In Côte d’Ivoire, popular beliefs associate mental illness with paranormal phenomena or spiritual manifestations. Prayer camps set up by pastors offer care to mentally ill people and their families. In these camps, the "care" provided is not appropriate in terms of the standards and protocols of mental health services. 

According to a 2021 World Health Organization (WHO) study, there were 541 unconventional facilities in the country, including prayer camps. The same study revealed that more than 98% of these non-conventional facilities offer no meaningful mental health services at all. 

"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", says Sabrina*, mother of Kouassy*, 32, who has been living in a prayer camp in Botro for four years. «With prayer, 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.

To support these unconventional centres, the Ivorian government launched the pilot phase of the CAMPSY (Psychological Camp) project in March 2023, in collaboration with the Mindful Change Foundation, through the National Mental Health Programme (PNSM). This initiative offers formal support to prayer camps, deploying mental health professionals to provide quality care to patients, while remaining mindful of their rights. 

About 30 health care workers have been deployed to 10 prayer camps in two health regions, benefiting 104 patients 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 upskilled 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 CAMPSY 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, head of the CAMPSY 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," he adds.

In Côte d’Ivoire, mental health statistics indicate that around 60 000 people with mental illness are receiving treatment in conventional psychiatric facilities. 

WHO is supporting the national strategic plan for mental health, which also includes a focus on neurodevelopmental disorders in children. As such, the Organisation is supporting the training of primary health care staff in surveillance, detection and early intervention in cases of neurodevelopmental disorders in children and adolescents. In line with current 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 the 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 mechanisms and professionals."

After five months of medication and psychosocial treatment, 75 patients continue to be compliant, and their conditions have stabilized. Life in the CAMPSY camps resembles an ordinary community. The residents take care of their surroundings, with some even taking up subsistence farming. This boosts their self-esteem and integration. 

Kouassy is doing better, much to his mother's relief. "Since he started taking the medication, things have changed. His behaviour is no longer the same. My son is calmer and more coherent," says Sabrina. "It's like a rebirth, and I'm hopeful for the future."

*Not real name