The image will never leave me. A young lady – she must have been not much older than I am now. Chained to a stone wall, in a room which wouldn’t look out of place in Elmina castle or any of the historical slave-holding castles dotted around Ghana. Legs shackled, she lay slumped in the damp darkness. No energy left to act out the distress her face betrayed she was still feeling. Sat helplessly in a concoction of excrement and feminine fluid which looked so putrid I could swear blind the stench emanated out of the photo on the website and through my laptop screen.
A modern-day re-enactment of crimes against humanity performed on our shores centuries ago? A depiction of torture?
No. She was simply a mental health patient. In a mental health facility. In Ghana. In the 21st century.
mentally ill in chains
In Ghana, mental health remains massively stigmatised and grossly misunderstood. And in the depths of misunderstanding and ignorance does not lie bliss, but rather a platform upon which traditionalist ideologies perform. The demonization of those with severe mental illness causes people to legitimise horrible treatment. A Human Rights Watch report on Ghana and BBC investigation into an Accra psychiatric facility found patients going without food or even clothes, being kept behind bars, and subjected to degrading physical treatment. It’s easier to perceive those with mental illness as animals, rather than understanding that these people need a greater, more intensive and careful degree of help than most.
Despite some progression over the years, you can tell that mental health provision remains an after-thought, almost a nuisance. That is why psychiatric nurses in Accra embarked on a nationwide strike to bring to attention the fact that the majority were in salary arrears (it’s also interesting to note that despite a news article reporting this being hosted on one of the biggest and most active of Ghanaian news sites, the comments in the comments section stood at a grand total of 0…).
Mental health workers are underpaid and overworked, with facilities badly under-resourced. Ghana records at least 1500 suicide cases annually – which constitutes about 7% loss of Ghana’s potential Gross Domestic Product (GDP) yearly! And those are just the reported cases – with suggestions that for every reported case, there are four unreported cases of suicide. However, only 2 out of every 100 Ghanaians with a mental illness will get the care they need.
Government spending on Psychiatry is very low and the bulk of services, albeit sparse, are centred on Accra, leaving much of the rest of the country with almost no provision. Ghana has only THREE psychiatric hospitals nationwide catering to Ghana’s population of 25 million – and ALL THREE are on the southern coast (2 in Accra, 1 in Central Region). Imagine how those in the Northern region feel, an area with the biggest mental health burden in the country. Logic.
While the UK is looking to spend a whopping £1.25 BILLION on mental health services over the next 5 years, Ghana spends a meagre £3million a year. Accra Psychiatric Hospital is a 700 bed unit – and yet, it houses more than 1200 patients….Go figure.
With few options for care outside these facilities, many people resort to prayer camps & traditional healers whose treatment methods can be inhumane at best. There is such a heavy stench of superstition and fear around psychiatric illness in Ghana. Don’t believe me? Here’s a bit of homework for you. Next time you’re in Ghana and an auntie asks you about job aspirations, tell her you want to be a Psychiatrist…
A paper published in the International Journal of Mental Health Systems found that while there are more than 1000 registered mental health nurses, there are only EIGHTEEN registered psychiatric doctors – NATIONWIDE. That works out at 0.07 psychiatrists per 100,000 Ghanaians. And those are just the registered – some of those 18 may not even be in active service. If these numbers fail to horrify you…
Dr Sammy Ohene, Head of Psychiatry at the University of Ghana, recently decried the ‘cash-and-carry’ culture which has seeped into the Accra Psychiatric Hospital, noting that Ghana law suggests costs to provide treatment should be covered by the taxpayer, not paid at the point-of-care. He goes on to suggest that those who cannot afford the new service fees will turn to herbalists and spiritual healers in an attempt to get psychiatric care. There is already a problem with the provision of medication, with some patients acknowledging having to take much lower doses of their medicines in order to make their medicine last as they cannot keep up with costs.
And that is the last thing you need. To begin to drive people away from facilities which can best cater to their needs and back towards the stone-age dark areas of the country where they will be further demonised. But who cares right? Because according to the Accra Psychiatric Hospital, the only reason they have resorted to ‘cash-and-carry’ is because the central government isn’t providing money to cover costs of treatment and keep the hospital running…
trapped for being mentally ill
The Mental Health Act 2012 seems to be just a means of simply keeping the watching international community off of our backs. The prospect of paying extortionate costs for care, and the ongoing stigmatisation and rampant traditional beliefs, are roadblocks preventing those who need care presenting themselves to receive it.
Listen – mental illness can happen to any of us. 1 in 4 will have some sort of psychiatric illness in our lifetime, of varying severity, regardless of race, nationality or creed. The people in the hospitals and those wandering the streets were once teachers, traders, hardworking wives or husbands, lovely children of parents and families. The social stigma so often associated with mental illness, allied with poverty and inadequate healthcare facilities, has conspired to rob these people of the care and support they deserve. Psychiatric care continues to suffer neglect in terms of practical, sustainable action that could benefit poor, marginalized people with mental illness. Will the image I described at the beginning of this article ever become a footnote in the legend of our nation? We have so much to do before we create enough light to drive out the darkness…
The paper ‘An overview of Ghana’s mental health system: results from an assessment using the World Health Organization’s Assessment Instrument for Mental Health Systems (WHO-AIMS) ‘ is available at http://www.ijmhs.com/content/8/1/16
By Dr Jermaine Bamfo (@Dr_Jabz27)