5(C). State inaction
It’s not worth reporting being raped.
A woman with mental health issues.
A former patient was abandoned by her family and now lives in a disbanded psychiatric unit. She makes and sells floor mats during the day and returns to the old psychiatric unit in the evening to sleep. “If something happens to her in here, no one will know,” said a psychiatric clinical officer.
The frequency of such attacks is unknown: victims of such assaults typically do not report them to the authorities. Monitors visited the victim protection unit at the central police station to obtain data but were told that the unit receives only cases of domestic violence and does not record mental health issues.63 One woman explained that her daughter, an outpatient of the main psychiatric hospital, was raped and murdered in the community and there was no response from the police. Another woman said that it was not worth reporting being raped as the police would never take her story seriously given her psychiatric history. A clinical officer confirmed that, “[i]f the person is a psychiatric case, the police aren’t involved. Nothing happens.”
Medical care following abuse is scarce. Healthcare services seem to put people with mental health issues at the bottom of the list of priorities (see section 7(G) of the report, below). Attitudinal shifts of healthcare workers have not been found since 2007 when researchers from King’s College London showed low rates of help-seeking and poorer quality of physical healthcare among people with mental illnesses in Zambia.64
Former psychiatric facility in Livingstone closed in October 2013. 29 January 2014 © MDAC
63 MDAC/MHUNZA visit, 6 February 2014.
64 Graham Thornicroft, Diana Rose and Aliya Kassam, “Discrimination in health care against people with mental illness”, International Review of Psychiatry, 19 (2007):113–122. The paper notes that, “[p]eople with mental illness often report encountering negative attitudes among mental health staff about their prognosis, associated in part with ‘physician bias’. ‘Diagnostic overshadowing’ appears to be common in general health care settings, meaning the misattribution of physical illness signs and symptoms to concurrent mental disorders, leading to under-diagnosis and mistreatment of the physical conditions.”