An updated situation analysis of mental health services and legislation in Ghana: Challenges for transformation

•17• Chapter 4 An Updated Situation Analysis of Mental Health Services and Legislation in Ghana: Challenges for Transformation A. Ofori-Atta, U.M. Read, C. Lund, and the MHaPP Research Programme Consortium1 Introduction Mental health care is often one of the lowest health priorities for low-income countries (World Health Organisation WHO 2001) and Ghana is no exception. In common with many low-income post-colonial countries in Africa, Ghana has not developed the infrastructure and public services, including mental health care, to keep pace with population expansion. The population of Ghana has more than doubled since independence in 1957 and currently stands at approximately 25 million (Ghana Demographic & Health Survey; 2003, 2005) with a consequent growth in the numbers of people suffering from mental disorders. Research has revealed the extent to which mental health care in many low- and middle-income countries is consistently under-resourced.(Jacob, Sharan, Mirza, et al 2007; Kohn, Saxena, Levav, Saraceno, 2004; Saxena, Thornicroft, Knapp & Whiteford, 2007) In the relative absence of community care, institutionalised care remains the norm for many of those with mental health problems in low-income countries (Saxena et al., 2007). Indeed, in countries such as Ghana, many of those in need of treatment do not reach psychiatric services at all, but seek the care of informal community mental health services (WHO, 2003) such as traditional and faith healers as well as family members who offer a varying quality of service and level of efﬁcacy. In addition, there is increasing evidence from developing countries that mental illness is strongly associated with poverty (Patel, 2001; Patel & Kleinman, 2003; Saraceno, Levav & Kohn, 2005). •18• Chapter 4 Despite some signiﬁcant economic growth in recent years, Ghana is classiﬁed as a low-income country with 28.5 percent of the population living in poverty, and 18.2 percent living in extreme poverty, especially in rural areas (Government of Ghana, 2007). Yet there is a growing body of research demonstrating innovative, cost-effective interventions for mental disorders such as schizophrenia and depression in low-income African countries (Wiley-Exley, 2007; Patel, Araya, Chatterjee, et al., 2007; Siskind, Bolton & Kim, 2007). Among these are agricultural rehabilitation villages in Tanzania (Kilonzo and Simmons,1998), family involvement in hospital care in Senegal (Diop & Dores, 1976; Franklin, Sarr, Gueye et al., 1996), group therapy for the treatment of depression in Uganda (Bolton,Bass, Neugebauer, et al., 2003), and collaborations with traditional healers in northern Ghana (Montia, 2008). In Africa therefore, as in other regions of the world, the deﬁcit is not in the evidence for interventions to address mental health problems, but in the resources and political will that can make these interventions available to those who need them. Ghana currently stands in a relatively unique position within the African continent to respond to this challenge. In spite of its low-income status, the country has one of the highest literacy rates (57.9 percent) within West Africa (United Nations Development Programme, 2005), is considered a relatively stable and peaceful democracy, with relatively good standards of governance, and has a strong and diverse civil society. Gaining independence as early as 1957, it was also one of the pioneers of primary health care in the region (Twumasi, 1974) and initiated attempts to develop mental health care in the ﬁrst years of independence with the establishment of new psychiatric hospitals and later the introduction of clinical psychology, occupational therapy and community psychiatric nursing. Today, despite the shortage of specialist psychiatric personnel, Ghana remains relatively well-resourced for mental health care in comparison to other countries in the region (Jacob, Sharan, Mirza, et al., 2007). There have been several attempts to respond to the call to develop mental health provision in primary care and to provide communitybased mental health services. The training of community psychiatric •19• An Updated Situation Analysis of Mental Health Services and Legislation in Ghana nurses was instituted in 1976 when these nurses were posted to approximately half the districts in the country. Between 1994 and 1998 primary health care and development workers in the Upper West Region of Ghana were trained in mental health care, integrating mental health into primary care (Sefa-Dedeh, Ofori-Atta, Ohene et al., 2006). Similarly, in 1998 the World Health Organisation ( WHO) Nations for Mental Health Project trained health volunteers to provide community support to patients with mental disorders (Asare, 2003; WHO, 2002). Despite these innovations, a comprehensive situation analysis of the mental health system in Ghana has not yet been undertaken...

Source: UG