The beginning: Kwame
It was a long time ago. Counting the years backwards now, I must have been about ten years old then when my cousin Kwame, who must have been about 18 years old at the time, was brought in by my auntie to stay with us for a brief period. His arrival was strange for two reasons. First was the fact that, I knew he was working in Ho as a taxi driver. What was he doing in Praso then, especially when it was not a festive period so at least, one could say he was visiting? Secondly, it seemed the ‘elders of the house’ were not exactly willing to host him. I would soon know why.
Soon after Kwame settled in, he went out for a stroll. One ‘elder of the house’ quickly summoned us kids and announced to us in hushed tones that, Kwame had gone to meddle with marijuana and had been taken to Ankaful for treatment but had been discharged not too long ago. Ankaful was, in fact, the Ankaful Psychiatric Hospital which is one of the few psychiatric hospitals in the country. The elder then went on to warn us to be careful around Kwame. And we followed his advice.
Even though Kwame did not even look aggressive or sick, nobody wanted to be around him. None of us wanted to eat with him, watch TV with him, talk to him or have anything at all to do with him. I believe he soon figured out that we knew his story and he stopped trying to get close to any of us.
The actual story
Years later, I found out that what had actually happened was that, Kwame had taken his taxi to some isolated bushes so he could use the stream there to wash his car. He stumbled across a group of marijuana smokers who were afraid he would go and report them to the authorities, so, they forced him to take a few puffs of the illicit drug. Those few puffs made him lose sanity momentarily, and in a few minutes, he was out on the streets of the Volta regional capital, naked.
Luckily, someone who knew him saw him quickly enough and took him to the regional hospital where his condition was stabilized and he was referred to the Ankaful Psychiatric Hospital for further assessment and treatment. It was after his course of treatment was complete that he was discharged and advised to take some rest for a few days before returning to work. That was when he was brought to our end. What this meant was that Kwame was harmless but we stigmatized him because we feared the unknown.
This firsthand experience is not a special one; there is a general stigma associated with mental health issues in Ghana.
The debate in 2017
Early in 2017, there was an upsurge in the number of suicide cases reported by Ghanaian media. Two schools of thought emerged. One claimed that the apparent increase in suicide cases was only because the media had begun reporting them as they occurred. The other school of thought had it that, the rise was cause for alarm; that something must be done in terms of creation and revamping of mental health care systems in the country. What was more interesting was how the episode of suicides exposed how the majority of the population generally perceives mental health matters.
Most people seemed to be of the view that depression, and consequently suicide, was either a sign of weakness or was attention-seeking behavior. They did not realize that like malaria, cancer, hypertension and myopia, depression, schizophrenia, psychosis and other mental health conditions were also clinical conditions that occur not because their sufferers are weak or are attention seekers.
Why has mental health been neglected in Ghana?
The Mental Health Authority was established in November 2013 to promote mental health in Ghana. Three years later in December 2016, it was revealed by Dr. Sammy Ohene, Head of Psychiatry at the Korle Bu Teaching Hospital that ever since the authority was set up by the then Mahama government, not a single penny from the government had gone into its funding. Not even the office building of the Authority was provided for by the government, the doctor claimed. This clear disregard for and neglect of mental health by the government is merely a reflection of the generally poor attitude of Ghanaians to mental health. What could be the reason?
First and probably the most glaring reason is ignorance. People either fear what they do not know, or they devalue its importance. Mental health education efforts are on the low. As to whether the lack of education is what has caused the general ignorance or otherwise, is a question for the gods. But a lot of work needs to be done. Knowledge and enlightenment are the surest ways of demystifying mental health and in effect, the psychiatric hospital, which is merely the institution that houses clinical and professional mental health care activities.
With the ‘suicide epidemic’ scare early in 2017 came the setup of a number of online mental health care centers and nongovernmental organizations. The reactive rather than proactive response is not the best. Preventive care must be given more attention than curative treatment because it is easier to do and is less costly to the healthcare system and the individuals, their families and society in general.
The spiritualization of mental health diseases is also one thing that must be looked at. It all comes back to the issue of ignorance. Most women who suffer from Post-Partum Depression or Post-Partum Psychosis are referred to churches and shrines for deliverance when their relief lies in the hospital. Even cases of drug addiction, bipolar disorder and schizophrenia are given a demonic touch and treated as such. This is sad.
Another issue is the structural system of mental health care facilities in the country. The 1972 Mental Health decree, NRCD 30, strongly emphasized institutional care as opposed to primary health care for mental health. This decree guided mental health care policy in this country for 40 good years before the Mental Health Bill was passed in 2012 to replace it.
Under this law, psychiatric hospitals are the first and only points of call for all mental health cases, whether mild, moderate or severe. There are only 10 psychiatric hospitals in the country and so, only the most severe cases are admitted there. The hospitals have therefore come to gain the tag of “mad men’s house” over the years. This is very wrong.
I posit that, if the community-based model of care is adopted for the mental healthcare as is used in the general healthcare system and as is enshrined in the 2012 Mental Health Act, the bad notions surrounding the psychiatric hospitals will be reduced. Let us take as an example, how malaria is treated in the general healthcare system. When it is confirmed that one has contracted uncomplicated malaria, he can be treated in a community care facility – a pharmacy, district government hospital or a private facility. If the individual does not get treated, however, the uncomplicated malaria will progress to severe life-threatening malaria which would necessitate the transfer of the patient to a regional or teaching hospital. If there are no primary care facilities, the higher hospitals then become pools, as it were, for serious cases which could have been arrested earlier if proper structures were in place.
Relating the analogy above to the mental health service provision system, if mental healthcare is incorporated into the basic mandate of the primary healthcare system, the number of advanced and severe cases will decrease. Also, the populace would be seeing more mental health cases at the community level and will eventually get used to them. This will translate into an appreciable degree of demystification.
In conclusion, if we want to remove the mystery and stigma associated with mental health and the psychiatric hospital, we need to embark on education and implement the policy changes that will manifest the change we wish to see.