Doris Appiah, 57, has bipolar disorder. In her early twenties, she was sent to an overcrowded psychiatric hospital followed by a “prayer camp” to be treated. She stayed there for five years, at times tied to a wall or forced to fast. Her story is mirrored by thousands of mentally ill people across Ghana, according to a 2 October Human Rights Watch (HRW) report entitled Like a Death Sentence.

The government is trying to update the country’s mental health care laws, starting with the passing of the 2012 Mental Health Act. The act is supposed to improve access to mental health services and prevent abuse. But HRW says the law does not go far enough as it only addresses the formal health sector rather than community-based mental healthcare needs.

Patients with mental health problems are often kept against their will in overcrowded and unsanitary psychiatric institutions.