The Status of Mental Health Care in Ghana, West Africa and Signs of Progress in the Greater Accra Region

The Status of Mental Health Care in Ghana, West Africa and Signs of Progress in the Greater Accra Region Olivia Fournier Department of Integrative Biology '12 Abstract Mental health care is becoming a critical international concern, but developing countries are still straining to attend to the mental health needs of their suffering and stig- matized citizens. This study assessed the situation of mental health care in Ghana, an Anglophone democratic republic in West Africa. For four months, interviews and secondary data were conducted and collected in the Greater Accra Region to gain information on the available mental health services, the condition of psychiatric hospitals, the most common diagnoses, the challenges the mental health system faces, the changes that need to occur, and the progress made thus far. Currently, the few psychiatric hospitals they have are severely congested, the number of mental health professionals is staggeringly low, community and rehabilitative care is non-existent, and the law on mental health has not changed in over thirty years. This is all due to inadequate funding, a longstanding stigma, the low fatality of mental illness, and the government's ambivalence towards mental health. Mental health personnel and NGOs have been involved in increasing the awareness of mental illness and improving the delivery of mental health care, but there are still many changes that need to take place in order to secure the rights of the vulnerable, and provide equal access to mental health treatment for all Ghanaians. Mental Health Care in Ghana Olivia Fournier Introduction Recently, neuropsychiatric disorders have been conservatively estimated to be 14% of the global burden of disease, more than the burden of cardiovascular disease or cancer, and their conditions account for a quarter of disability adjusted life-years (the sum of years lived with disability and years of life lost) [14]. The World Health Organization (WHO) also estimates that 25% of the world's population will suffer from mental, behavioural, and neurological disorders such as schizophrenia, mental retardation, alcohol and drug abuse, dementias, stress- related disorders, and epilepsy during their lifetime [15, 1, 14, 16]. Mostly affecting the poor and people from developing countries, depression impinges on more than 450 million people and might become the second most important cause of disability by 2020 [11]. Despite these new insights, as the 20th century revealed Herculean advancements in somatic healthcare worldwide, the mental aspect of healthcare has remained stagnant and in some cases, gravely depreciated. Mentally ill people are some of the most vulnerable people in society. They are often subject to discrimination, social isolation and exclusion, human rights violations, and an ancient, demeaning stigma which leads to bereavement of social support, self-reproach, or the decaying or straining of important rela- tionships [4, 5, 14]. Consequences of poor mental health also include being predisposed to a variety of physical illnesses, having quality of life be reduced, having fewer opportunities for income, and having lower individual productiv- ity, which affects total national output. Poor mental health can also account for violence, drug trafficking, child abuse, paedophilia, suicide, crime, and other social vices [12]. Even though mental health is becoming a serious international health concern, many countries, specifically the more impoverished countries, struggle to address the inadequate amount of resources being funnelled into the non- physical sector of health. Low-income countries often have insufficient imple- mentations of policies and limited mental health services confined to short- staffed institutions. Furthermore, in both developed and undeveloped countries, the poor are more vulnerable to common mental disorders due to experiences of rapid social change, risks of violence, poor physical health, insecurity, and hopelessness [13, 4]. Women, slum dwellers, and people living in conflict, war prone, and disaster areas of civil unrest constitute a large portion of the population in developing countries, and are specifically susceptible to the burden of mental illness. For instance, 90% of the 12 million worldwide schizophrenia suf- ferers who do not receive adequate psychiatric services are located in developing countries [11]. Only 50% of countries in Africa have a mental health policy, and if they do have a law, it is usually archaic and obsolete. Ninety percent of African countries have less than one psychiatrist per 100,000 people, and 70% of the countries allocate the mental health sector with less than 1% of the total health budget [8]. Less than 60% of African countries have community mental health care while the rest are focused on psychiatric hospitals [2]. The World Psychiatric Association suggested that the development of mental health programmes are impeded in Africa because of the scarcity of economic and staff resources, lack of awareness on the global burden of mental illness, and the stigma associated with seeking Berkeley Undergraduate Journal: Volume 24, Issue 3 9 Mental Health Care in Ghana Olivia Fournier psychiatric care. Mental health has been shunned in Africa, and several reports disclose a higher prevalence of stigma in developing countries than in first world countries [3]. Similar to many other developing countries, treatment of mental health in Ghana, West Africa is low and continues to rely on institutional care, a vestige from colonialism [16]. In Ghana, it is roughly estimated that at least 2,816,000 people are suffering from moderate to severe mental disorders, and only 1.17% of these people receive treatment from public hospitals because only 3.4% of the total health budget is dedicated to psychiatric hospitals [16]. Because there is one psychiatrist per 1.5 million people in the whole country, and the three major psychiatric hospitals (which are ironically located only in Southern Ghana) are under-financed, congested, and under-staffed, many resort to more ever-present and more affordable, traditional or faith healing [9]. Ghana has a deep-seated tradition of religious (Animist, Christian, and Muslim) observance. Thus, 70{ 80% of Ghanaians utilize unorthodox medicine from the 45,000 traditional healers, located in both urban and rural areas, for their vanguard healthcare despite recent advances in orthodox psychiatric services [3, 16, 9]. Although research shows that mental-health patients who used spiritual healing usually reported an improvement in their condition, the quality of treatment is not easy to en- sure [4, 5, 16]. Sometimes in order to exorcise supposed demons, individuals are chained, flogged, or incarcerated into spiritual, prayer camps [12]. In spite of these atrocious facts, policy-makers seem to have little concern for mental health, and focus more on physical health and population mortality. The Lunatic Asylum Ordinance of 1888, enacted by the Governor of the Gold Coast, Sir Griffith Edwards, marked the first official patronage to Ghana's mental health services. This ordinance encouraged officials to arrest vagrant \insane people and place them in a special prison in the capital city of Accra. After the prison quickly filled, a Lunatic Asylum was built in 1906. In accordance with international trends, the asylum was later transformed into the Accra Psychi- atric Hospital in 1951 with help from the first sub-Saharan psychiatrist, Dr. E. F. B. Foster. With high walls and barbed wire, to this day the hospital still resembles a prison, which harks back to how the mentally ill were dealt with during colonial times. Luckily, innovations such as the removal of chains from patients, abstaining from patient punishment, and use of chlorpromazine and electroconvulsive therapy arose in the fifties. During that time, the Accra Psy- chiatric Hospital was the only psychiatric facility in West Africa [9]. In 1962, the Ghana Medical School started training undergraduates in psychiatry and a Mental Health Unit was formed within the Ministry of Health in the 1980s [1]. Though Ghana's psychiatric care has come a long way since the 1800s, there are still a lot of changes that need to occur in order to attain a standard of quality that is appropriate to recent advances. Ghana's Mental Health Decree, which emphasizes institutional care and involuntary admission, has not changed since 1972, and treats the mentally ill as if they have no rights [16]. Fortunately, a new Mental Health Bill, which was drafted in 2006, finally made it into the lap of Parliament in October of 2010. This legislation will promote practice of mental health care at the community level and protect the rights of people with mental illnesses. It has gained the support of traditional healers, nurses, and doctors, and will serve as a model for developing progressive mental health legislation in line with international human rights standards. Several researchers have noted a need to increase accurate and comprehensive Berkeley Undergraduate Journal: Volume 24, Issue 3 10 Mental Health Care in Ghana Olivia Fournier data collection on mental health impact and prevalence in order to help improve perceptions on the legitimacy of psychiatric services, and ultimately influence policy [2, 8]. Due to a shortage in personnel, there is a deficit of mental health information, hard community based data, and scientific estimates for neuropsy- chiatry disorders in Ghana [5, 1]. Because the World Health Organization's agenda for mental health research in the developing world suggested to evalu- ate mental health services, this paper focuses on two of the three psychiatric hospitals, and analyzes the hospitals' available services, resources, recent annual number of out-patients and in-patients, and most common diagnoses which have not been published since 2003 [10]. In an attempt to provide an argument for improving the resources and commitment to mental health, this paper also reports on the status of mental health care via information from interviews with key people in the mental health delivery system and non-governmental agencies involved in mental health.

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