Possibly due to the non-uniformity in diagnosis, there also have been few consistent patterns of having a higher number of males or females being diagnosed with a specific mental illness. However, Dr. Osei reported that women in Ghana are most commonly diagnosed with depression and bipolar disorder while the majority of mentally ill men are diagnosed with bipolar disorder or substance abuse, specifically cannabis. Many Ghanaian women also suffer from anxiety while men suffer from alcohol abuse, but both sexes are unlikely to visit a psychiatric hospital for these problems. The most common reason for admission into a psychiatric hospital in Ghana is schizophrenia. There has been no attempt to get an accurate number of the amount of Ghanaians currently suffering from a mental illness thus far but the next census is supposed to include questions addressing the amount of mentally ill inhabitants in a household. Because medical professionals are preoccupied with long hours of clinical work, there is a severe lack of information and hard data focused on mental health and neuroscience in Ghana. There has been no attempt to obtain an accurate number of the amount of Ghanaians currently suffering from a mental illness thus far, but the next census is supposed to include questions addressing the amount of mentally ill inhabitants in a household. Schizophrenia, depression, epilepsy, and substance abuse of alcohol and cannabis are the most common diagnoses at the Accra Psychiatric Hospital and the Pantang Hospital. The records department at the Accra Psychiatric Hospital imparted the most common diagnoses for new cases in 2010, seen in Table 4, while Table 5 shows the most common psychiatric diagnoses amongst outpatients at the Pantang Hospital. Between 2009 and 2010, the Pantang Hospital saw a drastic increase in the number of outpatients diagnosed with mental disorders due to alcohol abuse, cocaine use , and other psychoactive substance use .
Outpatient diagnoses of behavioral syndromes ,growing rack adult personality and behavioral disorders, and epilepsy also displayed a significant increase in 2010. Schizophrenia and depression remained the leading diagnoses in 2009 and 2010. The most common cases for admission at the Pantang Hospital can be seen in Table 6.The Pantang hospital receives its funding from the government, internally generated funds, and donations. In 2010, their aid totalled to 1,742,185.25 GH cedis, 1,245,730.85 of which was given by the government. Donations amount to .88% of funding and internally generated funds from drugs and services represent 27.6% of annual income. Unfortunately, the hospital has been increasingly in debt over the past six years, and in 2010, the indebtedness totalled to 766,994.09 GH cedis. The government spends about four million Ghana cedis a year on the Accra Psychiatric Hospital, as the hospital is in debt and usually expends seven million a year, but receiving ten million would help things run more smoothly. Overshadowed by stigma, the psychiatric hospital receives little in donations, which amounts to about one percent of the total funding. Because of funding, the Accra Psychiatric hospital has 60–80% of the medicine they need, and most of the medicine they are given is older generation which cause negative side effects such as twisting of the neck, numb tongues, and metabolic problems. At Pantang Hospital, the in-patient sector of the hospital consists of nine wards with 50 beds, and any extra patients sleeping on thin mattresses. The VIP wards, which cost money to stay in, do not necessarily receive better treatment, but the rooms are less crowded , the food is better quality, and there is air conditioning. At the Accra Psychiatric Hospital there are 3 infirmaries and 23 wards total; 16 are male, six are female, and there is one children’s ward. One of the female and one of the male wards are reserved for geriatric cases. The largest special ward is reserved for forensic court cases and more aggressive males, 234 of them in total, though the official occupancy is only 60 for that particular ward. The largest female equivalent ward has 110 patients but the average number of patients in a ward is close to 50.
Because there are only 500 beds and currently1,000 inpatients at the Accra Psychiatric Hospital, the congestion leaves 500 patients to sleep on the concrete or on thin mats either inside or outside. There are no fans or air conditioning either. The ones forced outside without insecticides or mosquito nets are subject to the rigors of the weather during the day and the disease carrying mosquitoes at night. These unlucky ones also share their space with ants, cockroaches, and rats. Though there is tap water available, drinking it is not encouraged, so patients have to pay a small fee for filtered drinking water. Patients eat three low quality meals a day that usually consist of rice, adding up to 3.60 cedis a day , a recent increase from the 1.20 cedis spent before 2011. Uniforms are not provided so the patients are free to wear their own or donated clothes, however it is a common and disturbing sight to see people running around stark naked or half naked with tattered clothes hanging loosely off their body. The congestion of patients and the conditions of their living situation are human rights violations in and of themselves. To add to the situation, Dr. Osei admitted that behind the scenes, patients are sometimes physically or medically punished by nurses who are trying to control more patients than is feasibly possible. An undercover journalist also witnessed this injustice as well as pervasive drug trafficking between patients and employees. Although these acts are strictly discouraged, it is hard to prevent these human violations from occurring due to a lack of staff and security. Records are kept analog, in a room full of bulging, tattered folders; though they are trying to digitalize the system, it is difficult with only 15 of the necessary 100 computers. There is also an intercom that works 80% of the time. The building, initially built as a prison and not as a hospital, is 100 years old, which makes it gruelling to clean and maintain. There is asbestos in the roofing, sewage system pipes have broken, and the buildings look like a rundown dog pound instead of a pristine, sanitary hospital. In fact, people in the West would be appalled by the conditions even if it actually were a place reserved for rogue dogs. If the Mental Health Bill passes, then remodelling of the building might start in seven years’ time.
Dr. Osei proposes that if the buildings and wards ameliorate into sane conditions, then the morale of both the workers and patients will improve, and people will not want to leave the second they arrived. Pantang Hospital’s accretion of debt from insufficient funding over the past six years has led to unfinished structures, outdated equipment, shortage of prescribers, inadequate treatment programs , poor food quality, deficient road networks, old vehicles, under-supplied water and electricity, and encroachment of land and security. During my interview with Dr. Dzadey,drain trays for plants the electricity went out in true Ghanaian fashion, and was followed by many scolding and worried phone calls about the number of the samples the laboratory was losing every minute the generator refused to work. Water enters the pipes only twice a month so there is not enough water or disinfectants to properly clean the estate. In addition to that, the hospital is constantly buying water to fill tanks and filtered water to give to patients. The regular wards feed each patient on a mere 60 pesewas a day, but in 2008 it was rightfully increased to 2.5 cedis. Though the walls are covered in perma-dirt, and dust and a smell of sanitation chemicals lingers in the air, the facilities are much nicer and newer than at the Accra Psychiatric Hospital. The outpatient psych department is located in a three-story building, with a television in the lobby, and there is air conditioning in the consultant rooms. Possibly due to the workload and training, Dr. Dzadey also commented on how the nurses do not have the proper understanding on how to take care of patients. They complete their tasks, such as administering medicine, but there seems to be a lack of compassion in regards to keeping the patients’ best interests at heart. Ghana has only 11 psychiatrists, four of them at the higher, board certified consultant level, and 6 retired psychiatrists, four of whom continue to work at private psychiatric hospitals. In order to have an effective mental health care system in Ghana, Dr. Osei believes that there should be at least 80 working psychiatrists with half of them at the consultant level. To become a consultant psychiatrist in Ghana, one will have to complete six or seven of medical school, then five years of post-doctoral work in psychiatry. “Brain drain is a phrase all too common to the mental health care system in Ghana. Shockingly, there are currently twenty Ghanaian psychiatrists practicing in the U.K. when there are only seventeen psychiatrists in all of Ghana. While here is one retired occupational therapist in Ghana, Dr. Osei conservatively requests for twenty. In actuality, every mental health unit should have an occupational therapist, so the ideal number would be around 200. Hence, in Table 7 I averaged 20 and 200 to get a more accurate estimate of the amount needed. Furthermore, there are only 600 Psychiatric Nurses presently working when there should be at least 3,000 in order to care for most of Ghana’s mentally ill.
Psychiatric Nurses train at either Pantang or Ankaful, and complete one year of general nursing and two years of specialized psychiatric nursing. Clinical psychologists are regrettably not even recognized by Ghana’s Ministry of Health, and any clinical psychologists working at a Psychiatric Hospital have to be listed under another title on the payroll. A concise summary of the lack of mental health personnel is presented in Table 7. There is a severe lack of human resources at the Psychiatric Hospitals. Seven psychiatrists are working at the Accra Psychiatric Hospital when there should not be less than 30 psychiatrists. Dr. Osei referred to this number as his “dream figure. Table 8 presents other current and proposed numbers of staff. Although there are no trained psychiatric social workers, there are two generic social workers employed by the hospital. The hospital also has two volunteers who help feed and bathe the children in the children’s ward. There should be two security workers in every ward and some more patrolling the hospital, which led to the suggested fifty. Because of the lack of security, many patients escape by jumping over a wall, exiting through a ceiling, or simply walking out of the front entrance. Also, there is typically one incident involving a worker being injured or killed by a patient per year. While some nurses declared that a patient killed another nurse early in 2011, Dr. Osei said that the most recent incident was someone who was blinded in one eye after being hit by a patient. Many of the staff is forced to work at the hospital through either a nursing program or the national service requirement. The staff is terribly limited due to a combination of factors revolving around money and stigma. There are poor working conditions and the little pay reduces any incentive. For a 600-person workforce there are only 28 accommodation units, so most employees are dissuaded because they have to find their own housing closer to the hospital, or pay for transportation into the workplace from their home. As a result, many nurses have confirmed interest in moving to a different country in order to work in a more amicable and rewarding environment, which would further diminish the number of psychiatric nurses the Health Ministry has managed to train. In 2010, the staff strength of Pantang Hospital numbered 524, with two psychiatrists, one clinical psychologist, three medical assistants, three pharmacists, 260 psychiatric nurses, two welfare officers, 34 ward assistants, one bio-statistician, one biomedical scientist, eight occupational therapists, and zero occupational therapists. Dr. Dzadey suggests that the minimum number of psychiatrists the hospital should have is five, around one psychiatrist per two wards and one in OPD, but ideally, the number should be ten so that each ward has its own psychiatrist. In order to gradually reach that ten, the hospital can aim for five permanent psychiatrists and five training or rotating psychiatrists.