Mental health in Ghana: now and beyond

Authors: Appiah Poku Yankyera (MSc. Health Psychology)¹, Rita Adu-Boahene (BSN)² and Baffour Boaten Boahen-Boaten (MSc. Global Mental Health)^3
1Founder, Life Developers Movement, Ghana (✉ [email protected]); ² Research Nurse at Vanderbilt University Medical Centre, Nashville-TN, USA; ³Lecturer, Department of Psychology, Swaziland Christian University, Mbabane-Swaziland

The Sustainable Development Goals (SDGs) which replaced the Millennium Development Goals (MDGs) in 2015 is a 15-year long-term plan geared towards poverty eradication, protection of the planet and ensuring global prosperity. Altogether, the SDGs have 17 specific targets to be achieved by 2030¹. Notable among these goals is the SDG3 which seeks to promote healthy lifestyles and ensure well-being for all persons across the lifespan. This goal (SDG3) seeks to achieve basically one objective which is health promotion and disease prevention/control.

One cannot talk about health without making reference to the definition proffered by the World Health Organization (WHO) that describes health as a complete state of physical, psychological and social well-being and not the mere absence of infirmity or disease². This, therefore, suggests that health must be viewed not just from the physical or biological standpoint, but also from the social, psychological and emotional perspectives. Similarly, the seeming absence of an infirmity does not necessarily mean that a person is healthy. To be healthy is to maintain an optimal balance between a person’s physical, psychological, emotional and social aspects of life. Thus, to be physically healthy but emotionally, psychologically and/or socially unstable means that an individual is ‘ill’. This brings to the fore, the fact that one cannot talk about health, without talking about mental health.

Mental health, although, a very critical aspect of health and national development remains one of the most neglected sectors in Africa³ and the situation is no different from what pertains to Ghana. It is estimated that Ghana has a treatment gap of about 98%; meaning that, for every 100 people suffering a mental illness, only 2 are likely to access treatment⁴; this does not even consider the number of unreported cases. This huge treatment gap is largely attributed to a scarcity of resources in terms of finances, trained personnel and facilities^5,6. According to the Executive Director of the Mental Health Authority, the doctor-to-patient ratio within the mental health setting of Ghana is 1:1.7 million compared to 1:1 million for Nigeria and 1:500,000 for Kenya⁷. Again, there are only 3 major government psychiatric hospitals and all of them are located in the southern part of the country; two in the Greater Accra Region and one in the Central Region. There are also four privately-owned psychiatric hospitals available; two in Kumasi, one in Accra and one in Tema. On the issue of funding, although psychotropic medications are meant to be free, hospitals are compelled to bill patients usually due to financial challenges emanating from the government’s inability to provide annual budgetary allocations to the hospitals^4,8. Furthermore,  there is the issue of stigmatization and discrimination against those who are mentally ill, which has resulted in some of the worst forms of treatment meted out to them all in the name of spiritual healing centres⁹.

All these challenges, therefore, mean that a lot more mentally unhealthy people will be on the streets since all the public psychiatric hospitals do not have the aforementioned resources to help and care for them. These challenges are compounded by the congestion in the psychiatric hospitals and the inability of families to afford out-of-pocket payment for private psychiatric care services. Additionally, a concentration on tertiary mental health treatment will mean that those suffering from milder forms of mental illness may find it extremely difficult to access care. With all these highlighted  challenges staring us in the face, it becomes imperative to ask the question  ‘What are some of the practical steps to take in advancing the course of mental health in Ghana?’

To begin with, though Ghana’s  Parliament commendably passed the Mental Health Act in 2012, more radical steps are needed from this arm of government to ensure the passage of the legislative instrument (LI) that will make the Mental Health Act (2012) fully functional. The LI among other things shall provide guidance on the elaboration of a detailed action plan/regulations for putting the provisions of the law into effect as well as the establishment of a mental health fund.

There is also the need to expand existing major psychiatric hospitals and build additional ones. However, to overcome the financial cost and time limitations in building new psychiatric hospitals within the short to medium term, all regional and district hospitals should be strengthened by establishing psychiatric units. This will ensure that there is an equitable distribution of accessible mental health care facilities across all ten regions.

In addition, building on this integrated approach above, efforts should be geared towards making mental health care more community based, easily accessible and affordable. A key professional in mental health care is the psychologist who unlike the psychiatrist, adopts ‘talking therapy’ or ‘behaviour modification’ strategies as a form of intervention for mental illness. These two professionals complement each other, thus, it is essential to have both roles within Ghana’s mental health care settings. Along this line of thought,  it will be beneficial for the government to put in place a mechanism to ensure automatic recruitment of the clinically-trained psychologists (postgraduates from the University of Ghana MPhil Clinical Psychology programme and those from the MPhil Clinical Health Psychology programme at the University of Cape Coast) into the health service.

Similarly, the government should focus on training of more personnel (psychiatrists, psychologists, nurses, community mental health officers, etc) to augment the number of professionals we already have in the system which is abysmally low given the health worker to patient ratio. A project like the Kintampo Project (a collaboration between the Ghana Health Service and Southern Health NHS Trust, UK)¹⁰ which aims at training mental health workers is worth emulating.

Also, considering the hazards that come along with working in a psychiatric care environment, the working conditions of the health workers within this setting must be improved to incentivize them (this will help reduce the rate of sit-down actions by nurses) and also others must be  encouraged to  take up professional training in mental health care.

Lastly, the need for extensive and continuous research into mental health promotion and mental ill-health prevention cannot be overlooked. This, therefore, calls for more collaboration between academics and the various mental health institutions to produce cutting edge research that have applied contextual value to the Ghanaian setting and thus can be used as evidential basis to inform policies.

Going forward, mental health should be understood holistically as inclusive of all activities involved in the promotion of well-being, preventing mental disorders and the management of those who are psychologically unwell. Thus, the focus of mental health care should expand beyond working to ‘cure’ mental disorders, to ensure that individuals function optimally within the family, professional and community contexts¹¹. This can be achieved through a collective effort where the government ensures resource availability to address mental health care needs while the society also eschews negative attitudes towards the mentally ill. More often than not, there is a misconception that mental illness is caused by negative and immoral behaviours. Though this assertion may be true to some extent, it should be noted that not all mental disorders are due to one’s personal actions or behaviours.  Have you ever asked, “what wrong does a person who is depressed commit”? Have you thought about the other forms of mental disorders aside those related to substance abuse? Indeed, external social pressure on individuals to excel academically or meet some high social expectations could force such individuals to become depressed, abuse drugs and/or nurture suicidal tendencies.

Indeed, the next time you want to make derogatory comments about ‘mental health’, pause and think about how you will feel if you were to be at the receiving end. Pause to think, how you will feel if people blame you for catching flu or even accuse your family member of having cancer? Empathy, positive self-regard and unconditional love towards the mentally unwell are the keys to unlocking a society that is health conscious; a society that sees no difference between physical health and mental health.

References:

1. UNDP (2015), Sustainable Development Goals. Accessed from http://www.un.org/sustainabledevelopment/sustainable-development-goals/ on 17^th July, 2017
2. World Health Organization (2006). Constitution of the World Health Organization – Basic Documents, 45th edition, Supplement, October 2006.
3. Yankyera, A. P. (2016). Mental Health Bill Passed; What Next? Accessed from http://www.myjoyonline.com/opinion/2016/November-18th/the-mental-health-bill-passed-what-next.php on 17th July 2017.
4. World Health Organization (2007). Ghana a very progressive mental health law. Mental Improvements for Nations Development: Department of Mental Health and Substance Abuse, WHO: Geneva.
5. Antwi-Bekoe, T. and E. Mensah (2009). Financing Mental Health Care in Ghana. BasicNeeds. Accessed from https://goo.gl/xDWFU4 on 24th July, 2017.
6. Omar, M., A. Green, P. Bird, T. Mirzoev, A. Flisher, F. Kigozi et al. (2010). “Mental Health policy process: a comparative study of Ghana, South Africa, Uganda and Zambia,” International Journal of Mental Health Systems. Vol. 4, No. 24.
7. Abdul-Karim, M. A. (2016). Mental Health Care; Ghana among Worst in Africa. In press, Daily Graphic. Available at http://www.graphic.com.gh/news/health/mental-health-care-ghana-among-worst-in-africa.html
8. BasicNeeds (2010). Share Learn Share: Basic Need.  Newsletter Issue 1.
9. Human Rights Watch (2012). Like a Death Sentence: Abuses against Persons with Mental Disabilities in Ghana. Accessed from https://www.hrw.org/report/2012/10/02/death-sentence/abuses-against-persons-mental-disabilities-ghana on 24th July 2017.
10. Kintampo Project: Improving Mental Health in Ghana through Education. Visit http://www.thekintampoproject.org/ for more details
11. World Health Organization (2003). Investing in Mental Health. Department of Mental Health and Substance Dependence, Noncommunicable Diseases and Mental Health. World Health Organization: Geneva.

©2017 Scientect e-mag | Volume 2 (1): A3