Tackling Ghana’s Mental Health Challengesin an Unequal World

The COVID-19 pandemic has dealt a devastating blow to people living with psychosocial disorders, apart from the socio-economic problems it has unleashed on the entire world.

According to the World Health Organization (WHO), groups, including health and other frontline workers, students, people living alone and those with pre-existing mental health conditions, have been particularly affected.

Services for mental, neurological and substance use conditions have also been significantly disrupted in many countries.

The WHO defines mental health as “a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make contribution to his or her community.”

The pandemic has increased inequalities in human development, including unleashing unpleasant situations on mental health, by causing more mental disorders and emotional challenges and disrupting the already inadequate mental health services in Ghana and other parts of the world.

During the World Health Assembly in May 2021, governments across the world recognised the need to scale up quality mental health services and some countries have initiated new ways of providing mental health care to the people.

Ghana has made progress, particularly in terms of legal framework and delivery of mental health services despite many challenges.

On Sunday, October 10, 2021, the World Mental Health Day wasobserved on the theme “Mental Health in an Unequal World”.It is a special day set aside universally to acknowledge efforts in improving global mental health, by increasing mental health advocacy, education and awareness against the menace of social stigma and discrimination.

This year’s theme for the celebration underlines the pressing need to focus sufficiently on health beyond the physical in a sustained way in a world still struggling to fight COVID-19.

According to mental health experts, the subject was selected to highlight the fact that access to mental health services remains unequal, with about 75% to 95% of people with mental disorders in low and middle-income countries being unable to access mental health services at all, with access in high-income countries not being much better.

In Ghana, the day has presented a unique opportunity for the government to renew its commitment to transforming the country’s mental health infrastructure and ensuring equitable provision of critical services for the dignity of people with mental health problems.

Some people with mental illness across the globe, and Ghana in particular, do not receive the treatment they are entitled to and they, together with their families and care takers, continue to experience stigma and discrimination.

At the same time, the gap between the rich and the poor continues to widen and there is the need to tackle mental health problems in Ghana.In fact, issues regarding mental health are not given the needed attention as done to other health-related issues.

Setting the Local Context

As the theme for the World Mental Health Day suggests, it is an incontestable fact that issues of mental health have always been an afterthought and often relegated to the backburner. This has heightened the plight of persons with mental disorders and their caregivers in Ghana.

Discrimination and Social Stigma

Persons with mental health conditions are some of the most vulnerable people in society as they are often subjected to discrimination, social isolation and exclusion, human rights violations as well as demeaning stigma.

Stigmatization and discrimination experienced by people suffering from mental ill-health do not only affect their physical and mental wellbeing, but retards their educational opportunities, incomes, job prospects, and affects their families and loved ones.

This inequality needs should be addressed swiftly so that persons with mental health problems would be clothed with dignity,and integrated into society andgiven equal opportunities to develop.

Mental Health Policy

In Ghana’s Mental Health Policy (2019-2030), formulated by the Ministry of Health and Mental Health Authority, the government has admitted that in spite of efforts to improve mental health care in the country, “there still remains serious challenges.”

The policy seeks to provide a framework for promoting good mental health, taking into consideration the country’s culture, resources, geography and other considerations. There is no doubt that the ultimate goal of the programme of action is to ensure mentally-healthy and emotionally-satisfied populace.

The document acknowledges that mental health care currently is not adequate in its quality and spread, while services are skewed to the southern part of the country and saddled with inadequate logistics, human right abuses, stigma and discrimination.

What pertains now, according to the policy, is virtually the inverted pyramid of care with top-heavy concentration of services and resources at the psychiatric hospital as against the optimal pyramid where services and resources are spread in the country.

 Analysis by WHO

Analysis by the WHO in March 2020 estimated that 650,000 people in Ghana are suffering from a severe mental disorder and a further 2,166,000 suffering from a moderate to mild mental disorders”.

It said the treatment gap is “98% of the total number,meaning that an estimated 1.17% of these people receive treatment from public hospitals because only 3.4% of the total health budget is dedicated to psychiatric hospitals.

The three mental hospitals in the country, Pantang, Accra and Ankaful Psychiatric hospitals, have a total of 1,322 beds (5.5 beds per 100,000 population). Two of these hospitals are located in Ghana’s capital city and the other in the Central Region,but all in the southern partof the country.

Mental health services in the country are inadequate and there is the urgent need to do something about the situation to boost health service delivery. There should be a new direction for the improvement in the quality of mental health for the citizenry.

Governmental Interventions

It is gratifying that the Government of Ghana,apart from other initiatives, has set out an inter-sectoral mental health framework to capture the vision informing the mental health law.

The framework, according to government, is designed to support good mental health services in the country in a way that is integrated, holistic, decentralised and culturally sensitive.

These include the Mental Health Act, 2012 (Act 846) and the integration of mental health into general health care with the opening of psychiatric units in some Teaching and Regional Hospitals.

It is for this reason that MindFreedom Ghana, a non-governmental group, appreciates the Government’s “Agenda 111” that seeks to build hospitals across the country, including two psychiatric facilities in the middle and northern zones of the country, to bring mental healthcare and treatment closer and affordable to the people.

Additionally, the government should ensure that the Mental Health Fund established under the Actbecomes effective to support mental healthcare in Ghana.

Intensifying Mental Health Advocacy

It is also important for stakeholders to collaborate for effective advocacy to promote mental health and other disability issues. MindFreedom Ghana has received support from Open Society Initiative for West Africa (OSIWA) to implement a two-year project (2020-2022).

The project, titled: “Institutional Strengthening And Awareness Raising To Fight COVID-19 And Its Impact On People With Lived Experiences In Ghana”, when completed, will help strengthen the capacity of MindFreedom Ghana for advocacy and awareness creation, which are aimed at addressing the scourge of stigma and discrimination (associated with the disease) that patients, as well as relatives of the pandemic, suffer.

The project will help build awareness among the general public as a way to support the fight against COVID-19 in the country, through the development of well-thought-through and innovative programmes to reduce morbidity and mortality due to COVID-19.

There is no dispute that Ghana is facing mental health challenges. However, with the collective efforts of individuals, organisations and government, the country would experience an improved mental health delivery. -GN

by Dan Taylor