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The Breakdown of Ghana’s Mental HealthCare

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The MenthGhana

The hard truth or should we say; reality, is that the Ghana’s mental healthcare is yes, totally broken down. This is my conservative observation as a Practice Nurse when I recently visited Ghana in February 2013 after some five years uninterrupted stay in the United Kingdom. This conclusion is based not on any scientific research but rather physical observation of the number of unrestricted frail and helpless mental health patients who roam in the major cities/towns or streets of Ghana.

This is more disheartening than the impression I formed when I went to Ghana in September 2002, as the situation in relation to the resolution of the challenging problems confronting mental health patients, their responsible institutions, agencies, families and relations, seem to be on the decay. It might be therefore; fictional, when on Saturday, 12 October 2013, the Ghana News Agency (GNA), reported Dr Akwasi Osei- the Chief Psychiatrist, as saying that Ghana’s current mental health service delivery, has a 97 per cent treatment gap- explaining that 97, out of a100 mental patients, who require health care, do not get it. This was said at the Mental Health and Wellbeing Conference under the theme: “Understanding Inclusion and Stigma Reduction” that was organised by the Mental Health Foundation- Ghana, with the support from the Australian Embassy in Ghana.

There are many ways of measuring the efficiency and timely intervention of mental healthcare challenges and disorders. In the United Kingdom, it has been found that pressure on psychiatric wards has become so great that doctors are sectioning mentally ill patients unnecessarily, because it is often seen as the only way to gain access to a bed, Members of Parliament have found. For example, the House of Commons Health Select Committee said it was shocked by “disturbing” evidence that it was becoming increasingly difficult for mental health patients to gain access to hospital on a voluntary basis, resulting cases of doctors declaring patients a risk to themselves and others in order to speed admittance to a ward. As had been the traditional practice around the world, in the UK, patients who are detained under the Mental Health Act can be held in hospital against their will for up to 28 days before further assessments that can extend their detention indefinitely.

We recognise that no one wants to point her father’s house with his/her left finger. Nonetheless when the reality appears miserable, sorry, pitiful, paltry, imperfect, pitiable, shame, mean, coarse, inferior, below par, subnormal, under average, second-rate, reduced, defective, deficient, lower, subordinate, minor, secondary, humble, second-rate, pedestrian, beggarly, homely, crumbling, fourth-rate, tawdry, petty, threadbare, badly made, less than good, unwholesome, lacking in quality, vile, disgusting, despicable, rustic, crude, outlandish, old-fashioned, odd, rock-bottom, garish, shaky, showy, inelegant, loud, unattractive, inartistic, affected, ramshackle, pretentious, tumble-down, glaring, artificial, flaunting, newfangled, out-of-date, crummy, junky, then as a health professional, I dare make humble contribution, hence the visitation of The MenthGhana Project.

In the words of Dr Akwasi Osei, a recent study showed that Ghana had 41 per cent prevalence of psychological distress in various degrees- meaning as many as 47 in a 100 admitted were under negative stress which affected them mentally and that 19 per cent of those with negative stress had moderate to severe symptoms meaning their problem was serious enough to be considered a mental illness. Yet mental health care was largely limited to the urban area and even more specifically to the middle and northern belts of the country with only three psychiatric hospitals and 12 practicing psychiatrists for the 25 million people. The beggarly, homely, crumbling, petty and the threadbare dilemma, it is said, required number of professionals for a low income country was 150. Dr Osei states that Ghana has 12, 700 psychiatric nurses instead of 30,000 and four clinical psychologists instead of a 100. “The field of mental health in Ghana is vast and the workers are few,” he said.

Whereas in the Kingdom of Great Britain the concerns, as reported by The Independent Newspaper (Wednesday 14 August 2013), had been that mentally ill patients are sectioned unnecessarily as ‘only way’ to a hospital bed, the contrary is the case of the Republic of Ghana. As highlighted in our introductory paragraph, the mental health patients in Ghana, it seems to JusticeGhana, are deliberately allowed to roam and without any laid down measures, to ease the immeasurable distress of families, relations, the responsible health professionals and indeed the society at large. This makes one to question the highly-flagged Ghanaian hospitality to foreigners not forgetting the newly-created ministry whose area of responsibility includes human dignity and social protection? Legally, it is internationally accepted that in majority of cases all compulsorily detained mental health patients, should be suffering from a mental disorder or ailment which warrants detention in hospital or a mental home in the interests of their own health or safety, or the safety of others.

We acknowledge that even in most wealthy nations, the possibility of coming in direct contact with detained mental health patients, breaking bounds from their homes into the streets and highways are real. Yet the deplorable state of most mental health patients, we often see in the streets of Ghana, many of them meeting their untimely death without our needed care or being given the necessary urgent attention, care and support, represent perhaps the general mindset that the Ghanaian hold about these citizens. The Independent Newspaper report on mental health patients quoted a UK Department of Health spokesperson as saying: “Vulnerable people deserve to be fully protected at all times, particularly when they need to be deprived of their liberty in their own best interests. However, there are still unacceptable variations across the country and we are working with the CQC, health services and local authorities to ensure that these protections are used whenever they are needed. We will take swift action where necessary to protect individual patients...We remain committed to improving mental health services for everyone and will consider this report carefully.”

In a study (Poor mental health in Ghana: who is at risk? (2009–2010), which sought to estimate the national prevalence of poor mental health in Ghana, and to explore how it correlates on a national level and aimed to examine associations between empowerment and poor mental health among women on the basis of epidemiological data on mental health and how it may be useful in understanding the scope of the problem in Ghana- targeting particular subgroups for interventions, Heather Sipsma1*, Angela Ofori-Atta2, Maureen Canavan1, Isaac Osei-Akoto3, Christopher Udry4 and Elizabeth H Bradley1, using the Kessler Psychological Distress Scale (K10) to measure psychological distress and assessed women’s attitudes about their roles in decision-making, attitudes towards intimate partner violence, partner control, and partner abuse, found that overall, 18.7% of the sample reported either moderate (11.7%) or severe (7.0%) psychological distress.

“We conducted a cross-sectional analysis using data from a nationally representative survey conducted in Ghana in 2009–2010. Interviews were conducted face-to-face with participants...We used weighted multivariable multinomial regression models to determine the factors independently associated with experiencing psychological distress for our overall sample and for women in relationships. Psychological distress is substantial among both men and women in Ghana, with nearly 20% having moderate or severe psychological distress, an estimate higher than those found among South African (16%) or Australian (11%) adults. Women who are disempowered in the context of intimate relationships may be particularly vulnerable to psychological distress. Results identify populations to be targeted by interventions aiming to improve mental health.”

Born and bred in Ghana, I cannot be ignorant about the hassles of women and of course men in our major cities/towns and streets in making ends meet amid decongestion policies. The JusticeGhana Samaritan Street Project has had the chance of speaking to some of these street hawkers about this policy often referred to in Accra as “aba yee”- namely, the taskforce personnel deployed in our metropolis to ensure marketing or hawking-free street. Some of the women we spoke to in Accra and Madina confer to us that their partners were either unemployed or earn not enough to confront the collective financial challenges of their families. Majority of the street or station hawking youth complain of unemployment or vocational training. It came as no surprise to The Samaritan Street Project- The MenthGhana, to discover that there are indeed a glaring competing number of both men and women with mental health problems- both within the youthful and the elderly population.


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