The one present clinical psychologist overwhelmingly offers counselling, family therapy, individual therapy, and behavioural therapy to all of the hospital’s outpatients and inpatients. Due to this unfathomable ratio of one psychologist to around 17,265 patients, the quality of therapy and frequency of contact is low, and Dr. Dzadey proposed that there should be a minimum of three clinical psychologists. Preferably, there should be one in every ward, and one in the outpatient department, which would add up to an idyllic number of 10 clinical psychologists. Dr. Dzadey commended the use of physical therapy and recommends that the hospital should also hire at least four physical therapists;currently, there is none. Ghana’s only occupational therapist retired two years ago, but luckily, a temporary occupational therapist came from VSO, Voluntary Service Overseas, and helped train some future occupational therapist assistants to continue her year-long work. However, there should be at least three permanent occupational therapists. The two welfare officers in charge of tracing and contacting the families of patients and organizing repatriation with appropriate CPNs are also severely overworked,4 x 8 grow tray which leads to patients staying longer than expected. Dr. Dzadey advises that there should be a minimum of one nurse to five patients. This would result in an average of 275 psychiatric nurses working solely in the wards whereas there are only 260 currently working in either the wards, psych OPD, and/or general OPD. Table 9 shows a clearer representation in the gaps of human resource at the hospital.
A person with an acute case is expected to stay at the Accra Psychiatric hospital for two weeks but usually ends up staying for one to three months, while a person with a major case usually stays for about two years though some stay for twenty or thirty years. Inpatients stayed at the Pantang hospital for an average of 63.2 days while vagrants, geriatric patients, and paupers lived in the wards for an average of 173.9 days. These hospitals have a problem with patients overstaying their welcome because there is not enough manpower to frequently evaluate each patient’s progress, the courts do not come for them, or the patients live very far from the hospital. In some cases, the families forget to inquire about their relatives or refuse to pick them up due to the hospital’s distance from their village, or the families can no longer be reached . Moreover, the associated stigma results in a great deal of patients being abandoned by their families upon admittance into the psychiatric hospital. A heartbreaking pattern common to the children’s ward is parents giving spurious phone numbers and addresses to the hospital so that they can no longer be contacted in reference to their child. On average, only 20% of patients at the Accra Psychiatric Hospital have relatives who care enough to occasionally visit and how they are doing; this mainly occurs for those suffering from minor cases. For many years and still to this day, countless Ghanaians believe that supernatural, evil forces or spirits, bewitchment, or planted juju cause mental illness. The executives of MindFreedom find that most Ghanaians believe that the mentally ill cannot be productive in a society and that the reason they are mentally ill is because they are cursed or have offended a deity. The three noted that this perception cuts across all levels of age, education, and location. This assumption varies little between age and inhabited region, but sometimes varies in education level, with less schooled individuals often placing more blame onsupernatural forces while the more educated tend to hold more positive attitudes towards the mentally ill .
Ignorance leads to stigma, but with increased education and awareness, more are starting to be receptive of the fact that it is a general disease. Ghanaians, and most people in the world for that matter, view mental illnesses differently than physical illnesses because physical illnesses are tangible, easy to comprehend, and are generally easily treated with the right medication. People are more likely to attribute supernatural causes to things they do not understand. The average Ghanaian view is the same for both the mentally disabled and the mentally ill. Though epilepsy is a neurological condition and not a mental illness, people with epilepsy are also considered to be mentally ill in Ghana because they share the same stigma and because they have been historically treated by psychiatrists due to the lack of neurologists. The common Ghanaian perception of mental illness is changing. It was very troublesome for someone who was mentally ill, or related to someone who was mentally ill, to be married some time ago when families ran heritage checks for eligible bachelors or bachelorettes to be arranged in marriage. Now that families are becoming more independent and nuclear and the Western importance of romantic love is becoming a driving factor in marriage, a person who was mentally ill will no longer be completely disregarded as a potential mate. Also, in order to vote or become president it is written in the constitution that you “should be of sound mind, which becomes misinterpreted as denying the right to vote to anyone who has ever had a mental illness. For example, a person might be evicted from an apartment if the property owner finds out that the person has, or has had, a mental illness. Although you would not be asked whether you have ever had malaria or AIDS at a job interview, it is commonplace in Ghana to ask if you have ever suffered from a mental illness, which then becomes viable grounds for being denied the job. You can also be fired or denied a promotion if a co-worker discovers that you had or have a mental illness, though another random reason for dismissal is usually given.
The environment in education is also not conducive to people with mental illness. Although there is no policy that denies access to school, the attitude and stigma held by peers and faculty often leads a mentally ill person to drop out of school. Up until three years ago, if there was an international event or conference planned, it was common practice for police to round up all of the wayfarers on the main streets and dump them at the psychiatric hospital or on the outskirts of town. Fortunately, MindFreedom and BasicNeeds spoke against this inhumane action and it has not occurred since. Due to a plethora of challenges the countries have to face,bud drying rack mental health in Africa is largely marginalized. Most African countries do not have mental health laws and the others have out dated, forty to fifty year old laws that were written when human rights were not an issue. On a scale from one to ten, Dr. Osei rated the quality of mental health care in Ghana as a four. All hospitals in Ghana are underfunded with 94% of the budget being spent on paying the necessary salaries of medical professionals and the remaining 6% going into running the hospitals. On average, the government allocates mental healthcare with 2.58% of the total health budget which is strictly limited to finance just the three psychiatric hospitals and not community care. The funding by the Ministry of Health has been unstable since 2003 because psychiatric care does not appear to address urgent, life-threatening issues. The funding is not based on needs but rather on limits set by the Ministry of Finance. Politicians in Ghana do not want to give attention to mental illness, a sickness with low morbidity, when high fatality conditions grab more national and international attention. Because of this and its stigma, mental health care receives little donations from charities. Amegatcher, Adico, and Taylor respectively rated the quality of Ghana’s mental health care on the same scale as a four, two, and five. These low scores were supported by the lack of resources and funding available to psychiatric hospitals and the lack of priority in the government’s agenda. The belief in superstition also deprives the mentally ill in Ghana of sympathy and compassion. This combination of ignorance yields the mentally ill vulnerable to suffering human rights abuse, leading to Dr. Osei’s low rating. Fortunately or unfortunately, Dr. Osei believes that Ghana’s mental health care system is one of the best in West Africa besides maybe Nigeria. Instead of facilely increasing the number of psychiatric hospitals in Ghana, Dr. Osei wants to create 20-bed psychiatric wings in every regional hospital and 12-bed wings in every district hospital. Right now only five of ten regional hospitals have 20-bed psychiatric wings. General medical practitioners should also start receiving some training in psychiatric care so they can better treat their patients and discern when to refer them to a psychiatrist if necessary.
The Chief Psychiatrist also wants to downsize the three psychiatric hospitals, ultimately changing Accra Psychiatric Hospital’s admittance from 1,200 to 300 patients, Pantang from 500 to 200, and Ankaful from 300 to 100 in-patients. The downsizing of the large hospitals and the creation of small wings throughout the whole country will deinstitutionalize the mental health care system in Ghana so it can ultimately focus on community care. Dr. Osei finds that many Ghanaians now believe that mentally ill patients can lead a happy, healthy life after treatment, but still there are only two rehabilitation services in all of Ghana that help reintegrate mental patients into society. These facilities are run by Catholics in Kumasi and discharged patients who permanently live near the Ashanti Region are sent there after treatment to learn some trade. Dr. Osei recommends that these services should be replicated and that there should be at least one rehabilitation resource in every region. The Pantang hospital would like to establish a Half-Way home for rehabilitation of chronic patients , start a fishpond rehabilitation project, develop an addiction outpatients clinic hot line, equip the laboratory, records, and pharmacy departments with a software, utilize a computerized data system, create a web page, expand a Drug Rehabilitation Centre, build more staff accommodation units, ensure accessibility to needed medications at the pharmacy, increase security, focus on prevention, recovery, and relapse-reducing programs and activities, and enhance staff morale by providing better incentives, training, equipment, and uniforms. The Pantang Hospital is also working on a proposal to create an evaluation ward which would help to avoid long-stay patients and streamline the diagnosis and welfare process. In this ward the patients would be observed for a maximum of 72 hours by a specialized screening team in order to make sure the patients’ diagnoses are correct and that they require admittance into the hospital. The most recent mental health law, written in 1972 when international human rights was not much of a concern, also needs to be updated. Both the Chief Psychiatrist and MindFreedom were involved in the drafting and advocacy of the new Mental Health Bill. The bill will address a lot of setbacks in the mental health system. If passed, the Mental Health Bill will commit the government to release more funds and resources for mental health care , train more mental health personnel including psychotherapists and counsellors, give incentive for people to work in mental health care, provide newer generation medicine, overhaul and decentralize the hospital-based system and make mental health care more community based, create an anti-stigma and education campaign, and protect the human rights of the mentally ill. Right now there are no checks for human rights abuses of the mentally ill, and this bill will make it illegal to put the mentally ill in chains and a new standard committee will work closely with prayer camps to oversee and enforce the upholding of all human rights. All in all, the Mental Health Bill will ensure effective treatment for the mentally ill and the law will serve as a standard for other African countries to follow. The bill was submitted in 2006 and did not reach parliament until the end of 2010, where it is sitting to this day. It took four years before the government bothered to address the situation simply because they did not value the issue. Mental illness is such a low priority for the government because of the stigma that exists even in the minds of politicians and because mental health disorders have a low fatality .