Community's response to mental illness

MARCO WERMAN:  I’m Marco Werman, this is The World, a co-production of the BBC World Service, PRI and WGBH Boston.  Mental health is more than a medical issue.  It’s also a cultural one.  People from different parts of the world look at mental illness and define mental disorders in different ways.  Coming up we’ll speak with an author who argues that American is foisting its ideas about mental health on the rest of the world.  But first we visit an immigrant community in the United States that has its own way of responding when someone develops severe mental illness.  The affected individual is often put on a plane and sent home, back to Africa.  Some are now questioning this practice for medical and ethical reasons.  Laura Starecheski reports from New York.

LAURA STARECHESKI:  In the West African immigrant community in the Bronx, you’ll find a large man with gold framed glasses.  His name is Ibrahima Diaite.  He’s from Senegal and he’s a go-to guy here.  When people need help finding a job or an apartment, they call him.  He also gets involved in cases of mental illness and what he’s done in those cases now troubles him.  But he was cautioned, don’t talk about it with outsiders.

IBRAHIMA DIAITE:  They told me oh you talking too much.  They don’t want to talk.

STARECHESKI: But he believes it is time to talk about how his community handles people with severe mental illness.  The community repatriates them, sends them back to their home country, even when that’s not what an individual wants.  Diaite’s first experience was a few years after he arrived in New York about 15 years ago.  A friend, he says, had lost touch with reality.

DIAITE: He was completely out of it.  It was difficult to communicate with him.

STARECHESKI: Diaite says it’s hard to know exactly what was wrong with his friend.  It may have been bipolar disorder, perhaps schizophrenia.  Diaite says people in the West African community don’t want anything to do with psychiatric diagnoses, drug prescriptions or therapy sessions  so the community’s response wasn’t to get the friend into treatment in New York.  Instead, Diaite and others went door to door.  They raised money to buy the friend a one way plane ticket to Senegal.

DIAITE: He was okay all the way to the airport.  All the way to the airport there’s no problem.  But he changed his mind there, in the airport, when we got to the airport. So we said well, we’re here.  He said well I don’t want to go no more.

STARECHESKI: Then, the people who had taken the man to the airport started yelling at each other, arguing about how to get him on the plane.

DIAITE: There was so much noise that the police came and asked what was going on.  So we explained to the police, the police said you can’t force this guy to travel in this condition.  If he don’t want to go, he will not go.

STARECHESKI: They did get the man on a plane eventually.  An old teacher of his from Senegal, someone he trusted, flew to New York and convinced him to go home.  A few years later, Diaite was involved in a similar case.  His close friend, Dramane, started having mental problems.  Dramane’s family decided to send him back to Mali.

DIAITE: He didn’t want to go home because he don’t have money.  So I think that they decided to offer him a good package, lot of clothes, money packet, everything so he agreed.

STARECHESKI: Diaite says it was the money that made Dramane change his mind.  He as, in essence, paid to go back to Mali.  Many in Diaite’s community consider it an act of compassion to send someone who is ill back to Africa.  It keeps the person from ending up in an American mental institution or in prison.  Repatriation of the mentally ill can also be driven by pride.  Mamadou Keita heads a community association that assists immigrants from his home country of Mali.  When Malian citizens become mentally ill, Keita’s group helps send them home.  He says if Malians are left to deteriorate, and perhaps end up homeless on the streets of New York, that doesn’t reflect well on their country of origin.

INTERPRETER:  We represent Malian culture in this country.  That’s why when we see things like this, we are ready to act and nip the problem in the bud before it gets bigger.

STARECHESKI: But some in the African immigrant community are reconsidering the ethics of repatriating people with mental illness.  They say the practice is driven by shame.  Zeinab Eyega runs a community center for African women and families in the Bronx.

ZEINAB EYEGA:  People don’t want to associate themselves with a family with those kind of illnesses.  It affects business relationships, it affects social contracts like marriage.  The repercussions are larger.  So that’s why people hide it.

STARECHESKI: And hide the sufferers by putting them on airplanes back to Africa.  Eyega says West Africans are used to placing the good of the community first, before individual rights.

EYEGA:  People don’t think about the legalities and issues around consent.

STARECHESKI: Now, there’s nothing illegal about buying someone a ticket to West Africa and encouraging him to use it.  But Jeanette Zelhof, a New York lawyer who advocates for people with mental illness, says it’s coercive because families are essentially saying get on that plane or you’re on your own.

JEANETTE ZELHOF:  The problem is that they’re not making a free choice.  If they refuse to go back, they will be left without any means of support.

STARECHESKI: And some health advocates worry about what awaits mentally ill immigrants when they arrive back in West Africa.  Julian Eaton is a psychiatrist with an organization called CBM.  It helps people with disabilities in the developing world.  He’s based in Nigeria and he says in West Africa, people with severe mental illness don’t fare well.

JULIAN EATON:  They’re often treated very, very badly and there’s some appalling abuses going on.  They are often put into prison and kept in a place that they’re no trouble to society.  Of course that covers absolutely no benefit on them at all, but it’s just a way of dealing with difficult behavior.

STARECHESKI: Eaton says that immigrants with mental illness in New York would be much better off staying in the U.S. where psychiatrists and mental health clinics are plentiful.

EATON:  I think that sending someone back to an environment where they are not able to receive the kind of medication that we know is needed to keep them well, is a violation of their human rights.  It’s taking away their right to health.

STARECHESKI: Back in the Bronx, Ibrahima Diaite questions his involvement with repatriation.  He wonders if sending his friends home was the right thing to do.  All he’s been able to find out about his close friend Dramande is that shortly after he retuned to Mali, he died.

DIAITE: And he was young.  I think he was about like 31 or 32 years old.  I don’t know what killed him.  I don’t know if he was sick.  I didn’t get no information.

STARECHESKI: And he says he doesn’t know anything about what happened to the other people he helped repatriate.  No one, he says, is willing to talk.  For The World, I’m Laura Starecheski in New York.

WERMAN: Laura Starecheski reported that story as a National Health Journalism fellow at the University of Southern California.

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