Chain-free initiative

Back

Chain-free initiative pilot project in Somalia
Habeb Mental Hospital, progress report May 2008

The chain-free initiative is a new project developed by the World Health Organization (WHO) Regional Office for the Eastern Mediterranean in response to the dire and pressing need to provide support for: hospital reform (chain-free hospitals); the enablement of families and communities to provide improved domestic conditions for people with mental illness (chain-free homes); and the development of community care programmes, raising mental health literacy in the community and among health workers, and ensuring that basic rights are monitored and guaranteed (chain-free environment).  

The chain-free initiative as a pilot project is currently implemented in Somalia in Habeb Public Mental Health Hospital in Mogadishu in collaboration with the Regional Office for the Eastern Mediterranean.

The Habeb Mental Hospital started preparations for implementation of the chain-free initiative in late 2006 but formally undertook the first phase of the initiative in September 2007. In the process, much effort was exerted to improve the condition of the hospital, especially focusing on the quality of services, communicating with people with mental illness and treating them with respect and dignity and conducting capacity-building for staff and families of service users. 

The hospital was cleaned, renovated and maintained to an acceptable standard. Chains were removed from the hospital and patients are no longer chained. 

In addition, the hospital received mental health medical supplies to bridge the treatment gap as treatment was either not affordable by patients or the hospital lacked certain medications.  

Seminars, on-the-job training and awareness-raising campaigns, etc. were organized in order to improve conditions both physically and psychologically within the hospital and among the community. The awareness of hospital staff was raised regarding users’ rights and they received training on how to deal with mentally-disturbed behaviour professionally and humanely. Users and their families were also made aware of their own rights and how to reserve these rights. 

On 13 May 2008, an audit was conducted by WHO Somalia country office to monitor the implementation of the project. Their report stated that there were 208 persons suffering from mental illness in the hospital. Most patients appeared calm, chain-free and at ease. However, the hospital was overcrowded as there were not enough rooms. 

All of this implies that the initiative still needs support for phase 1, and phase 2 should be started immediately to move patients more quickly from the hospital into the community.