Benin: Treatment of people with mental illness, including schizophrenics, by society and the authorities (2009-May 2013) [BEN104449.FE]

Research Directorate, Immigration and Refugee Board of Canada, Ottawa

1. Overview

During World Mental Health Day on 10 October 2012, the Minister of Health in Benin stated that

[translation]

according to the comprehensive studies of psychiatric disorders by the Jacquot National Psychiatric Hospital (Centre National Hospitalier de Psychiatrie de Jacquot) in Cotonou and the National Hubert Koutoubou MAGA University Hospital (Centre National Hospitalier Universitaire-Hubert Koutoubou MAGA), individuals diagnosed with depression accounted for 26 and 40 percent of patients, respectively. (Benin [2012]).

In an interview with AfricaMedia21, a pan-African information group with a [translation] "participative" Internet site and Web radio (n.d.), the Director of the Jacquot National Psychiatric Hospital stated that [translation] "depression is the top mental illness requiring treatment and hospitalization in Benin" (AfricaMedia21 13 Oct. 2010). He also stated that 1 percent of the population of Benin suffers from schizophrenia (ibid). Corroborating or additional information about the situation of schizophrenics in Benin could not be found among the sources consulted by the Research Directorate.

2. Treatment of People with Mental Illness by Society

An article published by Podcast Journal, an international journal broadcast by podcasts (Podcast Journal n.d.), indicated the following:

[translation]

In Beninese society, "insanity" is generally considered to be caused by demonic possession or witchcraft rather than an illness. People with mental illness are rejected and mistreated by their families and the general public, and are often forced to resort to violence in order to be accepted and "earn" a living (ibid. 18 July 2010).

In a telephone interview with the Research Directorate, a trained psycho-educator and representative of Friends of St-Camille (Amis de la Saint-Camille) also stated that, in Benin, people with mental illness are associated with witchcraft (Les Amis de la Saint-Camille 24 May 2013). The representative explained that they are not considered to be [translation] "sick" but "possessed by demons" (ibid.). Friends of St-Camille is a Canadian NGO that develops networks of mutual assistance and cooperation in Côte d'Ivoire and Benin; it also supports the Saint-Camille-de-Lellis Association (Association Saint-Camille-de-Lellis), its African partner (ibid. n.d.a).

2.1 Treatment of People with Mental Illness by Their Family

An article on a study conducted by the Psychiatry Training and Research Unit of the University of Parakou at the Borgou Departmental Hospital (Unité de formation et de recherche de psychiatrie de l'Université de Parakou au Centre hospitalier départemental du Borgou) in Benin and published in the Revue internationale des sciences médicales indicated that, of the 54 cases of people with manic episodes surveyed by researchers between January 2003 and May 2011, approximately 39 percent of them received medical treatment, and about 40 percent received traditional or religious care (Tognon et al. 2012, 83, 86). According to the authors of the study, [translation] "this attitude of the patients' families is rooted in the popular beliefs of their culture, which consider mental illness to be a traditional or religious problem" (ibid., 87).

Similarly, the representative of Friends of St-Camille stated that families generally turn to traditional medicine first, which consists of treating the afflicted person with [translation] "potions" or "spells" (Les Amis de la Saint-Camille 24 May 2013). As a second resort, families can call on a [translation] "specialized sect" led by a "pastor who is a self-proclaimed healer" and who offers to take the afflicted persons home to treat them (ibid.). The representative stated that the treatment consists of, for example, flogging the afflicted person in order to [translation] "drive the demon out of their body" and tying them to a tree (ibid.).

He also noted that a person with a mental illness brings [translation] "shame upon the family," and that physical contact with them is very rare because people "are afraid of being contaminated" (ibid.). The representative added that when families have no other choice, those who live in villages will tie the afflicted person to a tree in the forest or out in a field, usually close to a hut so that they are protected from the sun (ibid.). On occasion, the family will take [translation] "table scraps" to the afflicted person, but "no hygienic care is given to them out of fear of catching the illness" (ibid.). In the city, afflicted persons are left to their own devices and [translation] "wander the streets" (ibid.). Corroborating information could not be found among the sources consulted by the Research Directorate.

3. Resources Available to People with Mental Illness

According to a report published by the World Health Organization (WHO), Benin has no law on mental health in particular, and there are no legal provisions concerning mental health in general health legislation or in other laws (UN 2011). The WHO also indicated that there is no official mental health policy, but it is specifically mentioned in the general health policy (ibid.). The WHO also noted that most primary health care doctors and nurses had received no official training on mental health between 2006 and 2011, that most primary health care clinics have no official manuals on the treatment of mental disorders, and that there is no official procedure for referring persons from one level of care to another (ibid.). Additional information corroborating that provided by the WHO could not be found among the sources consulted by the Research Directorate.

According to Podcast Journal, [translation] "mental health is not a primary national concern. The only psychiatric hospital in Cotonou is destitute and owes its survival to the goodwill and commitment of its staff and management" (18 July 2010). Similarly, the representative of Friends of St-Camille also stated that mental health is not considered a government priority (24 May 2013).

However, the representative of Friends of St-Camille noted that people who are ill can be treated at the Jacquot Psychiatric Hospital, located in Cotonou (ibid.). He stated, however, that [translation] "the medication is expensive and patients spend much of their time in cells," and that they are "restrained when agitated" (ibid.). He also indicated that there are few psychiatrists in Benin (ibid.). An article in Adjinakou, a daily newspaper launched in 2003 in Porto-Novo, Benin (PANAPress 5 Dec. 2003), indicated that in 2012 there were 495 patients at the Jacquot Psychiatric Hospital who were being cared for by a team of 44 people, including 2 psychiatrists (Adjinakou 29 Nov. 2012). Moreover, the premises are dilapidated and the equipment is inadequate (ibid.).

People suffering from a mental illness can also use the services of the Saint-Camille-de-Lellis Association, an African charity organization that has been present in Côte d'Ivoire since 1991 and in Benin since 2004 (Les Amis de la Saint-Camille n.d.b). The Friends of Saint-Camille website indicated the following with regard to the Saint-Camille-de-Lellis Association:

[translation]

Ten centres are currently operating in Côte d'Ivoire and five in Benin. The afflicted person is admitted to a nursing centre, diagnosed by a psychiatrist, treated and surrounded by stakeholders (former patients), who provide a healing, loving and rehabilitating living environment. After a few months, and according to each individual's progress, the patient is sent to a Work (or Rehabilitation) Centre in the community to learn a trade and begin their integration into social life. When they are ready, they are then reintegrated into their community of origin (village, neighbourhood). An external network provides medication and medical follow-ups in the community. In 2010, more than 30,000 men and woman benefited from this healthcare organization and are now active in their community. The operation of the St-Camille Association relies solely on donations: no government funding is provided (ibid.).

Nevertheless, according to the representative, the Saint-Camille-de-Lellis Association received a credit of 20,000 Canadian dollars from the Beninese government for the purchase of medication sold by the state pharmacy (ibid. 24 May 2013). The representative went on to state that the Saint-Camille-de-Lellis Association was also offered a plot of land by the municipal authorities in Adjara, where construction of the Saint-Camille Hospital is underway (ibid.).

Additional information on the Association Saint-Camille-de-Lellis or on the other resources available to persons with mental illness in Benin could not be found among the sources consulted by the Research Directorate.

This Response was prepared after researching publicly accessible information currently available to the Research Directorate within time constraints. This Response is not, and does not purport to be, conclusive as to the merit of any particular claim for refugee protection. Please find below the list of sources consulted in researching this Information Request.

References

Adjinakou [Porto-Novo]. 29 November 2012. "Prise en charge des malades mentaux." [Accessed 5 June 2013]

AfricaMedia21. 13 October 2010. Reece Adanwenon. "Bénin : Centre national hospitalier et psychiatrique de Jacquot : 225 malades pour 100 places!" [Accessed 30 May 2013]

_____. N.d. "Qui somme-nous." [Accessed 30 May 2013]

Les amis de la Saint-Camille. 24 May 2013. Telephone interview with a representative.

_____. N.d.a. "Accueil." [Accessed 24 May 2013]

_____. N.d.b. "Présentation." [Accessed 31 May 2013]

Benin. [2012]. Ministère de la Santé. "Journée mondiale de la santé mentale au Bénin : 'La Dépression : une crise mondiale,' le thème retenu pour la célébration." [Accessed 23 May 2013]

PANAPress. 5 December 2003. "'Adjinakou,' 26ème quotidien béninois." [Accessed 5 June 2013]

Le Podcast Journal. 18 July 2010. "Bénin : le chemin de croix des malades mentaux." [Accessed 30 May 2013]

_____. N.d. "Qui sommes-nous?" [Accessed 30 May 2013]

Tognon Tchegnonsi F., A. Djidonou, B. Houinou Ebo, P. Gandaho and D. Kone. 2012. "Les accès maniaques au Centre hospitalier départemental du Borgou (Bénin) : aspects épidémiologiques et itinéraire thérapeutique." Revue internationale de sciences médicales, Vol. 14, No. 1. [Accessed 5 June 2013]

United Nations (UN). 2011. World Health Organization (WHO). "Benin." Mental Health Atlas 2011. [Accessed 5 June 2013]

Additional Sources Consulted

Oral sources: Attempts made to contact the following people and organizations were unsuccessful: Benin – Hôpital Jacquot-Psychiatrique, ministère de la Santé; Euro-Mediterranean Network on Migration and Mental Health; Médecins sans frontières; The World Bank in Benin; World Health Organization; World Psychiatric Association.

Internet sites, including: Africa Intelligence; Africa Presse; Afrique Express; Les Afriques; AllAfrica; Amnesty International; Benin – ministère de la Santé; ecoi.net; Factiva; Freedom House; Human Rights Watch; International Crisis Group; Médecins sans frontières; Minority Rights Group International; Perspectives Psy; Royal African Society; United Nations – Refworld, ReliefWeb; United States – Department of State, Overseas Security Advisory Council; The World Bank in Benin.