verde is the exception, with 4.6% of its population living in extreme poverty. When psychiatric services require out-of-pocket payment, voluntary care becomes inaccessible for most people. Involuntary admission, supposed to be a measure of last resort, becomes the main pathway to formal mental health care. And even this pathway is available only to families with enough money to pay for it.

Across all five countries, traditional healers, faith healers and prayer camps serve as the primary accessible option for families facing mental health crises. These practitioners are trusted, affordable and culturally familiar.

Yet only Ghana’s Mental Health Act acknowledges their existence, requiring collaboration with the Traditional and Alternative Medicine Council.

Read more: Why Africa needs to invest in mental health

Why human rights matter in mental health care

The consequences of weak rights protections in mental health care are severe.

Human Rights Watch has documented cases of people being chained in prayer camps, denied food, and subjected to conditions that amount to abuse. Since these places fall outside formal legal frameworks, there is no mechanism to inspect them, regulate conditions, or protect the people inside.

Simply condemning these spaces misses the point. For many, they offer community and spiritual support that psychiatric hospitals do not. The failure is not that these places exist. The failure is that the law has never seriously tried to engage with them.

Poverty deepens the problem. Even where formal psychiatric services exist, the costs, transport, fees and lost wages are beyond the reach of most families. Voluntary care only works when people can choose to access it. When distance and poverty make that choice impossible, the right to voluntary treatment means nothing in practice.

There is also a deeper tension. International frameworks like the UN Convention on the Rights of Persons with Disabilities place individual autonomy at the centre. In many African societies, however, major health decisions are understood as collective family responsibilities, a value captured in the widespread African philosophy that “a person is a person through other persons”.

All five countries require family notification for involuntary admissions, reflecting these communitarian values. But none has resolved the tension between protecting individual autonomy and respecting traditions of collective care. No country provides for advance directives that would allow individuals to specify their treatment preferences ahead of time.

Read more: Colonial powers tried to stifle traditional healing in Zimbabwe. They failed and today it’s a powerful force for treating mental illness

Moving forward

Governments need regulatory frameworks that apply to traditional healers, prayer camps and community-based care, not to ban them, but to establish minimum safety standards, prevent people from being held without oversight, and create referral pathways to clinical care when needed.

Reform agendas must address poverty directly. Expanding voluntary mental health services is a worthy goal, but it requires removing financial and geographic barriers.

Mobile outreach services, community health workers trained in basic mental health support, and removing user fees for mental health care are practical steps governments can take now.

People with lived experience of mental health conditions, and the families and communities who care for them, must be central to law reform. Laws written primarily by psychiatrists and lawyers tend to reflect the realities of clinics and courtrooms, not rural households.

Africa’s mental health reform movement is commendable but laws that look past the places where most people actually seek help will remain good laws for a small number of people, while millions remain without human rights protection.

Deborah Aluh is affiliated with University of Nigeria Nsukka and the University of Greater Manchester