After the prison quickly filled, a Lunatic Asylum was built in 1906. In accordance with international trends, the asylum was later transformed into the Accra Psychiatric Hospital in 1951 with help from the first sub-Saharan psychiatrist, Dr. E. F. B. Foster. With high walls and barbed wire, to this day the hospital still resembles a prison, which harks back to how the mentally ill were dealt with during colonial times. Luckily, innovations such as the removal of chains from patients, abstaining from patient punishment, and use of chlorpromazine and electroconvulsive therapy arose in the fifties. During that time, the Accra Psychiatric Hospital was the only psychiatric facility in West Africa. In 1962, the Ghana Medical School started training undergraduates in psychiatry and a Mental Health Unit was formed within the Ministry of Health in the 1980s. Though Ghana’s psychiatric care has come a long way since the 1800s, there are still a lot of changes that need to occur in order to attain a standard of quality that is appropriate to recent advances. Ghana’s Mental Health Decree, which emphasizes institutional care and involuntary admission, has not changed since 1972, and treats the mentally ill as if they have no rights. Fortunately, a new Mental Health Bill, which was drafted in 2006, finally made it into the lap of Parliament in October of 2010. This legislation will promote practice of mental health care at the community level and protect the rights of people with mental illnesses. It has gained the support of traditional healers, nurses, and doctors, and will serve as a model for developing progressive mental health legislation in line with international human rights standards. Several researchers have noted a need to increase accurate and comprehensive data collection on mental health impact and prevalence in order to help improve perceptions on the legitimacy of psychiatric services, and ultimately influence policy.
Due to a shortage in personnel,vertical grow system there is a deficit of mental health information, hard community based data, and scientific estimates for neuropsychiatry disorders in Ghana. Because the World Health Organization’s agenda for mental health research in the developing world suggested to evaluate mental health services, this paper focuses on two of the three psychiatric hospitals, and analyzes the hospitals’ available services, resources, recent annual number of out-patients and in-patients, and most common diagnoses which have not been published since 2003. In an attempt to provide an argument for improving the resources and commitment to mental health, this paper also reports on the status of mental health care via information from interviews with key people in the mental health delivery system and non-governmental agencies involved in mental health. Ghana is a middle-income, developing, constitutionally democratic republic located in sub-Saharan West Africa along the Gulf of Guinea in between Cˆote d’Ivoire and Togo. Once a British colony of the Gold Coast, in 1957, Ghana was the first sub-Saharan country to gain its independence and is relatively politically stable. The population estimate for July 2011 is 24,791,073. The life expectancy is 61 years and high risk infectious diseases present include malaria, typhoid fever, meningococcal meningitis, hepatitis A, and diarrhoea. Malnutrition and poor reproductive health are also familiar problems to sub-Saharan countries. There are three prominent religions; 68.8% of Ghanaians are Christian, 15.9% are Muslim, and 8.5 percent follow a traditional religion. The official language is English but there are about 100 linguistic and cultural groups in Ghana, and English only accounts for 36.1% of the population’s primary language. The 2010 GDP, purchasing power parity, was $38.24 billion dollars, with one-third produced agriculturally. Gold, cocoa, and timber are the country’s main exports and recent oil production is expected to heighten economic growth. Twenty-eight and one half percent of Ghanaians live below the poverty line and 11% are unemployed .
Ghana’s health expenditure is roughly 4.5% of the Gross National Product, compared to 15.2% in the US . Ghana is divided 10 regions and 170 districts. Due to the proximity to the University of Ghana, Legon Campus, interviews were conducted in the metropolitan capital city, Accra , and in the surrounding Greater Accra Region, which lies on the south-east coast. In order to gain first-hand information and opinions on the current mental health situation in Ghana, 1.5-3 hour interviews were conducted with prodigious psychiatrists and a mental health NGO during spring of 2011. The first two interviews were with Dr. Akwasi Osei, the acting Chief Psychiatrist of the Ghana Health Service and Administrative Head of the Accra Psychiatric Hospital, the oldest and main psychiatric hospital in Ghana. In addition to holding these positions for the past six years, Dr. Osei is also a senior lecturer, researcher, and spokesperson for Ghana’s mental health care. The first interview dealt with matters based on Ghana’s mental health system and the stigma of mental illness, while the second interview addressed the logistics and condition of the Accra Psychiatric Hospital. Dr. Anna Dzadey, a psychiatrist from Poland, was the second interviewee. She has been the Medical Director and Psychiatric Specialist in charge of the Pantang Mental Hospital since 2005. Dr. Dzadey provided ample amounts of information on the Pantang Hospital, one of the three psychiatric hospitals in Ghana. One of the most prominent mental health NGOs in Ghana, MindFreedom, was also interviewed to learn how they are helping to improve the care available to the mentally ill, and to see if they are noticing signs of advancement. The interview with Mind Freedom involved Janet Amegatcher, Nii Lartey Adico, and Dan Taylor, the executives and founders of the NGO. In all of Ghana, there are only three public psychiatric hospitals and four private psychiatric hospitals. The three public hospitals, Accra Psychiatric Hospital, Pantang Hospital,mobile grow systems and Ankaful Psychiatric Hospital, are all located in the South, with two in the Greater Accra Region and one about three hours away in Cape Coast in Ghana’s central region.
Treatment for mental health care in government hospitals is free and is funded by the Ghana Health Service, which allocates a mere, debatable 0.5–3.4% of the health budget to the mental health sector. There are also four private psychiatric hospitals, two in Kumasi, one in Accra, and one in Tema . Although Kumasi is not along the coast, it is still in the southern half of Ghana. The private hospitals are criticized for being too expensive, and it is said that their patients usually end up at a public hospital once their resources are drained. It is uncertain whether the quality of care at a private psychiatric hospital is superior to that of a public hospital, but there are most likely better accommodation, less congestion, and more doctor-patient contact time. The Accra Psychiatric Hospital offers in-patient and outpatient services, limited counselling and therapy, and clinical training for doctors, psychologists, and psychiatric nurses. Technically, all services are free to the Ghanaian public, but some small fees are charged in order to help keep the hospital running. New patients are obliged to pay four Ghana cedis for a hospital records folder, ID card, and some forms. Patients are also asked to pay about 80 pese was for their medication, which can cost up to 400 Ghana cedis. In turn, this helps the patient to value the medicine on top of providing money for the hospital. Typically two psychiatric nurses and two aids work in each ward on a daily basis, taking care of an unbelievable amount of patients by dispensing medication, noting observations, feeding, washing, and offering group therapy if there is any time or motivation left. The nurses write down the progress of each patient almost every day, but when asked how often the doctors review these notes, the nurses laughed and encouraged me to ask the medical director of the Accra Psychiatric Hospital. Although doctors should be checking in on their inpatients every day, in actuality, it happens about every two weeks due to the overload of outpatients and inpatients. A nurse will usually only report to a doctor if the condition of the patient has become very poor or if they believe the patient is well enough to be discharged.
The Pantang Hospital, the largest of the three psychiatric hospitals, was commissioned in the rural Pantang Village in the Greater Accra Region in 1975 in order to reduce the congestion at the Accra Psychiatric Hospital. It was planned to be a regional psychiatric hospital with a 500 bed capacity, but in addition to the original psychiatric services, the hospital now offers primary health care, reproductive and child health services, and, under the National Health Insurance Scheme, HIV counselling, screening, and ART service. The psychiatric services are free by description, but similar to the Accra Psychiatric Hospital, Pantang asks patients to pay a small fee for their folders and medication if they can afford it. Nurses, nursing students, Health Assistant Training School students, and Community Health Mental Officers also gain clinical psychiatric experience at the Pantang Hospital. Community mental health care exists in Ghana, however, it is not well developed. A Community Psychiatry Nursing Programme began in 1975, and there are currently 120 Community Psychiatric Nurses working in all ten regions, but some regions may have just one or two CPNs. The nurses are not distributed evenly throughout the country, and only 70 districts out 170 are covered by at least one CPN. To become a CPN, a psychiatric nurse only has to train for three to six weeks after their completion of the mental nursing program but soon there will be an official degree program that spans over one or two years. Dr. Osei believes that there should be at least 2,000 CPNs working in the country in order to provide adequate community based psychiatric care.CPNs are responsible for identifying and managing cases, referring cases to the next level of care, counselling, providing after-care services , and creating awareness and promoting mental health in the community. In addition to institutional care and community mental health, another key component of treatment is traditional healing. Due to the nation-wide presence of unorthodox healthcare and the Ghanaian belief that mental illness is caused by spiritual forces, traditional and spiritual healers tend to the largest sum of mentally ill sufferers in the country.Dr. Osei believes that traditional or faith healing, which uses herbal preparations and/or spiritual incantations/invocations, could be valuable if the administrators recognized their limits. Minor disorders like anxiety, minor depression, neurosis, phobias, or OCD, which might not require medication for treatment, can sometimes benefit from the therapy provided by healers. A healer is typically well trusted and has considerable influence over one’s emotions, so a patient might subsequently change their way of thinking after treatment, or receive reassurance that whatever provoked the problem has been removed in a spiritual manner. However, except for the occasional use of antipsychotic herbs prescribed by herbalists, traditional healers generally cannot help a person suffering from a severe mental disorder. It is well reported that abuse of the mentally ill occurs at prayer camps. In a documentary released by Mind Freedom Ghana, the mentally ill are chained to trees, exposed to the sun and rain, deprived of food and/or water, and even chained or flogged in an attempt to exorcise the supposed demons. The violations of a mentally ill person’s human rights have yet to be curbed because there are no laws governing mental health care outside of the psychiatric hospitals. Nonetheless, seeing a faith healer is seemingly less stigmatizing than visiting a psychiatric hospital. A mentally ill person is usually shown some sympathy from the community if they attend therapy from a traditional healer while no empathy is given to one who visits a mental hospital. The executives of Mind Freedom encourage a balance between faith healing and physical treatment when necessary, agreeing that seeing a traditional or faith healer brings fewer stigmas and is more convenient transport wise. Because of this, the normal pattern for Ghanaians involves utilizing traditional care first and then going to a psychiatric hospital if the problem was not cured. Twenty to thirty percent of the Accra Psychiatric Hospital’s patients try spiritual or traditional healing before a family member or the court brings them to the psychiatric hospital.