11. Concluding comments


The mission statement of Chainama Hills Hospital is to improve “the mental health status of our patients and the people of Zambia in order to contribute to overall economic development.” This usefully makes explicit the link between upholding the human rights of people with mental health issues and macro-economic development. If a person cannot access supports for their mental health issues, they will likely lose their jobs. Similarly, if a person is harmed by psychiatric hospitals or traditional healers and not provided with access to remedies, they will be traumatised and may not be able to look after their family.

There is widespread acknowledgment among many people from different sectors that mental health services in Zambia – both formal psychiatric services and those provided by the traditional healing sector – have significant shortcomings. Various plans are underway for improvement, including a Mental Health Bill, development of mental health services at the primary healthcare level, and plans to demolish some decrepit psychiatric wards.

A strong argument can and should be made for increasing the tiny amount of spending on mental health services. The budget currently available should be spent in a different way, with more investment into community support services, and into awareness-raising at the grassroots level. Funding an independent inspectorate and ensuring access to justice when things go wrong are both good investment choices which will pay dividends in terms of preventing injustices. Involving a wide range of people with disabilities in law and policy reform as the government rolls out these reforms will reduce the likelihood of gaps and duplication, and will make implementation more likely to be successful.181

Without fundamental changes to the way mental health services are organised, professionals will be forced to continue practices which result in serious human rights violations and which are laid out in detail in this report. Without change, people with mental health issues in Zambia will continue to be denied their basic rights: to health, to liberty, and to freedom from torture, exploitation, violence and abuse.

There is already wide agreement that people are not receiving the care and support they are asking for, because the government’s focus (and the funding) is directed almost entirely to confinement in psychiatric wards where pills and little else are provided. The main message of this report is that the government’s attention and their budgets must be directed towards establishing and maintaining a range of services in community settings.

The government plans to build new mental health facilities. It should think again. Constructing new facilities will recreate segregation where little else beyond a roof and medication will likely be provided. Instead, the government should empower people to make choices about their own lives, including their mental health care. It should provide opportunities for people to live, with choices equal to others, in their community, as set out so powerfully in Article 19 of the UN Convention on the Rights of Persons with Disabilities, which Zambia has ratified.

This report may be the first comprehensive analysis of mental health in Zambia through the lens of human rights. But it is not the first to conclude that community services are the solution. In 2012, the Mental Health Users Network of Zambia and the Zambia Federation of Disability Organizations issued a report about mental health. In this report they say:


[R]emoving people from the community to address their mental health needs through an institutional model often results in breaking the bonds of social support with family, friends, co-workers and community members – relationships which are so fundamental in creating sustainable pathways to health and well-being. Institutionalization in psychiatric facilities often results in a ‘revolving door’ – every time a person has a mental health crisis they end up back in the institution; and in stigmatisation, loss of relationships and little or no long-term recovery. Psychiatric institutions may have little to offer in response to the real needs, and are often accessed only because of the absence of any other mechanism to respond to an individual’s situation. Often the true need is for a person to be supported in regaining his or her place in the community – find a home, lead a life that is meaningful to oneself and develop ways to deal with crisis.182


Zambia has much to build upon including an active mental health service user network, impressive and committed mental health professionals, leaders of traditional healing who are willing to introduce rights-based regulation, and experience of collaboration with civil society which has produced the Mental Health Bill.

Addressing the issues identified with law, regulations, enforcement, attitudes and resourcing gives every person interested in mental health and disability in Zambia the opportunity to uphold and reaffirm their commitment to human rights. Ending abuses in the community, in traditional healing and in psychiatric facilities, and instead rolling out community support services for people with mental health issues will benefit the people of the nation. Zambia can serve as an example to Africa, and beyond.

181 Article 4(3) of the CRPD states: “In the development and implementation of legislation and policies to implement the present Convention, and in other decision-making processes concerning issues relating to persons with disabilities, States Parties shall closely consult with and actively involve persons with disabilities, including children with disabilities, through their representative organizations.”

182 Mental Health Users Network of Zambia (MHUNZA) and Zambia Federation of Disability Organizations (ZAFOD), A Framework for Change: General principles and key concepts and implications for the Mental Health Bill. Pathways to Health, Human Rights and Community-based Supports Protecting and Promoting Legal Capacity and Transforming the Mental Health System in Zambia (draft available to the authors, September 2012), 11.

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