Ignorance leads to stigma, but with increased education and awareness, more are starting to be receptive of the fact that it is a general disease. Ghanaians, and most people in the world for that matter, view mental illnesses differently than physical illnesses because physical illnesses are tangible, easy to comprehend, and are generally easily treated with the right medication. People are more likely to attribute supernatural causes to things they do not understand. The average Ghanaian view is the same for both the mentally disabled and the mentally ill. Though epilepsy is a neurological condition and not a mental illness, people with epilepsy are also considered to be mentally ill in Ghana because they share the same stigma and because they have been historically treated by psychiatrists due to the lack of neurologists. The common Ghanaian perception of mental illness is changing. It was very troublesome for someone who was mentally ill, or related to someone who was mentally ill, to be married some time ago when families ran heritage checks for eligible bachelors or bachelorettes to be arranged in marriage. Now that families are becoming more independent and nuclear and the Western importance of romantic love is becoming a driving factor in marriage, a person who was mentally ill will no longer be completely disregarded as a potential mate. Also, in order to vote or become president it is written in the constitution that you “should be of sound mind, which becomes misinterpreted as denying the right to vote to anyone who has ever had a mental illness. There are many other unwritten rules that prevent the mentally ill from attaining full access to human rights. For example, a person might be evicted from an apartment if the property owner finds out that the person has, or has had, a mental illness. Although you would not be asked whether you have ever had malaria or AIDS at a job interview, it is commonplace in Ghana to ask if you have ever suffered from a mental illness,pot for growing marijuana which then becomes viable grounds for being denied the job. You can also be fired or denied a promotion if a co-worker discovers that you had or have a mental illness, though another random reason for dismissal is usually given.
Although there is no policy that denies access to school, the attitude and stigma held by peers and faculty often leads a mentally ill person to drop out of school. Up until three years ago, if there was an international event or conference planned, it was common practice for police to round up all of the wayfarers on the main streets and dump them at the psychiatric hospital or on the outskirts of town. Fortunately, Mind Freedom and Basic Needs spoke against this inhumane action and it has not occurred since. Due to a plethora of challenges the countries have to face, mental health in Africa is largely marginalized. Most African countries do not have mental health laws and the others have out dated, forty to fifty year old laws that were written when human rights were not an issue. On a scale from one to ten, Dr. Osei rated the quality of mental health care in Ghana as a four. All hospitals in Ghana are underfunded with 94% of the budget being spent on paying the necessary salaries of medical professionals and the remaining 6% going into running the hospitals. On average, the government allocates mental healthcare with 2.58% of the total health budget which is strictly limited to finance just the three psychiatric hospitals and not community care. The funding by the Ministry of Health has been unstable since 2003 because psychiatric care does not appear to address urgent, life-threatening issues. The funding is not based on needs but rather on limits set by the Ministry of Finance. Politicians in Ghana do not want to give attention to mental illness, a sickness with low morbidity, when high fatality conditions grab more national and international attention. Because of this and its stigma, mental health care receives little donations from charities. Amegatcher, Adico, and Taylor respectively rated the quality of Ghana’s mental health care on the same scale as a four, two, and five. These low scores were supported by the lack of resources and funding available to psychiatric hospitals and the lack of priority in the government’s agenda. The belief in superstition also deprives the mentally ill in Ghana of sympathy and compassion.
This combination of ignorance yields the mentally ill vulnerable to suffering human rights abuse, leading to Dr. Osei’s low rating. Fortunately or unfortunately, Dr. Osei believes that Ghana’s mental health care system is one of the best in West Africa besides maybe Nigeria. Instead of facilely increasing the number of psychiatric hospitals in Ghana, Dr. Osei wants to create 20-bed psychiatric wings in every regional hospital and 12-bed wings in every district hospital. Right now only five of ten regional hospitals have 20-bed psychiatric wings. General medical practitioners should also start receiving some training in psychiatric care so they can better treat their patients and discern when to refer them to a psychiatrist if necessary. The Chief Psychiatrist also wants to downsize the three psychiatric hospitals,container for growing weed ultimately changing Accra Psychiatric Hospital’s admittance from 1,200 to 300 patients, Pantang from 500 to 200, and Ankaful from 300 to 100 in-patients. The downsizing of the large hospitals and the creation of small wings throughout the whole country will deinstitutionalize the mental health care system in Ghana so it can ultimately focus on community care. Dr. Osei finds that many Ghanaians now believe that mentally ill patients can lead a happy, healthy life after treatment, but still there are only two rehabilitation services in all of Ghana that help reintegrate mental patients into society. These facilities are run by Catholics in Kumasi and discharged patients who permanently live near the Ashanti Region are sent there after treatment to learn some trade. Dr. Osei recommends that these services should be replicated and that there should be at least one rehabilitation resource in every region. The Pantang hospital would like to establish a Half-Way home for rehabilitation of chronic patients , start a fish pond rehabilitation project, develop an addiction outpatients clinic hot line, equip the laboratory, records, and pharmacy departments with a software, utilize a computerized data system, create a web page, expand a Drug Rehabilitation Centre, build more staff accommodation units, ensure accessibility to needed medications at the pharmacy, increase security, focus on prevention, recovery, and relapse-reducing programs and activities, and enhance staff morale by providing better incentives, training, equipment, and uniforms.
The Pantang Hospital is also working on a proposal to create an evaluation ward which would help to avoid long-stay patients and streamline the diagnosis and welfare process. In this ward the patients would be observed for a maximum of 72 hours by a specialized screening team in order to make sure the patients’ diagnoses are correct and that they require admittance into the hospital.The most recent mental health law, written in 1972 when international human rights was not much of a concern, also needs to be updated. Both the Chief Psychiatrist and Mind Freedom were involved in the drafting and advocacy of the new Mental Health Bill. The bill will address a lot of setbacks in the mental health system. If passed, the Mental Health Bill will commit the government to release more funds and resources for mental health care , train more mental health personnel including psychotherapists and counsellors, give incentive for people to work in mental health care, provide newer generation medicine, overhaul and decentralize the hospital-based system and make mental health care more community based, create an anti-stigma and education campaign, and protect the human rights of the mentally ill. Right now there are no checks for human rights abuses of the mentally ill, and this bill will make it illegal to put the mentally ill in chains and a new standard committee will work closely with prayer camps to oversee and enforce the upholding of all human rights. All in all, the Mental Health Bill will ensure effective treatment for the mentally ill and the law will serve as a standard for other African countries to follow. The bill was submitted in 2006 and did not reach parliament until the end of 2010, where it is sitting to this day. It took four years before the government bothered to address the situation simply because they did not value the issue. Mental illness is such a low priority for the government because of the stigma that exists even in the minds of politicians and because mental health disorders have a low fatality . Though mental illnesses do have a low morbidity, mentally ill people experience many years living with pain, stigma, lifestyle changes, complicated therapeutic regimes, the long-term threat of decline, and shortened life expectancy. With a lack of general funding for healthcare, more money is given to high fatality, international attention-grabbing physical diseases like malaria, AIDS, TB, cancer, etc. Now, after the advocacy from doctors and NGOs bombarded the media, the Ministry of Health is finally being forced to change their stance on mental health care. The Parliament is currently conducting consultations and is reviewing the bill to guarantee that fragmentation of the mental system is what is best for Ghana. Mind Freedom and Dr. Osei hope that the bill will be passed by June 2011, and if it is not, then Dr. Osei flippantly said he will personally march all of his patients at the Accra Psychiatric Hospital down to the Parliament building to fight for their rights. Dr. Osei hopes that the long struggling advocacy for mental health improvement will not lose steam and keep pushing until the bill is passed and even after to ensure the implementation of the law. Immediately after the bill is passed, he advises that a mental health board needs to be established with the purpose of overseeing the implementation of the bills requirements and the training of judiciaries, policemen, mental health personnel, nurses, and traditional faith healers in the law’s policies. He wants Ghana to have state-of-the-art mental health care which delivers care to the doorsteps of every Ghanaian, provides a wide range of medicine, is part of the national health insurance scheme, employs mental health personnel of various categories, and is adequately funded and operated by motivated leaders and supported by research and evidence based data. This could be achieved by having one of the best mental health laws in the world and by removing the emphasis from hospital based care to community care. Similar to Dr. Osei, Mind Freedom thinks that Ghana’s mental health system should change from institutional care to community care. The hospitals should be decongested, CPNs should be given transportation to move between communities, newer medication should be used, and mental health workers should be given more incentives and should be covered by insurance. Most importantly, psychiatrists need to more frequently go into the community, human resource needs to increase, and medication needs to be more available. Also, the perception of mental illness needs to be worked on. Stigma makes the situation drastically worse and makes people less likely to seek treatment even when it is important to seek early treatment so the problem does not aggravate. Despite the Accra Psychiatric Hospital’s disturbing conditions and appalling lack of resources, Dr. Osei’s undaunted and resolute passion for mental health is leading the country towards progress. In the beginning of 2011, Dr. Osei launched a repatriation of 600 recovered patients, whose families could be tracked down, to be discharged and returned home. Dr. Osei oversees each case to make sure that each discharged patient is well enough to go home and that they have a family or home to return to. So far the repatriation has been successful in decongesting the hospital, as 200 patients have been discharged by March 2011 and the total of 600 is expected to be achieved by June 2011.