Christian prayer camps and healing churches

1. Introduction

Version followed: prayer camps and healing churches as Ghanaian and international scholars (Kpobi and Swartz; Ofori-Atta et al. 2018; Benyah 2024; Ampong 2004), Ghana's Mental Health Authority (as reported) and Human Rights Watch (2012, 2017, 2019, 2022, 2023) describe them. The psychotherapist's own work follows the DSM-5-TR Cultural Formulation Interview (APA) and the two published collaboration trials (Ofori-Atta et al. 2018; Gureje et al. 2020, COSIMPO).

This entry is not a therapy. It covers a living religious healing setting: Christian prayer camps and healing churches in Ghana and elsewhere in West Africa, and their counterparts in diaspora congregations. Human Rights Watch describes the Ghanaian camps as linked to Pentecostal churches and run by prophets, mostly outside government oversight [source: HRW 2012]. A study of ten neo-prophetic pastors from eight Accra churches found that they understood "mental illness" mainly as psychosis. They attributed it mostly to supernatural forces but also to drug misuse and road accidents. Their treatment centred on prayer, anointing oils, holy water and spiritual counselling of patients and caregivers, and they were not opposed to hospital referral when they judged it necessary [source: Kpobi and Swartz, IJMHS vol. 12]. Within the tradition, healing and deliverance are understood as freeing the person from spiritual causes of affliction. In the deliverance literature these causes include demonic influence or possession, witchcraft and ancestral curses, and they are invoked for illness and for life problems such as poverty or delayed marriage [source: Ampong 2004]. These are the tradition's own explanations. They are reported here as its members hold them, neither affirmed nor dismissed.

Change, for the psychotherapist, happens in parallel with the tradition, not through it. The client's religious meaning and community are respected. Their problem is understood in their own terms (the Cultural Formulation Interview and explanatory model). Effective mental-health care is made available alongside faith-based support, and the evidence is that adding it improves symptoms even inside a prayer camp [source: Ofori-Atta et al. 2018; Gureje et al. 2020]. Coercive practices (chaining, caging, forced fasting, denial of medicine) are safeguarding matters, not cultural options. The psychotherapist does not lead prayer, deliverance or any church ritual, and does not judge whether a spiritual diagnosis is true. [synthesis]

A full four-part harm account appears in "Harm account" below. Risks are also flagged where they arise in sections 4 and 5.

2. Framework

The setting and who holds authority

Within the church or camp: the founding prophet or pastor holds authority over admission, practices and discharge. In the Ghana trial, the prophet who founded and led the camp welcomed the clinical team, but camp staff kept every final decision on chaining [source: Ofori-Atta et al. 2018]. HRW reports camps run by "self-proclaimed prophets" operating outside state control [source: HRW 2012]. Denominational oversight bodies (Pentecostal or Christian councils) and their positions on camps are [uncertain: not verified].
What residents receive (as sources describe it): prayer and Bible study, fasting, and residence. In a sanitarium building, residents judged agitated, at risk or likely to leave were chained by one leg [source: Ofori-Atta et al. 2018]. Some camps prohibit prescribed medicine [source: HRW 2012]. The ritual content of prayer, anointing and deliverance belongs to the church and is not described here.
Who goes, and why: families often bring relatives because they believe curses or witchcraft cause the condition, and because community mental-health services are scarce [source: HRW 2019; HRW 2023]. People with chronic illness also seek prayer camps for support and meaning when medicine offers no cure [source: Benyah 2024].
State authority in Ghana: the Mental Health Act 2012 took effect in June 2012 [source: HRW 2012]. It bars torture, cruelty, forced labour and other inhuman treatment of people with psychosocial disabilities, including shackling [source: HRW 2023], and mandates the Mental Health Authority (MHA) to regulate non-orthodox healers in mental-health care [source: WHO-AIMS Ghana 2020]. The Mental Health Regulation, 2019 (L.I. 2385) commenced on 19 July 2019 [source: Judy Legal, L.I. 2385]; WHO-AIMS reports its full implementation was not yet achieved for lack of resources [source: WHO-AIMS Ghana 2020]. The MHA announced the ban on chaining on World Mental Health Day 2017 under Dr Akwasi Osei [source: HRW 2019]. Osei said the MHA would not close prayer camps but would train them as informal actors [source: Peace FM 2017]. The Act provides for regional Visiting Committees and a Mental Health Tribunal. These were only recently set up by late 2022, and HRW reported in 2023 that only five of 16 regions had committees [source: HRW 2022; HRW 2023]; in 2026 the MHA said committees were still not present everywhere intended and could not give a figure for registered prayer camps [source: MyJoyOnline 2026]. Draft guidelines for traditional and faith-based healers were discussed in 2017 [source: HRW 2017]; the WHO-AIMS 2020 report states the MHA developed guidelines for traditional and faith-based (TFB) healers in 2018, covering inpatient accommodation, safety, food and clothing, abolition of chaining and caging, and a ban on forced confessions and flogging, with MHA training of healers through mental-health coordinators in collaboration with the Traditional Medicine Practitioners Council; it also notes abuses still occur despite them [source: WHO-AIMS Ghana 2020]. Their formal title and legal force are [uncertain]; check the current text with the MHA before citing them to a camp or family.

Phases of the psychotherapist's work [synthesis]

No source sets phases or session counts for psychotherapy with clients connected to prayer camps or healing churches. The structure below is synthesis, built on the CFI's design and on the collaboration trials.

Engagement and cultural assessment (sessions 1 to 2): core CFI, plus the Spirituality, Religion and Moral Traditions and Explanatory Model modules as needed. The APA states the modules can be given at first evaluation, later, or repeatedly [source: APA CFI Supplementary Modules]. A time per CFI is [uncertain]. Field-trial clinicians found later interviews took less time [source: Lewis-Fernández et al. 2017]. Move on when you can state the client's own name for the problem, their causal account, their current church or camp involvement and their wishes about it.
Safety and safeguarding screen (session 1, repeated whenever needed): current or past confinement, restraint, forced fasting, withheld medicine, children at risk. If anyone is currently confined or a child is at risk, safeguarding comes before any further phase.
Formulation and shared plan (sessions 2 to 4): distinguish religiously normative experience from disorder (DSM-5-TR and ICD-11 criteria), consult a cultural broker if needed, and agree a plan that names both the clinical care and the spiritual support the client chooses. Move on when the client agrees the plan and any medical assessment has been arranged.
Collaboration (ongoing, only with consent): contact with the pastor or prayer-camp leader the client wants involved, on agreed terms. Skip this phase if the client does not want it, or if the setting uses coercion and will not stop.
Treatment and integration (ongoing, usual length for the presenting disorder): evidence-based treatment for the presenting problem, held within the client's religious frame where they wish. This includes making sense of healing experiences, family work and relapse planning.
Survivor work (where relevant): trauma-informed treatment of the after-effects of confinement, starvation, assault or witchcraft accusation. See "Harm account" below.

3. Guiding principles

Faith is not the problem, coercion is. Practical meaning: respect prayer, church membership and the client's spiritual account, and treat chaining, caging, forced fasting and withheld medicine as rights violations whatever their rationale. [source: HRW 2023; Ofori-Atta et al. 2018; synthesis]
Attribute, don't adjudicate. Practical meaning: record spiritual causes (demons, witchcraft, curses) as the client's or church's explanation, in their words, without stating them as fact or dismissing them. [synthesis]
The client defines the problem first. Practical meaning: begin with the CFI's cultural definition of the problem before giving your own. [source: APA CFI]
Pastors and prophets hold authority within their churches, not over the client's rights. Practical meaning: you may seek a pastor's support for treatment, but you never trade safety away to keep a collaboration. The trial authors themselves note chaining did not fall when the camp kept control over it. [source: Ofori-Atta et al. 2018; synthesis]
Collaboration is optional and consent-based. Practical meaning: contact a church or camp only with the client's informed consent, sharing only what they agree. [synthesis]
Normative religious experience is not pathology, and pathology is not excused by religion. Practical meaning: use DSM-5-TR and ICD-11 cultural exclusions, such as trance or possession "not part of" accepted practice. Don't call shared church experiences psychotic, and don't miss psychosis because the family calls it spiritual. [source: PMC9199574; Lewis 2023 study guide; findacode ICD-11 6B62/6B63; synthesis]
Never advise on medicine. Practical meaning: if a church or family urges stopping medication, or a client is torn, route the question to the prescriber and support the client's own decision-making. [synthesis]
Families are partners and sometimes the source of risk. Practical meaning: involve family through the CFI Informant Version while staying alert to pressure to admit a relative or to accuse a child. [source: APA CFI Informant Version; HRW 2019; synthesis]
Children: safeguarding overrides cultural deference. Practical meaning: any accusation that a child is a witch or possessed, or any deliverance involving harm, triggers normal safeguarding procedures. [source: National FGM Centre, CALFB]
Know the gap that camps fill. Practical meaning: camps are often families' first or only option where services are scarce. Offer real alternatives rather than condemnation. [source: HRW 2019; Peace FM 2017; Benyah 2024]
Self-examination. Practical meaning: notice your own reactions to Pentecostal belief, African religion or the harm reports, whether contempt, romanticism or fear, and bring them to supervision. [synthesis]

4. Intervention inventory

The inventory below is the psychotherapist's own culturally responsive work. Prayer, anointing, deliverance and other church practices belong to the church's own ministers and are not described or performed here. All example language is illustrative.

4.1 Cultural humility and self-examination

Purpose: to reduce the clinician-side bias that leads to either pathologising the client's faith or overlooking abuse. Use it before and throughout the work. [synthesis]
Steps: (1) Before the first session, note what you assume about Pentecostal or prophetic churches, deliverance and African healing, including what the harm reports evoke in you. (2) Ask yourself whether you would treat a mainstream congregation's prayer the same way. (3) In session, state your role and limits plainly: you are not a religious authority. (4) Take recurring reactions, such as contempt, fear or over-identification, to supervision. [synthesis]
Example language (illustrative): "I'm not a pastor, and I won't tell you what's true spiritually. I'd like to understand what your faith means to you, and how it helps or weighs on you right now."
Watch for: the client testing whether you will mock their church, or pulling back when you mention medicine. It is working when the client begins to use their own religious vocabulary freely with you. [synthesis]

4.2 Core Cultural Formulation Interview (DSM-5-TR)

Purpose: to clarify the problem from the client's and their network's perspective: its meaning, sources of help and expectations of care. The APA designed it for any clinician in any setting, and it is not meant to be the sole basis for diagnosis [source: APA CFI; APA DSM-5-TR Section III]. Use it at intake with every client who mentions a prayer camp, healing church, prophet or deliverance.
Steps: Work through the four APA domains in your own words [source: APA CFI]. (1) Cultural definition of the problem: what the client calls it, and how family and church describe it. (2) Cultural perceptions of cause, context and support: causes, stressors and supports (including the church), and the role of cultural identity. (3) Self-coping and past help seeking: what they did, which pastors, prophets, camps or hospitals they consulted, and what got in the way. (4) Current help seeking: what help they want now, and what might affect the relationship with you, such as racism, language or fear of judgement. Clinicians may reproduce the form for use with their patients. Modification or translation needs APA permission [source: APA CFI].
Example language (illustrative): "People describe problems like this in different ways. How would you describe it, and what does your pastor or your family call it?" / "Before coming here, who else did you go to for help, at church, at a camp, or at a hospital? What was that like?"
Watch for: the client giving a 'clinic-friendly' answer to hide a spiritual account they fear you'll reject. Check gently for a second explanation. It is working when the client's own name for the problem and their causal story are in your notes in their words.

4.3 CFI supplementary modules relevant to this setting

Purpose: to deepen the parts of the core CFI that matter most here. The APA lists 12 modules, usable as add-ons or standalone, at first evaluation or repeatedly [source: APA CFI Supplementary Modules].
Steps: Choose by need. Use Spirituality, Religion and Moral Traditions for church role, membership and conflict between faith and treatment. Use Explanatory Model when spiritual causation is central. Use Coping and Help-Seeking for prayer camp or deliverance history. Use Social Network and Psychosocial Stressors for family pressure and poverty. Use Immigrants and Refugees and Cultural Identity for diaspora clients. Use School-Age Children and Adolescents for minors. Use Caregivers, given to the caregiver not the patient, for family members. Use the CFI Informant Version (17 questions) with a relative [source: APA CFI Supplementary Modules; APA CFI Informant Version]. Paraphrase questions. Do not reproduce items in documents beyond permitted clinical use.
Example language (illustrative): "Does your church have a view about this kind of problem, or about coming to someone like me?"
Watch for: conflict between church teaching and treatment, such as the client being told that taking medicine shows weak faith. This is a cue for 4.10 and 4.11. [synthesis]

4.4 Explanatory model inquiry (Kleinman)

Purpose: to make the client's model of the illness explicit so that the treatment plan can be negotiated against it [source: Kleinman, Eisenberg and Good 1978, as summarised in the Tanenbaum handout].
Steps: Ask, in your own words, the eight areas: what they call the problem; its cause; why it started when it did; what it does and how it works; how severe it is and how long it will last; what treatment they think they should get; the main problems it has caused; and what they fear most [source: Tanenbaum handout]. Then summarise their model back to them and say where your clinical understanding overlaps, such as sleep loss or stress. [synthesis]
Example language (illustrative): "You've said this started after a curse was spoken against the family. What do you think would help it most, and what are you most afraid will happen?"
Watch for: models that make a vulnerable family member the cause ("my niece brought this"). That is a possible witchcraft accusation and a safeguarding cue (4.12). It is working when the client corrects or adds to your summary. [synthesis]

4.5 Non-judgemental inquiry about camp and church history, with a harm screen

Purpose: to learn what the client actually experienced in a prayer camp or healing church, and to detect current or past coercion. Use it with every client or family who mentions a camp, prophet or deliverance. [synthesis, informed by HRW 2012 to 2023 findings]
Steps: (1) Ask open questions first: which church or camp, who led it, how long they stayed, what helped. (2) Then ask specifically, without leading, about: being prevented from leaving; being tied, chained or caged; fasting they could not refuse, including going without water; medicines being stopped or forbidden; beating; sexual contact; children in the same setting. These are the practices HRW and the trial authors document [source: HRW 2012; HRW 2022; HRW 2023; Ofori-Atta et al. 2018]. (3) Record what was voluntary and what was not, in the client's words. (4) If anyone is currently confined or a child is involved, move to 4.12 the same day. [synthesis]
Example language (illustrative): "Many people find real comfort at prayer camps, and some have hard experiences there too. Were you ever kept from leaving, tied or chained, or made to go without food or water when you didn't want to?"
Watch for: minimising ("it was for my own good"), shame, or loyalty to the prophet. Coercion may be described in religious terms, for example as fasting for deliverance [source: HRW 2023]. It is working when the client can describe both the comfort and the harm. [synthesis]

4.6 Cultural concepts of distress and the normative-versus-disorder distinction

Purpose: to avoid diagnosing religiously normative experience as illness, and to avoid missing illness that the family frames spiritually. [source: APA DSM-5-TR Section III; synthesis]
Steps: (1) Note that DSM-5-TR includes cultural concepts of distress (idioms, explanations and syndromes) in Section III and revised its examples to avoid stigmatising language [source: APA DSM-5-TR Section III]. The exact DSM-5-TR list is [uncertain]. Whether any West African Christian idiom is among them is [uncertain: not verified]. (2) For possession or trance presentations, apply the cultural exclusions. DSM-5 dissociative identity disorder allows that identity disruption may be described as possession, and excludes disturbance that is a normal part of a broadly accepted cultural or religious practice. Other specified dissociative disorder (dissociative trance) carries a similar exclusion. DSM-5-TR keeps these points in substance, though its exact wording is [uncertain] [source: PMC9199574; Lewis 2023 study guide]. ICD-11 6B62 trance disorder and 6B63 possession trance disorder require the state to be involuntary, unwanted and not part of accepted cultural or religious practice [source: findacode mirror; PMC9199574]. (3) Ask what the client's own congregation regards as normal, and whether the experience is wanted, time-limited and occurs in worship, or is unwanted, persistent and impairing. (4) Look for features that are not explained by shared belief: disorganisation, prolonged sleeplessness, command hallucinations, or beliefs the congregation itself finds strange. The DSM-5-TR note on culturally sanctioned beliefs and psychosis is [uncertain]. (5) Where unsure, consult a cultural broker (4.7) and seek a psychiatric assessment. [synthesis]
Example language (illustrative): "In your church, when someone is touched by the Spirit during worship, what does that look like? How is what's happening to you the same, or different?"
Watch for: pastors in one study equating "mental illness" mainly with psychosis [source: Kpobi and Swartz], so depression or anxiety may go unrecognised by the community. It is working when your differential can name which features are shared religious experience and which are not. [synthesis]

4.7 Cultural brokers and interpreters

Purpose: to get informed context on the client's church tradition and language, without breaching confidentiality. [synthesis]
Steps: (1) Use professional interpreters, not church members or family, for clinical content. The Ghana trial translated consent materials into Twi with back-translation and read them aloud to people who could not read [source: Ofori-Atta et al. 2018]. (2) With consent, consult a cultural broker, such as a chaplain or a colleague from the same tradition, about what is normative in that church. (3) Share only de-identified information unless the client agrees otherwise. [synthesis]
Example language (illustrative): "Would it help if I talked, without using your name, with someone who knows churches like yours, so I understand better?"
Watch for: brokers who hold strong views on deliverance or on psychiatry and steer you. Use more than one source. [synthesis]

4.8 Collaboration with pastors and prayer-camp leaders (only when the client wishes)

Purpose: to let the client keep the spiritual support they value while getting effective care, and to reduce harmful practices. Two trials support this. In Ghana, adding psychiatric care (a psychiatrist and residents, with a community mental health officer giving medication daily) to prayer-camp care lowered symptoms at six weeks, but did not significantly reduce days in chains. The authors called it co-location of services, not integration [source: Ofori-Atta et al. 2018]. In Nigeria and Ghana, collaborative shared care between traditional or faith healers and primary-care workers reduced psychotic symptoms more than usual care, and harmful practices fell from 57% to 9% [source: Gureje et al. 2020, via PubMed abstract mirror].
Steps: (1) Obtain explicit, informed consent from the client, including whom you may contact and exactly what you may share. (2) Learn the leader's model with respect. Pastors in Accra were open to hospital referral when they judged it necessary [source: Kpobi and Swartz]. (3) Agree a clear division of roles: the church provides prayer and pastoral support as it chooses, and clinicians provide assessment, therapy and (through prescribers) medicine. (4) State non-negotiables in writing before any joint working: no chaining, caging, locked rooms, forced fasting, or withholding of medicine or food. These practices are unlawful in Ghana [source: HRW 2019; HRW 2023]. (5) Set a review point. If coercion continues, end the collaboration and move to safeguarding (4.12). The trial authors note that camp control over chaining limited change, and call for government oversight [source: Ofori-Atta et al. 2018]. (6) Never present yourself as endorsing church practices. The trial authors stated there was "neither endorsement nor legitimation of any abusive procedures" [source: Ofori-Atta et al. 2018].
Example language (illustrative), to a pastor with the client's consent: "She values your prayers and wants you involved. Our part is her treatment and checking on her health. Can we agree that if she's distressed, she can always leave or call us, and that nothing will stop her taking what the doctor prescribed?"
Watch for: agreement in meetings but unchanged practice; pressure on the client to choose between church and clinic; your own wish to keep the relationship at the cost of safety. It is working when the client attends both freely and reports no coercion. [synthesis]

4.9 Working with families

Purpose: families often decide on camp admission and may hold spiritual explanations [source: HRW 2019; HRW 2023]. Engaging them early can prevent admission under pressure. Ghana's gender minister stressed engaging families before they refuse to take relatives back [source: HRW 2019].
Steps: (1) With consent, use the CFI Informant Version or the Caregivers module [source: APA CFI Informant Version; Supplementary Modules]. (2) Explore the family's explanatory model and their fears, including stigma, cost and safety at home. (3) Offer concrete alternatives: crisis contacts, community services, respite. (4) Name any plan to confine or restrain a relative as unsafe and unlawful. (5) Hear accusations against a child or another relative as a safeguarding cue, not as information to discuss with the accused. [synthesis]
Example language (illustrative): "You're exhausted and frightened for him, and the camp felt like the only option. Let's look at what else could keep him and the rest of you safe."
Watch for: family members speaking for an adult client; the client agreeing in front of family and saying something different alone. Interview separately as well. [synthesis]

4.10 Medication conflicts: routing to the prescriber

Purpose: some camps prohibit medicine even when a doctor prescribes it [source: HRW 2012]. Clients may also be told that medicine conflicts with faith. You do not advise starting, stopping or changing any medicine. [synthesis]
Steps: (1) Ask what the client has been told and what they themselves want. (2) Tell them that any change belongs with their prescriber, and offer to help them prepare questions. (3) With consent, inform the prescriber of the conflict. (4) If medicine is being withheld from someone against their will, treat it as a safeguarding issue (4.12). [synthesis]
Example language (illustrative): "That's a real dilemma between your pastor's advice and your doctor's. I can't advise on the medicine itself, but I can help you talk it through with your doctor so you can decide."
Watch for: abrupt stopping announced as a test of faith; relapse signs after a deliverance session or a fast. Liaise with the prescriber. [synthesis]

4.11 Integrating faith and healing experiences into treatment

Purpose: prayer camps can give people with chronic illness support, meaning and a way to manage identity when cure isn't available [source: Benyah 2024]. Integration helps the client keep what sustains them. [synthesis]
Steps: (1) Ask what a healing experience or deliverance meant to them, without evaluating its spiritual truth. (2) Identify the sustaining elements: community, hope, a sense of being prayed for. (3) Link them to treatment goals, for example church attendance as behavioural activation or social support, and the client's own faith-based coping in relapse plans. (4) If the client felt shamed, for example told their illness came from sin or that they "didn't have enough faith" when they weren't healed, explore this as a possible source of guilt or spiritual distress. [synthesis]
Example language (illustrative): "What from your time at church helps you most now? How could we make room for that in your plan?"
Watch for: spiritual struggle after an expected healing does not occur. It is working when the client describes faith and treatment as compatible on their own terms. [synthesis]

4.12 Safeguarding and reporting for adults

Purpose: to act on chaining, caging, locked confinement, forced fasting, denial of food, water, sanitation or medicine, beating or sexual violence. HRW documents all of these in Ghanaian prayer camps, and the UN Special Rapporteur on torture has said shackling amounts to torture even by non-state actors [source: HRW 2012; HRW 2022; HRW 2023].
Steps: (1) Establish facts: where, who, current or past, and who else is at risk. (2) Discuss options with the client and support their choice where they have capacity, unless others such as children are at risk or the law requires reporting. (3) In Ghana, the bodies responsible include the Mental Health Authority and, under the 2012 Act, the regional Visiting Committees and the Mental Health Tribunal [source: HRW 2022; HRW 2023]. Police and emergency routes apply to immediate danger [synthesis]. (4) Elsewhere, follow local adult-safeguarding and mandatory-reporting law [synthesis]. (5) Document carefully and get supervision.
Example language (illustrative): "What you're describing, being chained and kept without food, is against the law in Ghana and isn't something anyone should go through. Can we talk about what you'd like to happen, and who needs to know so others there are safe?"
Watch for: fear of spiritual consequences or family rejection if the client reports. Address these directly and plan for safety. [synthesis]

4.13 Child safeguarding: witchcraft and possession accusations

Purpose: child abuse linked to faith or belief (CALFB) includes physical abuse (beating, burning, tying up), emotional abuse (telling a child they are a witch or possessed, threats of abandonment), neglect (withholding medical care or food), and sexual abuse, including sexually abusive "deliverance" [source: National FGM Centre, CALFB]. HRW found children under 10 forced to fast in camps, and girls held in cages [source: HRW 2012; HRW 2022]. UNICEF reports that accusations usually affect children already vulnerable in multi-crisis settings [source: UNICEF 2010 (catalogue page)].
Steps: (1) Treat any statement that a child is a witch, possessed or has brought misfortune as a risk indicator. (2) Follow normal safeguarding procedures, stating your concern that this may be abuse linked to faith or belief and why [source: National FGM Centre, CALFB]. (3) Do not confront the family about the belief before safeguarding advice, which could raise risk. (4) Seek the child's assent and age-appropriate participation. Use the CFI School-Age Children and Adolescents module where you are the child's clinician [source: APA CFI Supplementary Modules]. (5) Never name minors in records shared beyond need. [synthesis]
Example language (illustrative), to a parent: "You're worried something spiritual is affecting your son. I need to make sure he's safe while we understand what's happening. That means I'll be talking with colleagues whose job is to support children and families."
Watch for: a child scapegoated after a family misfortune, withdrawn, hungry, injured or missing school; the abuse most often happens at home [source: National FGM Centre, CALFB].

4.14 Diaspora healing churches

Purpose: clients in African diaspora congregations may consult prophets or deliverance ministries in their new country or be sent back to camps in their country of origin. UK safeguarding counts 1,460 CALFB-linked assessments in the 2016/17 Children in Need Census [source: National FGM Centre, CALFB]. [synthesis on application]
Steps: (1) Use the Immigrants and Refugees and Cultural Identity modules [source: APA CFI Supplementary Modules]. (2) Ask about plans for travel to a camp, especially for a relative with psychosis or a child. (3) Recognise that most congregations do not abuse, and look for the specific features in "Recognising it today" below. (4) Apply local safeguarding law, including for planned removal abroad. [synthesis]
Example language (illustrative): "Has anyone in the family talked about taking you, or someone else, back home to a prayer camp for healing?"
Watch for: sudden travel plans; a family member "going home for prayer" with no return date. [synthesis]

4.15 Trauma-informed care for survivors of camp confinement or accusation

Purpose: to treat the psychological after-effects of chaining, starvation, isolation, sexual violence or accusation (see "Harm account" below). [synthesis]
Steps: (1) Assess for PTSD, depression, and shame or spiritual injury, separately from the original presenting condition. (2) Give choice and control in sessions, since confinement removed both. (3) Use an evidence-based trauma therapy matched to the diagnosis, held within the client's faith frame if they wish. (4) Address spiritual conflict, such as anger at a prophet versus love of the church, without asking the client to give up faith. (5) Medical review for consequences of malnutrition or injury. [synthesis]
Example language (illustrative): "You can stop or pause anytime here. Nothing will happen to you in this room that you haven't agreed to."
Watch for: re-traumatisation from locked doors, restraint in hospital, or enforced routines. Check before any inpatient admission. [synthesis]

4.16 Addressing stigma and service gaps

Purpose: camps fill gaps where community mental-health services are scarce [source: HRW 2019; HRW 2023]. Clients may have met racism or dismissal in services. [synthesis]
Steps: (1) Ask about prior experiences of services, using CFI domain 4 [source: APA CFI]. (2) Make access easier: crisis contacts, help with cost and transport where possible. (3) Recognise that spiritual help-seeking is often rational given what is available. [synthesis]
Example language (illustrative): "Some people have felt looked down on in clinics because of their faith. Has that happened to you? I want this to be different."
Watch for: dropout after a single visit; follow up proactively. [synthesis]

5. Handling problems

The sources do not address psychotherapy process problems in this setting. Everything below is [synthesis] unless a source is tagged.

The client wants spiritual help only and sees therapy as unnecessary. Respect it. Ask what would show the spiritual help is working, agree a check-in, and keep the door open. If psychosis or risk is present, explain plainly why a medical assessment matters, and involve family or a supportive pastor with consent. Pastors in one Accra study accepted hospital referral when they judged it necessary [source: Kpobi and Swartz], so a pastor may be an ally in this.
The client asks you to pray with them or to confirm a spiritual diagnosis. Decline gently, state your role, and affirm their freedom to seek prayer from their own minister. "I'll leave the spiritual side to your pastor. My part is helping with the sleep and the fear." (illustrative)
Rupture: the client thinks you are against their church. Name it, apologise for anything dismissive, and restate the principle that faith is not the problem and coercion is. Return to their explanatory model (4.4).
Stuck: the client attributes every setback to spiritual attack and disengages from treatment. Work within the frame. Ask what in their tradition helps a person stand firm while waiting for healing, and link that to the treatment tasks. Check for depression and spiritual distress (4.11).
Non-adherence to medicine after church advice. Do not advise on the medicine. Route the issue to the prescriber, support the client's informed choice, and watch for relapse (4.10). If medicine is being withheld against someone's will, treat it as safeguarding (4.12) [source: HRW 2012 on camps prohibiting medicine].
The family insists on admitting a relative to a camp. Explore what they fear, offer concrete alternatives and crisis plans, and state clearly that chaining, caging and forced fasting are unlawful in Ghana [source: HRW 2019; HRW 2023]. If the person lacks capacity or is a child, follow safeguarding and legal procedures.
The client discloses past camp abuse but refuses any report. For an adult with capacity and no others at current risk, respect the decision and keep offering options. If others, especially children, are still held, discuss your duty and consult supervision or legal advice on whether you must report.
The client is currently held, or calls from a camp. Treat this as an emergency: find out where they are, whether they are free to leave, and who can reach them. Contact emergency services or the responsible authority in that country (in Ghana, the Mental Health Authority) [source: HRW 2022; HRW 2023 on authority roles].
A collaboration with a camp leader produces agreement but no change. The trial authors found that chaining did not fall while camp staff kept control over it [source: Ofori-Atta et al. 2018]. Set a time-limited review. If coercion persists, withdraw and report. Do not keep a collaboration that lends legitimacy to abuse.
Overwhelm after recounting confinement or accusation. Slow down, ground, give control over pacing, and move to stabilisation before trauma processing (4.15).
Diagnostic uncertainty between religious experience and psychosis. Avoid deciding alone: get a cultural broker's view and a psychiatric assessment, and observe over time (4.6, 4.7).
Your own moral distress or beliefs. If you share the client's tradition, guard against colluding with harmful beliefs or imposing your own church's teaching. If you are hostile to it, guard against contempt. Use supervision (4.1).
Interpreter or broker from the same congregation. Confidentiality and pressure risks are high. Use an independent professional interpreter (4.7).
Child accused, but the family denies harm. Do not argue the belief. Follow safeguarding procedures and record the exact words used [source: National FGM Centre, CALFB].

Harm account

This account covers practices documented in some Ghanaian prayer camps and healing centres, and abuse linked to faith or belief more widely. It does not describe all churches or camps. Several sites named below are traditional (non-church) healing centres, and this is noted where so.

What was actually done

2012, eight prayer camps (Human Rights Watch, "Like a Death Sentence"): HRW conducted more than 170 interviews across three psychiatric hospitals, eight prayer camps and the community. At the camps, nearly all residents were chained by the ankles to trees. They slept, urinated, defecated and bathed there, some for up to five months. Residents, including children under 10, were routinely made to fast for weeks, usually beginning with a period of about 36 hours without water. Some camps prohibited medicine even when a doctor had prescribed it. Healing was framed as miracles, consultation with "angels" and spiritual healing. At Heavenly Ministries, people were chained to walls in individual cubicles and could not leave without staff permission. HRW reports that one adult woman spent more than ten years between camps and hospitals, was tied with ropes for over two months, and was made to take local herbs that harmed her tongue. HRW found conditions in camps worse than in the psychiatric hospitals, and noted that the 2012 Mental Health Act did not then cover camps [source: HRW 2012].
2015: the UN Special Rapporteur on torture visited Ghana and said shackling amounts to torture even when committed by non-state actors [source: HRW 2023, reporting the Rapporteur].
2017, Nyakumasi Prayer Camp, Central Region: in April, HRW counted more than 15 people in shackles. On 30 June 2017 the Mental Health Authority released 16 people, including two girls, and took them to Ankaful Psychiatric Hospital [source: HRW 2017]. Elsewhere at the time, people were reported to have been chained to trees for years, forced to fast and given little or no medical care [source: Peace FM 2017]. The ban on chaining was announced on World Mental Health Day 2017 [source: HRW 2019].
Ghana trial camp (Mount Horeb, near Accra, Evangelical Pentecostal), around 2016 to 2017: the camp's 2012 mission statement spoke of setting free "those held captive by Satan" through fasting and prayer. At admission, residents fasted for up to three weeks on minimal food. In the "sanitarium" building, residents judged agitated, at risk of harm or likely to leave were chained by one leg to the floor with a short chain, with staff giving food, water and hygiene help. Admissions were described as voluntary, though families may have pressed people to enter [source: Ofori-Atta et al. 2018].
2019, six prayer camps and traditional healing centres (Greater Accra, Eastern, Central): at one traditional healing centre, 16 men were held in a dark, stifling room with short ankle chains. At a prayer camp, men were kept in cages too narrow to stretch their arms and used buckets outside their cells. At two other facilities, people were not chained but were denied food for up to seven days, on the belief that fasting makes healing through prayer possible. Nyankumasi residents remained unchained and the camp then referred crises to the psychiatric hospital [source: HRW 2019].
2022, five sites (Eastern and Central regions): HRW found more than 60 people chained or caged, including children, some for more than seven months. At Edwuma Wo Wo Ho Herbal Center (a traditional herbal centre, Senya Beraku), 22 men wore short ankle chains in a dark room, shared a bucket passed around the room, and bathed only every two weeks. About 30 more were in a section researchers were blocked from. At Mount Horeb Prayer Centre (Eastern Region), people were locked in a room 24 hours a day. At Jesus Divine Temple Prayer Camp (Nyankumasi), several people were chained again, reversing the 2017 release. At Heavenly Ministry Prayer Camp (Edumfa), eight men, five women and two girls were held in cages. One woman reported repeated sexual violence at a camp and no post-rape care [source: HRW 2022].
2023, two prayer camps (Eastern Region, 19 to 23 October): at Mt. Horeb Prayer Centre, Mamfi, a staff member told colleagues to "clean things up" when the researcher arrived, and chains were later found on the ground. A 19-year-old woman had been chained for two weeks in a poorly ventilated room, with fasting as her prescribed treatment for "deliverance." A man had been chained for two months. Residents reported constant hunger and some appeared emaciated. People were held in stalls, a "VIP" room, or a windowless "condemned" room for those in acute states. The camp's leader, a prophet, said prayer and fasting are his interventions. He attributed psychosocial disabilities to ancestral curses, evil spirits or a relative who had been a traditional priest or priestess. A long-term resident said people are also sent there for drug use and same-sex sexual activity. At Pure Power Prayer Camp, Adeso, nine people, including one woman, wore short ankle chains and shared a small bucket as a toilet, and one man was chained under a tree [source: HRW 2023]. Whether the Mount Horeb sites in the trial and in the 2022 and 2023 reports are the same camp is [uncertain: not verified].
Children accused of witchcraft or possession (Africa and diaspora): forms of abuse include beating, burning, cutting, tying up, rubbing irritants on eyes or genitals, isolation, threats of abandonment, being told they are a witch or possessed, withheld food or medical care, and sexually abusive "deliverance" [source: National FGM Centre, CALFB]. Accusations usually fall on already vulnerable children in multi-crisis settings [source: UNICEF 2010 (catalogue page)]. The specific role of individual churches or prophets in these accusations is [uncertain: not verified].
Deaths: specific deaths in prayer camps, with dates and places, are [uncertain: not verified].

How it caused harm

Deprivation of liberty and torture: chaining, caging and locked rooms are indefinite detention and ill-treatment [source: HRW 2023]. HRW's disability rights director called chaining "a form of torture" [source: HRW 2022], and the UN Rapporteur considered shackling torture [source: HRW 2023].
Starvation and dehydration: forced fasting, including periods without water and fasts imposed on children, caused constant hunger and visible emaciation [source: HRW 2012; HRW 2023].
Exposure, sanitation and infection risk: people slept and excreted where they were chained, shared buckets, bathed rarely, and lived in unventilated rooms or outdoors [source: HRW 2012; HRW 2022; HRW 2023]. The specific medical consequences are [synthesis].
Denial of effective care: medicine was prohibited in some camps, and symptoms persisted untreated [source: HRW 2012]. In the trial, adding psychiatric care improved symptoms, which implies a treatment gap without it [source: Ofori-Atta et al. 2018].
Sexual violence: one woman reported repeated rape and no post-rape care [source: HRW 2022]. Sexually abusive "deliverance" is a recognised form of CALFB [source: National FGM Centre, CALFB].
Herbal harm: forced herbal intake damaged one woman's tongue [source: HRW 2012].
Psychological sequelae: Systematic data on these are [uncertain: not verified]. Expected consequences of prolonged restraint, starvation, isolation and accusation include trauma symptoms, shame, fear of help-seeking and spiritual injury [synthesis].
Who was most at risk: people with psychosis or behaviour judged disruptive [source: Ofori-Atta et al. 2018]; children, including girls caged with adults [source: HRW 2012; HRW 2022]; women, at risk of sexual violence [source: HRW 2022]; people sent for drug use or same-sex sexual activity [source: HRW 2023]; and families without access to community services [source: HRW 2019].

Recognising it today

Features: a "sanitarium," "condemned" room or separate locked building for disturbed residents; chains, ropes, cages or stalls; buckets for toilets; fasting "for deliverance" that a person cannot refuse; rules forbidding medicine; staff deciding when someone may leave; admission arranged by family rather than the person [source: HRW 2012; HRW 2022; HRW 2023; Ofori-Atta et al. 2018].
Phrases and rationales: chaining framed as preventing escape or harm to self or others [source: Peace FM 2017; Ofori-Atta et al. 2018]; illness framed as spiritual attack, curse or witchcraft requiring prolonged fasting [source: HRW 2023; Peace FM 2017]; a child said to be a witch or possessed or to have brought misfortune [source: National FGM Centre, CALFB].
Concealment and relapse: staff hiding chains during visits, re-chaining after releases (Nyankumasi, 2022), and leaders saying chaining has ended [source: HRW 2022; HRW 2023]. Treat assurances as needing verification [synthesis].
Red flags in a colleague, programme or congregation: "collaborations" that leave coercion in camp hands; clinicians referring to camps without checking conditions; diaspora congregations proposing to send a relative or child home for camp healing; deliverance involving undressing, isolation or physical force [source: Ofori-Atta et al. 2018; National FGM Centre, CALFB; synthesis].
How legitimate versions differ: voluntary attendance with freedom to leave; prayer and pastoral support without restraint or food deprivation; medicine allowed; referral to hospital in crisis, as Nyankumasi reportedly began doing [source: HRW 2019]; and pastors who accept referral when needed [source: Kpobi and Swartz].

What to do instead and how to help those harmed

Safer alternatives: collaborative shared care between faith or traditional healers and primary-care workers, which reduced symptoms and harmful practices in the COSIMPO trial [source: Gureje et al. 2020, PubMed abstract mirror]; co-located psychiatric care with explicit non-negotiables on coercion [source: Ofori-Atta et al. 2018; synthesis]; rights-respecting community mental-health services with housing, independent-living and job support [source: HRW 2019; HRW 2022; HRW 2023]; training of faith and traditional healers in rights-based approaches, such as WHO QualityRights e-learning, launched in Ghana in 2019 [source: HRW 2019], and the Mental Health Society of Ghana's training [source: HRW 2023].
Assessment of affected clients: use the CFI and harm screen (4.2, 4.5); assess PTSD, depression, psychosis, substance use and spiritual distress; arrange medical review for consequences of malnutrition, injury or sexual violence [synthesis].
Treatment: trauma-informed, choice-centred care (4.15); integrate the client's faith where they wish (4.11); avoid restraint and seclusion where possible, given re-traumatisation risk [synthesis].
Ethical, reporting and legal duties: in Ghana, the 2012 Mental Health Act bars inhuman treatment including shackling, and the MHA, Visiting Committees and Mental Health Tribunal are responsible [source: HRW 2022; HRW 2023]. Ghana ratified the UN Convention on the Rights of Persons with Disabilities in 2012 [source: HRW 2012]. For children anywhere, follow normal safeguarding procedures and name the concern as possible abuse linked to faith or belief [source: National FGM Centre, CALFB]. Elsewhere, local adult-protection and mandatory-reporting law applies [synthesis]. Never name minors in shared documents, and document survivors' accounts accurately with consent [synthesis].

Sources

Web sources:

Papers and books cited:

Ofori-Atta A, Attafuah J, Jack H, Baning F, Rosenheck R; Joining Forces Research Consortium. Joining psychiatric care and faith healing in a prayer camp in Ghana: randomised trial. British Journal of Psychiatry, published online 4 January 2018; 212(1); doi 10.1192/bjp.2017.12. NCT02593734.
Gureje O, Appiah-Poku J, et al. (2020). Effect of collaborative care between traditional and faith healers and primary health-care workers on psychosis outcomes in Nigeria and Ghana (COSIMPO): a cluster randomised controlled trial. The Lancet. Published 28 August 2020; ClinicalTrials.gov NCT02895269.
Kpobi LNA, Swartz L. 'The threads in his mind have torn': conceptualization and treatment of mental disorders by neo-prophetic Christian healers in Accra, Ghana. International Journal of Mental Health Systems 12. The year is [uncertain].
Benyah FEK (2024). Healing the incurable? Pentecostal prayer camps and healing of chronic illnesses in Ghana. Mission Studies 41(2):173–194. doi 10.1163/15733831-12341962.
Ampong EA (2004). Deliverance in Ghanaian neo-pentecostal ministries: a critical assessment from an evangelical perspective. Master's thesis, Stellenbosch University.
Human Rights Watch (2012). "Like a Death Sentence": Abuses against Persons with Mental Disabilities in Ghana. 84 pp.
Kleinman A, Eisenberg L, Good B (1978). Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine 88:251–258.
Lewis-Fernández R, Aggarwal NK, Lam PC, et al. (2017). Feasibility, acceptability and clinical utility of the Cultural Formulation Interview. British Journal of Psychiatry 210(4):290–297.
American Psychiatric Association (2022). DSM-5-TR, Section III: Culture and Psychiatric Diagnosis.

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