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Dan Taylor,MindFreedom-Ghana

Tackling Ghana’s Mental Health Challenges in an Unequal World

The COVID-19 pandemic has unleashed a devastating blow on people living with psychosocial disorders. According to the World Health Organization (WHO) some 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 disorders have also been significantly disrupted in many countries.

This year’s theme for World Mental Health Day: “Mental Health in an Unequal World”, underlines the pressing need to focus sufficiently on health beyond the physical in a sustained way in a world still struggling to fight the corona virus. The COVID-19 pandemic has increased inequalities in human development, including unleashing unpleasant situations to mental health by causing more incidence of mental disorders as well as emotional challenges and disrupting already inadequate mental health services in many parts of the world not excluding our Homeland Ghana.

During the World Health Assembly in May 2021, governments from around the world recognized the need to scale up quality mental health services at all levels. And some countries have found new ways of providing mental health care to their populations.

Ghana has made a lot of progress, particularly in terms of the legal framework, in the delivery of mental health services, though many challenges persist.

Sunday, 10th October 2021, the world turns its focus on issues relative to mental health. It is a special day set aside universally to acknowledge efforts in improving global mental health, by increasing mental health advocacy, education and awareness-raising against the menace of social stigma and discrimination.

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

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

The theme, according to mental health experts, 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 unable to access mental health services at all, and access in high-income countries is not much better.

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

At the same time, the gap between the rich and the poor continues to grow wider and there is continuing unmet need in the care of people with mental health problems in Ghana.

In effect, it will not be out of place for one to say that issues bothering mental health are not given the needed attention as done to other health-related problems.

Setting the Local Context

Indeed, 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, a situation that has heightened the plight of the 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. They are often subject to discrimination, social isolation and exclusion, human rights violations as well as demeaning stigma. These are some of the inhuman attributes that accompany mental health patients. The stigma and discrimination experienced by people who experience mental ill-health not only affects that person’s physical and mental health, stigma also affects their educational opportunities, current and future earnings and job prospects, and also affects their families and loved ones. 

This inequality needs to be addressed swiftly and must not be allowed to continue so that persons with mental disabilities would be clothed with dignity and ensure an inclusive Ghanaian society with equal opportunities for all.

As a people, we have a role to play to address these disparities and ensure that people with lived experiences of mental health are fully integrated into all aspects of life.

 Government Admits There Are Challenges

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

The Mental Health Policy (2019 – 2030) seeks to provide a framework for supporting the achievement of good mental health for the populace taking into consideration our culture, resources, geography and other considerations. At the end of the day, ensuring a mentally healthy and emotionally satisfied populace must be the ultimate goal.

The Policy document acknowledged 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 a top-heavy concentration  of  services and  resources at the psychiatric hospital as against the optimal pyramid where  services and  resources  are spread in the  community.

Situation analysis

According to a situational analysis by the World Health Organization in March 2020, it is estimated that, 650,000 people in Ghana are suffering from a severe mental disorder and a further 2,166,000 are suffering from a moderate to mild mental disorder” and the treatment gap is “98% of the total.  This means 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.

There are three mental hospitals in the country with a total of 1,322 beds (5.5 beds per 100,000 population). Two of these hospitals are located in the capital city and the other located in the Central Region of Ghana which is also in the south of the country.

Why the need to accelerate access to mental health services

The statistics in the preceding paragraphs give an indication that access to mental health services in the country is nothing to write home about, thus calling for an urgent need to address the inadequate amount of resources for the mental health sector to boost service delivery. There should be a new direction for the general improvement in the quality of mental health for the citizenry.

Governmental interventions

 To offer solutions to the problems chronicled above, Government of Ghana has set out an inter- sectoral mental health framework to capture the vision informing the mental health law. Framework according to government is designed to support good mental health services in Ghana in a way that is integrated, holistic, decentralized and culturally sensitive. Some of government efforts include the Mental Health Act, 2012 Act 846 and the integration of mental health into general health care with opening of psychiatric wings in some Teaching and Regional Hospitals.

Flowing from this germane commitment, MindFreedom Ghana appreciates the Government’s “Agenda 111” that seeks to build two new psychiatric facilities in the middle and northern zones of the country to bring mental healthcare and treatment closer and affordable to the populace in these catchment places.

Furthermore, our organization is strongly encouraging Government to take the necessary steps expeditiously to fix the levies to raise money into the Mental Health Fund established under the Act which will go a long way to support mental healthcare in Ghana.

Intensifying mental health advocacy

It is within the context of the foregoing including the need for collaboration for effective advocacy towards mental health and other disability issues- that we recognize and appreciate the funding support MindFreedom Ghana, has received 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 support in strengthening 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.

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

Let us always dare to care because “Mental health is total health!

By Dan Taylor

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