“I was looking down. My house is on the fourth floor. There are tiles and a tree, a cherry tree on the ground. My balcony is made of glass. You have to have one leg inside the aluminum window and one leg outside to clean the glass… I started imagining what it would look like if I threw myself… it would look like I slipped and fell… then I’d feel sorry for my children; thinking that if I died, my children will have a rough life, so I began thinking of killing myself and my children.”  

 

Amira Al-Jamal is 48 years old. She has been living with depression for more than 25 years. Her own family considered her a rebel, including her husband, who was completely unsupportive. In fact, he secretly married another woman while he was still married to Amira. When Amira sought treatment for depression, her husband exposed her to their children and community, and then took her to court to prove she was not fit to be a mother. He won custody of the children.

 

Mental illness remains heavily stigmatized in Jordan. Whether you are diagnosed with something as common as depression, or as rare as schizophrenia, your family will do everything in their power to make sure no one finds out. You may find yourself tied up to the metal bars on your bedroom window, sedated without your consent, taken to a local sheik for exorcism, or left to die in a mental health institution.

 

Human rights violations, including janitors beating patients with mental illness, unnutritious and meagre meals, no privacy and neglecting patient hygiene, are ignored. Family members are commonly allowed to make decisions for the patient and have them sedated, or tied up. Psychiatrists are expected to see up to 60 patients a day compared to only eight in Canada.

 

Paragraph three of Article 467 in the Jordanian penal code states that “any person who has a wild animal, or insane person, and he or she released the animal, or the person shall be fined by five Jordanian Dinars,” Muhanned il-Izza, a Jordanian lawyer and advocate for the rights of people with disabilities, told us. You can imagine the level of stigma in a country where the law equates an individual with mental illness to a dog without a leash.

 

On top of that, many Jordanian psychiatrists refuse to disclose the patient’s diagnosis for years. They also prescribe medication after talking to patients for only two to five minutes. In most cases, doctors will not discuss side effects, or even respond to questions from patients and their families. There have even been reports of doctors shaming patients’ relatives for asking questions about mental illness or medication.

 

Stigma, mistreatment, human rights violations and unaffordable, inaccessible treatment, all contribute to the deplorable environment in which Amira leads Our Step’s operations. With guidance from the World Health Organization, she is now leading the first association in the Middle East that is run by people with mental illness for people with mental illness.

 

Amira believes that people with mental illness need to be integrated into society, fight stigma and lead healthy lives. Through Our Step Association, she is helping people like herself understand their rights, like the right to know their diagnoses and ask for information about their medication and other treatment options. She also teaches them that they have the right to get married, hold a job, spend their own income as they wish and that no one should be making these decisions for them.

 

However, Amira’s job is not easy. Our Step is located in Al-Russeifah, one of Jordan’s poorest and most unsafe neighbourhoods, in a building donated by the Ministry of Health. The building is far from the capital, where most of the association’s members live, and is surrounded by heaps of garbage. Most of those members live at, or below, the poverty line, making transportation to and from the association a big hurdle. It can take up to three hours one way by transit; a challenging feat considering that many attend Our Step’s activities without their families’ knowledge or consent.

 

Our Step has over 110 members despite all odds, though. After spending time at the association, with members in their homes and Amira and her family, we witnessed the difference that this non-profit is making. It is fighting stigma by talking about mental illness and disability. It is teaching people with mental illness and their families about their rights and giving them practical skills so that they can work. Our Step’s message is that people with mental illness can be perfectly functional human beings given the right environment.

 

The association is changing perceptions in Jordan. On World Mental Health Day, we saw its members rubbing shoulders with the Minister of Health, representatives of the kingdom’s royal family, and international NGOs. Our Step Association is recognized as the only organization of its kind in the Middle East. What is worth noting here is that the director of the only public mental health hospital in the country, Doctor Nayel Adwan, stood at the podium to admit that human rights violations against people with mental illness do occur in Jordan, something he denied in an interview with us two weeks earlier.

 

We want to share this story because stigma and prejudice against mental illness exist virtually everywhere. Mental health is a neglected topic that desperately needs strong voices to bring attention to its complex and deep-seated issues. Equally, or even more important though, are the solutions, including initiatives like Our Step.