Innovation summary

In Somalia, like in many low-income countries, mental healthcare consists largely of institutional care in a small number of psychiatric facilities. Conditions are dismal, drugs almost non-existent and mental health services are not available in primary care. In Somalia, it is estimated that 170,000 people with mental health problems are kept in chains.1 The Chain-Free Initiative aims to improve the quality of life of people with mental health problems through combating discrimination and facilitating humane treatments in hospitals, at home and in communities.

Impact summary

  • 1,700 people were released from chains at the Habeb Mental Hospital, from 2007 to 20101
  • 15,109 people with mental health problems have been diagnosed and treated (11/2005 – 08/2013)
  • The Chain-Free Initiative has expanded to all areas of Somalia

"When the doctor requested me to remove the chains, and the wife started to object, I did not know what to do…[however,] as the doctor was insisting to remove [the chains], I had to decide, and I started to remove [them]…to my surprise and the bewilderment of everyone present, the patient stood up and kissed my face."


-Dr Aden Haji Ibrahim, Transitional Federal Government Minister of Health and Human Services


Innovation details

The Chain Free Initiative originated to abolish the use of restrain for people with mental health problems, in hospitals, homes and other environments.

Chain-free hospitals

Removal of chains and reformation of hospital standards.

Chain-free homes

Removal of chains and providing psycho-education, trainings and home-visits.

Chain-free environments

Elimination of invisible chains of stigma and restrictions leading to universal access to opportunities for all people.

The initiative has created capacity building programs for health-workers to enable mental healthcare to be delivered in the community rather than in institutions.

In addition, Habeb Mental Health Foundation provides nutritious meals, housing and access to mental health workers, all features with limited availability for people living with mental health problems.


Professional Training Opportunities

  • Shortage of professional training opportunities and psychiatric diplomas resulting in less than adequate mental health professionals

Lack of Resources and Supplies

  • Shortage of psychotropic medications, equipment, and materials
  • Lack of financial resources


  • Habeb Mental Health Foundation (Somalia)

Evaluation methods

The Chain Free Committee monitors the activities of the Chain-Free Initiative during the last Thursday of every month.

Established in 2007, the committee is responsible for the following monitoring and evaluation activities:

  • Developing the sanitary standard and neediness of the inpatient
  • Understanding the effect of anti-psychosis medication on the patient
  • Investigating human rights violations of the in- and outpatients
  • Investigating the number of remaining chained individuals
  • Monitoring staff trainings on communication and service provision
  • Monitoring psychotropic medications and diet (nutrition and quality) of service user

Cost of implementation

$204,410 USD for implementation of Chain-Free Initiative for one year

Impact details

Between 2007 and 2010 in Habeb Mental Hospital in Mogadishu, more than 1,700 people were released from chains, about 80% of them were from hospitals and 20% from a community-based setting. Currently, no one is chained at this facility.1

The capacity building program has trained 55 health workers, enabling six new community based facilities to be opened to provide an alternative to institutionalized care. These clinics have now treated 15,000 patients.2

The Chain-Free Initiative has expanded to all areas of the country. A national mental health strategy has been developed and the integration of mental health into primary care is on the agenda.


  1. World Health Organization (2013) Building Back Better: Sustainable Mental Health Care After Emergencies. Geneva: WHO Press.
  2. BBC News Magazine (2013) Where Hyenas are used to treat mental illness.
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