Mental health — Shifting focus from institutionalised care

By Doreen Allotey

Mental illness presents one of the most challenging moments that could confront a family. While the direct effects are obviously on the victim, its impact on the family as a whole is equally unpleasant.
The obvious ones are the high cost of seeking cure for a loved one and the stigmatisation of the entire family. Stories are told of how members of certain families are shunned by prospective suitors for the simple reason that some great uncle or auntie once suffered from a mental condition .
Perhaps, it is for this reason that most families, whether rich or poor would leave no stone unturned in their bid to seek cure for a mentally ill relative.
According to Dr Akwasi Osei, Chief Psychiatrist and Medical Director of the Accra Psychiatric Hospital, some of the common measures such families resort to include visiting prayer camps, hiding the patient in a room from the public eye (sometimes in chains) or sending the patient to a psychiatric hospital where they plead with the psychiatrist to keep him/her for a very long time. Even years after these patients have been treated and recovered, some relatives are just reluctant to admit them back into their homes and the patient is abandoned at the hospital.
Dr Osei has been dissatisfied with this situation which he describes as disturbing, and continues to appeal to families to come for their relatives who have recovered from the psychiatric hospitals.
The approach adopted in treating or maltreating the mentally ill is often informed by beliefs. Some of these beliefs are based on assumptions or the perception that mental illness is a spiritual ailment, a mystery and a curse. Most importantly also there is the lack of knowledge on the part of society that there is a scientific explanation for mental illness and that mental disorders can be medically and socially managed.
Though different methods are adopted to handle the situation, the common thread running through these thoughts seem to be, keeping the patient away from the community where he /she is thought to be a nuisance. This attitude has worsened the plight of the mentally ill in Ghana and contributed to their worsening stigmatisation. The stigmatisation is so rife that even health workers involved in the management of mental illness are also roped in and do not escape stigmatisation as one retired mental health nurse stated.
But the mentally ill are part of us, our society and most of us stand the risk of suffering from one mental disorder or the other in our lifetime.
According to Dr Osei, WHO estimates that as of 2005, there were 2.166million Ghanaians with mild to moderate mental illness with another 650,000 having severe forms of mental illness.
Accoding to him, “These are WHO estimates, based on about 10 per cent of every population world-wide having some form of mental illness”.
October 10 was World Mental Health Day, a day set aside by the World Health Organisation to draw attention to issues of mental health and the need to address them.
The theme for this year’s celebration is: Mental Health in Primary care: Enhancing Treatment and Promoting Mental Health.
It was intended to address the continuing need to “make mental health a global priority and stress the all too often neglected fact that mental health is an integral element of every individual’s overall health and well-being.
It is in line with the WHO’s definition of Health as “ A state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity”.
The World Mental Health Day highlighted the opportunities and the challenges that integrating mental health services into the primary health care delivery system will present to people living with mental disorders and poor mental health, their families, caregivers and healthier professionals.
As explained by Dr Margaret Chan, Director-General of the World Health Organisation, for centuries, the illness of the mind has been treated as a social issue that is separate from any physical health issue. But mental health disorders do not happen in isolation and they frequently occur in relation to or alongside other medical conditions and as a response to many life situations. Examples of such conditions are heart disease, diabetes, cancer and neurological disorders.
It has been established that an individual’s medical issues and life circumstances do not affect just one area of the body. The way to go, therefore, in treating the individuals’ health is adopting a holistic and integrated manner to achieve positive outcomes.
In Ghana , the theme for this year’s celebration is very appropriate in view of the shift in focus from institutionalised care of the mentally ill to the integration of mental health with general healthcare at each level in the health system and to multi-sectoral liaison with the education, social welfare , criminal justice and non-governmental systems.
These are contained in the draft Mental Health Bill currently receiving attention at the Attorney General’s Department.
This shift in policy has also given rise to calls from various stockholders for the passage of a new mental health bill, which among other things, provides for the establishment of a Mental Health Authority which will have as its aim, the promotion of mental health and provision of humane care in a least restrictive environment. The authority is to provide mental health services at the primary healthcare level, among others.
Indeed Mental Healthcare in Ghana has come a long way from the 1888 Lunatic Asylum Ordinance, Cap 79, which became law and allowed custodial care for the mentally ill. This saw the building of the first asylum in 1906 at Asylum Down in Accra to decongest the prison where arrested mentally ill people were kept.
The ordinance remained in force with little modification until the Mental Health Act of 1972, (NCRD 30) was enacted. NRCD 30 focused mainly on institutional care, but was an improvement on the ordinance because it also took account of the patient, the property of the patient and voluntary treatment. NRCD 30 has never been amended even though attempts were made to revise it in 1996.
So from a situation where the mentally ill were locked up in an institution, a number of stakeholders have been at the forefront of advocating the passage of the bill into law because it seeks to improve the plight of the mentally ill in our society.
The mentally ill have suffered abuse of their rights as human beings, been stigmatised, and to seek their welfare, there is the need for the bill to be passed into law because that, it is hoped, will encourage the early identification and prompt treatment of mental disorder at the primary care level and the district general hospital level. This in turn will discourage admission to the three state-run psychiatric institutions which are often far from most homes and, therefore, difficult and expensive for families to visit regularly.
BasicNeeds Ghana is a non-governmental organisation which has been collaborating with various government institutions in seeking the welfare of mentally ill patients and pushing for the passage of the mental health bill into law.
This organisation focuses on initiatives in mental health and development.
According to the Country Programme Manager of BasicNeeds, Mr Badimak Peter Yaro, the organisation has been working to bring about a lasting change in the lives of mentally ill people around the world.
Mr Yaro explains that in Ghana, BasicNeeds recognised that the mentally ill were stigmatised by their local communities and had become marginalised as a result.
He said it was very difficult for the mentally ill to find employment, which therefore placed an enormous financial burden on their benefactors.
Mr Yaro explained that the lack of money often prevented the mentally ill from accessing treatment, and that further worsened their illness and increased stress on caretakers.
The organisation has programmes in both Accra and northern Ghana. It also carries out research in mental health and develops mental health policies in favour of people with mental illness.
As a development-oriented organisation, BasicNeeds’s approach has always emphasised community treatment and rehabilitation.
Through its operations, BasicNeeds addresses not only issues of treatment and rehabilitation which the global awareness theme for the 2009 World Mental Health Day campaign on enhancing treatment emphasises, but also the fundamental issues of human rights denial and violations that mentally ill people and their carers are subjected to.
The BasicNeeds Ghana programme began in 2002 with a pilot project in northern Ghana which focussed on access to treatment and sustainable livelihood programmes through partnerships with the Mental Health Unit and community-based organisations.
In all, 16,691 people with mental disorders have benefited from BasicNeeds Ghana’s activities since its inception.
Added to this, 16,024 people with mental disorders receive regular psychiatric treatment by attending outreach clinics organised quarterly in four sub-metros in Accra, namely Ashiedu Keteke, Ablekuma, Okaikoi and Ayawaso and in the three northern regions.
The work of BasicNeeds has resulted in the stabilisation of 14,208 people with mental disorders, out of which 12,257 are engaged in productive work.
The organisation has financially assisted or provided equipment for 3,603 of such people to engage in self-employment that enables them to earn some income.
It has been organising workshops for media personnel in Ghana, aimed at providing information on mental illness, with the view to making mental health issues better understood and enable them cover and report on mental health and development-related issues.
To discourage stigmatisation, bring some relief to families of the mentally ill and improve care for the mentally ill, the passage of the Mental Health Bill seems to be the way out.