The Decentralization of the Ghanaian Mental Health System through the Psychiatric Institution, Prayer Camp, and Non-Profit Sector: A Case to Improve Access to Care and Disrupt the "Othering" of the Mentally Ill?

Mental health services, with my research focus on the most prevalent disorders, schizophrenia and depression, are incredibly under-resourced. Ghana has just 18 practicing psychiatrists and only three psychiatric hospitals for the entire country. It is estimated that, “of the 24.3 million people living in Ghana, 2.4 million suffer from mental illness” (ACCA Global 2013). With less than 20 practicing psychiatrists, there is a 98% treatment gap in Ghana. Mental health services funding is nowhere near the level of funding concerning infectious diseases or reproductive health. The misconception that mental illness is contagious leads to the stigmatization of not only the mentally ill but also mental health professionals. Due to resource constraints and the stigma attached to mental illness, the majority of the population suffering from psychiatric conditions is not treated with modern medicine like psychotherapy or medication. Instead, they are sent to spiritual churches or prayer camps where they are sometimes severely mistreated. This includes being chained up (sometimes outside in poor weather conditions) or prevented from using adequate medical care (ACCA Global 2013). Furthermore, the dearth of research in mental health contributes to insufficient understanding of how the Ghanaian mental health system may influence the social differentiation, or “othering,” of the Ghanaian mentally ill and impact Ghanaian mental health care-seeking behavior or utilization of the Ghana mental hospital system. Those who are mentally ill are unfortunately ostracized from the rest of the community and perceived to be straying from what society considers normal. Through my ethnographic research with key actors in the Ghanaian mental health system, I analyze what “abnormal” means in this society and how the mental hospital and prayer camp may have different forms of othering the mentally ill. This study focuses on the following research questions: (1) How do Ghanaian mental health institutions influence the social “othering” of the mentally ill (primarily through confinement and social isolation)? (2) How does this not only impact the vulnerable population but also impact voluntary mental health care utilization and mental health care seeking behaviors in Ghanaian society? In my final analysis, I conclude that the roots of the issues behind mental health are education, resource allocation, awareness that mental health is on an expansive spectrum, and the understanding that people must heed to their mental health and wellness as much taking care of their physical health. Thus, I argue, decentralization does not solve issues of stigma because the social and political body’s issues are so deeply ingrained in the culture and cannot be changed with a complete revolution of what it means to have a mental illness -- normal life can still be maintained, the mentally ill can still contribute to society, etc.

Keywords:  Department of Science
Ghana
Mental Health
Mental Illness
Psychiatry
Culture
Religion
Stigma
Science Technology and Society at Stanford University
Thesis
Advisor: Fullwiley Duana
Brawn Shay
Ikoku Alvan
Hubbard Laura