Mental Health in Northern Ghana is in Horrific State
By Ziem Joseph Philip
(published in the July 2011 edition of the advocate)
Northern Ghana, with over 60 percent of its population classified under the poorest and mostly underserved in terms of mental health services, does not have a single psychiatric clinic or hospital, although it has a large number of mental patients.
Not only that, there is only one psychiatrist stationed at the Tamale Teaching Hospital in the Northern Regional capital, taking care of patients scattered all over Northern Ghana which comprises the Upper West, Upper East and Northern Regions – and only 34 out of 600 psychiatric nurses countrywide serve the population, estimated at 4,177,798 (2010 PHC provisional results), says BasicNeeds-Ghana, a Non-Governmental Organisation providing support to mentally sick and epileptic patients.
The three regions are reported to have a greater number of mentally sick and epileptic patients with many of them roaming the streets of cities and towns. While some of them are confined in rooms by relatives with little or no attention at all, others are put under the care of traditional herbalists who sometimes subject them to all forms of abuse including (impregnating female patients), according to Yaro Badimak Peter, Country Programme Manager of BasicNeeds-Ghana.
According to the NGO, there are about 15,976 mentally sick and epileptic patients in Northern Ghana. The organisation attributes the increase in epileptic cases in particular in the area to lack of drugs for treatment, stressing that epilepsy is a condition and not a disease or illness which one can contract.
Nationally, it says the country has only 15 psychiatrists and just four of them were in active service. This gives the ratio of one psychiatrist to 1.7 million people as compared to 1:506 in Kenya and one to a million people in Nigeria. In Kenya, Uganda and Nigeria, where budgetary allocation to mental health was less than Ghana’s 2.58 percent, mental care is decentralized and better managed than Ghana which is focused on centralized institutional care.
There are 600 psychiatric nurses and 115 community psychiatric nurses when Ghana needs 3000 personnel for each of the two categories of health professionals, BasicNeeds-Ghana said in one of its research publications.
A 2003 government report dubbed “Mental Health Profile (Ghana)” showed that Ghana has only three psychiatric hospitals available to the over 24 million population – the Accra, Pantang and Ankaful hospitals – all of which are under-funded, overcrowded and located in the urban and better-developed South of the country.
The distance to cover when traveling by road from Wa, Bolgatanga and Tamale, all regional capitals of the three regions of the North, to any of the public psychiatric hospitals in the nation’s capital is 417, 505 and 404 miles, respectively. Transportation fare ranges from US$20 to US$30 and the journey could last for about a whole day or beyond 24hours. This is due to the long distances the vehicles have to cover coupled with the bad nature of the road networks leading to each of these hospitals.
The Accra Psychiatric Hospital for instance, was built in 1906. It has capacity for 800 patients but currently houses an estimated 1000 inmates.
Ankaful Psychiatric Hospital also built in 1965 in the Central Region of Ghana, has a capacity for 500 beds but currently has 150 in-patients. The reduction in the number of in-patients is due to dwindling number of nurses and doctors there.
The Pantang Hospital on the other hand, was commissioned in1975 to decongest the Accra Psychiatric hospital. The original intention of the then Head of State Dr. Kwame Nkrumah, according to the report, who initiated the building of Ankaful and Pantang hospitals was to provide a Pan-African Mental Health Village for Research. As the report put it, “It was a grandiose project that would have recruited experts from Africa”. Currently, the hospital has a capacity for 500 beds but accommodates 450 patients. It has a vast land with a number of uncompleted wards, bungalows and junior staff accommodation left in the bush. Both Ankaful and Pantang have nursing training schools attached, producing Registered Psychiatric Nurses.
The report added that there are two private hospitals in Kumasi in the Ashanti Region – Pankrono Neuro-Psychiatric Hospital and Adom Clinic at Santase.
In the nation’s capital Accra, there is one private hospital –Valley View Clinic and in the Port city of Tema, The Alberto clinic.
BasicNeeds-Ghana observes that inadequate funding constrains these public institutions’ ability to maintain and upgrade their facilities. The overflowing records department of the Pantang Hospital, according to the organization, has apparently not been refurbished since it was constructed in 1975. All of the records of the 43,170 patients treated to date are maintained here, in paper form, it added.
The organization revealed that at another institution, the carpentry department in the occupational therapy unit has virtually no functioning tools and lacks sufficient wood for patients to work with.
Despite the gravity of these statistics, mental health continues to suffer neglect in terms of practical, sustainable action that could benefit poor, marginalized people with mental illness.
These days mental health treatment is viewed as a right, but many people still consider the treatment of mental conditions as a privilege. Due to these changes, Ghana is revising its Mental Health Law. The new mental health bill drafted in 2004 and completed in 2006, though delayed for many years, seeks, when finally passed into law, to improve the care of poor, vulnerable people with mental illness or epilepsy, safeguard their human rights and promote their participation in restoration and recovery.
The pending Bill, which has been hailed by the World Health Organization (WHO) as one of the best legislations worldwide, also seeks to ensure that adequate provision of resources has nine parts consisting of a Mental Health Board, a Service, a Review Tribunal (to review mental cases), Visiting Committee, Voluntary Treatment and Involuntary Treatment. The other parts of the Bill are the Rights of a Person (to take a look at human right abuses and discrimination associated with mental health), Protection of the Vulnerable Group and Miscellaneous provisions. The Bill would further de-emphasize institutional care and help place mental care on the National Health Insurance Scheme (NHIS).
The W.H.O requires that mental healthcare should start from self-care through informal community care, primary healthcare, community health service, regional and finally to long stay facilities. But sadly, the opposite is what prevails in Ghana.
Launching a photo-book in Tamale recently, on the horrific state of mental health situation in Ghana particularly Northern Ghana, Yaro Peter, stressed the need to highlight the living conditions of persons with mental health problems saying “there are human rights issues to such lives that cannot be ignored”.
He indicated that a significant number of Ghana’s population experience one form of mental illness or epilepsy, disclosing that Ghana has 2.4 million people who experience one form of mental illness with only two percent having access to care, hence the need to advocate the concerns of people with mental problems.
According to Yaro Peter, people with mental health problems contribute to a large proportion of persons with disability, globally estimated to be 650 million people.
The 37-page photo-book highlighting the lives that most people with mental illness or epilepsy and their care-givers, including some of the people that work in the sector live, was produced from a project called “Ghana – A picture of Mental Health”, which was funded under the Mwananchi Grant Scheme managed by Participatory Development Associates of Ghana.
The photo-book depicts horrific situations whereby mentally challenged persons have been chained, legs pinned through tree trunks, confined or kept in partially-enclosed porches or rooms, shackled, among others. Those confined in rooms eat, sleep and answer nature’s call there.
The collection of photos does not just portray the disgusting treatment and living conditions under which persons with mental disorders or epilepsy have to undergo, but also show the humanness and hidden potential that people who are currently ill, or have stabilized in their condition, as well as their primary care-givers, have to contribute to their own wellbeing and those of their families.
Most of the people in the photo-book were once teachers, traders, hardworking wives or husbands, lovely children of parents and families. Unfortunately, the social stigma so often associated with mental illness or epilepsy, poverty and inadequate healthcare facilities have conspired to rob these people of the care and support they deserve.
The photo documentary clearly reveals that there is much to be done to improve the situation of people suffering from mental illness and epilepsy in Northern Ghana. As Yaro Peter reflects, “Mental health in Ghana is in an orphaned state.”
All the same, he is happy that all is not lost, as increasing attention is being given to mental health issues and the welfare of people with mental disorders. He told this journalist that, “I hope parliament would pass the mental health bill before Ghana’s presidential and parliamentary elections next year, which is 2012. The Parliamentary Select Committee on Health has been touring some countries including the United Kingdom and South Africa to understudy how mental health services were being implemented there.”
In Ghana, the top ten mental problems often found with patients on admission at psychiatric hospitals according to the 2003 government report include schizophrenia, substance Abuse, depression, hypomania, acute organic brain syndrome, manic depressive psychosis, schizo-affective psychosis, alcohol dependency syndrome, epilepsy and dementia. According to psychiatry experts, cannabis admissions are higher each year and there are more men using drugs than women. This is cultural as Ghanaians frown on female drug users. The multiple drugs used involved cannabis, cocaine, heroin and alcohol.
BasicNeeds Ghana, since its establishment in 2002, has reached 18,838 people with mental illness or epilepsy from over 18,700 families, together with 18,335 care-givers in Northern Ghana and some parts of Accra.
Currently, the organisation is working actively with 17,603 people with mental illness or epilepsy, all of whom are receiving regular treatment. 4,681 of them who have stabilized have been trained or being trained in vocational skills; 2,014 people are operating small businesses; 1,032 are engaged in horticultural activities; and 8,476 of them are involved in several different income generating activities to cater for themselves.
BasicNeeds is a pioneer development agency in mental health in the country. Its Mental Health and Development model uses a holistic and multi-faceted approach, facilitating treatment and stability for poor people with mental illness and epilepsy, working towards reducing poverty through sustainable livelihoods and promoting human rights.
Meanwhile, mental health practitioners and organizations working in the field as well as observers are hopeful that it will not be long before Ghana and its citizens enjoy quality mental healthcare and people with mental illness or epilepsy and their care-givers and families actively participate in development processes and benefit from them.