Reflections On the Mental Health Situation in Ghana

by: Badimak Peter Yaro

Ever since the findings of the undercover investigation recently carried out at the Accra Psychiatric Hospital – Ghana’s leading mental hospital were made public, discourse on mental health, which has long been neglected, suddenly became a topical issue discussed by most sections of the Ghanaian public.

The published report on the investigations induced some knee-jerk ministerial reactions which in themselves are good but further displays the kind of fire-fighting we do with very important issues that surely impact our national development.

For those of us who have been in mental health doing our bit to bring some improvement in the lives of people with mental illness or epilepsy and their care-givers and families, this makes the adventure of the investigative journalists (Anas Arimiyaw Anas) unearthing the various issues and practices that go on in the hospital (ranging from physical beatings and unnecessary sedation of patients, over-crowding and unsanitary conditions, pilfering of food items meant for the inmates, as well as insensitivity and/or unprofessional conduct on the part of some of the workers of the hospital) immensely important.

Brief History of Mental Health in Ghana

Any discussion of the current mental health situation in Ghana needs to be situated within an historical context. Literature on the history of mental health in Ghana abounds but this is just a very brief account. Real action to address mental health issues was through the 1888 the ‘Lunatic Asylum Ordinance’ which was passed in response to the growing numbers of mentally ill people who were destitute and roaming the streets, seen mostly as nuisance and an eye-sore to the public. In the 1970s the Lunatic Asylum Ordinance of 1888 was revised and modernised into the mental health law of 1972 which emphasised institutional care and incorporated innovations in mental health care delivery. By 1996 there was a policy aimed at sending mental health care to the doorstep of every community. The implementation of this policy was hampered by a plethora of manpower and logistical problems.

Presently, mental health in Ghana is in a state of an orphaned none-exist community mental health system and deplorable mental hospitals, with the Accra Psychiatric Hospital having the unenviable lead.

Why mental health needs to be accorded attention

Mental health is one of the silent but growing issues that could constrain the agenda of the country to reach middle income status by 2015. Good health is one of the key determinants of human development. It is clear that unsound mind does not give the individual 100% health. With the growing incidence of stress and depression among many of our population, these conditions will surely undermine our human resource capacity if left un-addressed. Much as there is no significant prevalence study to warrant generalisation, reliable estimates based on WHO projects put about 2.2 million people to be experiencing one form of mental illness or the other. Despite this, mental health continues to suffer neglect in terms of practical sustainable actions that will bring about results for the benefit of the poor and marginalized people with mental illness.

Strangely, only about 1% of the annual health budget goes into mental health. Out of a total budgetary allocation of eight hundred and sixty-seven million, two hundred thousand Ghana Cedis, (GHc867.2 million) to the health sector for 2009, only nine million and seven hundred thousand Ghana Cedis (GHc9.7million) was allocated to the mental health sub-sector (“Financing Mental Health Care in Ghana”: January 2009: study conducted by BasicNeeds). Of this amount over 90% of it was for personnel emoluments with the remaining shared among feeding and medical logistics (such as cleaning detergents and stationery) and rehabilitation of facilities. Findings from this study showed that over the past five years (between 2004-2009) Government’s funding for mental health has not only nose-dived but has been erratic and unpredictable, making effective planning very daunting in both the short and long term.

Suicide and Mental Health – Any connection?

Over the last year or so the media have carried disturbing reports of suicides and murders which clearly point to the situation that the country is gradually, but steadily been plagued with an undesirable phenomenon- increased violence and self-harm. One may describe this as a society growing in violence and despair. The World Health Organisation (WHO) in 2006 called for improved treatment for mental illness to reduce suicide. With a theme ‘Building Awareness – Reducing Risk: Mental Illness and Suicide’ that year the WHO devoted attention to suicide as a leading cause of premature and preventable death and recognised the need to build awareness and reduce risks in the areas of suicide and, more broadly, mental illness (Ref: World Health Organisation Publication for the World Mental Health Day 2006: Geneva October 2006).

What the above overwhelmingly underscore is that any country that trivialises mental illness will soon be caught in such unsavoury situations with dire implications for human security and sustainable development.

Human Rights and the Mentally Ill Person

It is clear that majority of people with mental illness or epilepsy are not accorded fundamental human rights, starting with a right to proper treatment, including privacy and confidentiality; rights relating to education, employment, protection from harm and abuse; to rights to freely associate and belong to groups. Most people with mental illness are marginalised and hardly get the opportunity to be included let alone being asked for their opinions and impressions. It is common that until recently, any major national event, especially which was likely to have foreign dignitaries come into Accra, resulted in the rounding up and incarceration of destitute mentally ill people in the Accra Psychiatric Hospital or their dumping in the outskirts of the metropolis. They are seen as dirty and a public eyesore. The powers that be are usually oblivious of the poor infrastructure and inadequate personnel of the hospital resulting in over-crowding and all the unmentionable practices that occur there but will twist arms to make sure these people are locked away from the public. The point to note in this discourse on human rights and the mentally ill is that human right must be enjoyed by all irrespective of state of health, social status, age or gender, or even ethnicity.

BasicNeeds approach emphasizes community care

BasicNeeds works to bring about lasting change in lives of people affected by mental illness and epilepsy. The organisation has built an innovative approach that tackles people’s poverty as well as their illness called the model for Mental Health and Development. BasicNeeds empowers people with mental illness to access mental health and development services and exercise their basic rights. BasicNeeds has since 2002, when it started operations, worked with the Ghana Health Service to support improved access to mental health treatment services by facilitating psychiatrist outreach clinics and other community based services at the regional and district levels. It has also collaborated with a number of local NGOs to increase means to secure livelihoods for poor people with mental illness or epilepsy and their primary carers and families. BasicNeeds continues to show through its work that mental illness can be stabilised and that people with mental illness can lead a normal happy life.

The Deplorable Conditions of Psychiatric Hospitals in Ghana

The deplorable conditions that characterise Ghana’s psychiatric hospitals are well documented and are no secrets any longer. The Acting Chief Psychiatrist at the Accra Psychiatric Hospital must be having a hoarse voice now for the uncountable times he shouts out pleas for support for the mental hospital in particular and mental health in general.

The conditions at the Accra Psychiatric Hospital bring to focus that the policy of community based mental health care service provision needs more attention. When this happens the pressure on the mental hospitals reduces. Some of the patients who otherwise are well enough to go home have acquired “permanent residents’ status” in the hospitals thus swelling the numbers there. Today, there are over 1,080 patients in admission at the Accra psychiatric hospital, a facility that was built to accommodate 600.

Administratively, the Chief Psychiatrist doubles as the Medical Director and Administrative head of the premier mental hospital (Accra Psychiatric Hospital). A genius is not needed to point out the extreme burden placed on such a soul. Even though there is the Institutional Care Division (ICD) of the Ministry of Health that is charged with overseeing mental health and headed by a very experienced health practitioner Dr. Cynthia Bannerman, it is unclear to us whether it is just the mental hospitals or the Community Psychiatric Units at the regional and district hospitals, (where they exist), that the ICD exercises authority over. Due to this arrangement virtually everything about mental health revolves around the Accra Psychiatric Hospital. Can one say if it is the case with the rest of the health-care system? As the premier hospital, and a Teaching Hospital for that matter, is Korle-Bu overseeing the regional and district hospitals? The obvious answer is a no. If not then is it the case that the arrangement with mental health is convoluted and needs to be looked at? Some clarification here will be helpful to the interested public.