“It is the devil, not a disease”: Misconceptions, stigma, and mental health in Somalia’s outpatient psychiatric settings

Abstract

In Somalia, a treatment gap exceeding 80% reflects the combined effects of supernatural explanatory models, multi-level stigma and a critically under-resourced mental health system. Misconceptions framing psychiatric illness as jinn possession, divine punishment or medication-induced harm are pervasive and clinically consequential, driving delayed presentation, treatment refusal and nonadherence. Stigma operates simultaneously at individual, family and community levels, each reinforcing the other. This Perspective, grounded in clinical observations from outpatient psychiatric practice in Mogadishu, describes these patterns, situates them within published evidence and proposes actionable, feasible responses: culturally adapted community education, structured psychoeducation as a mandatory clinical step, anti-stigma programming, primary care integration using the WHO mhGAP framework, task-shifting and family-inclusive care. The effectiveness of these interventions must be tested through locally led implementation research.