ABRABO PRAYER CAMP CRIES FOR ASSISTANCE

Text and photos by: Francesco Rocco

The World Health Organization estimates that close to 3 million Ghanaians live with mental disabilities and 600,000 of these have very severe mental conditions.

Ghana’s three public psychiatric hospitals – in Accra, Pantang, and Ankaful – house an estimated 1,000 people with mental disabilities. In all three institutions, Human Rights Watch found filthy conditions, with foul odors in some wards or even feces on the floors due to broken sewage systems. The hospital in Accra was severely overcrowded and many people spent all day outside the hospital building in the hot sun, with little or no shade.

Human Rights Watch found that at least hundreds – and possibly thousands – of people with mental disabilities are institutionalized in prayer camps associated with Pentecostal churches. Managed by self-proclaimed prophets, these camps operate completely outside of government control. People with mental disabilities at these camps do not receive any medical treatment – in some, such treatment is prohibited even when prescribed by a medical doctor. Instead, the prophets seek to “cure” patients through spiritual healing.

Along the street from Yamonransa and Asebu we visited the Abrabo Prayer Camp. Central Press spoke with the founder of the camp, Mr. Kojo Abrabo, and we had a conversation with an old woman of 95 years old who joined the camp two months ago.

She explained to us that she had already tried to go to an hospital structure, but with no success, bacause of the lack of psychological support and the bad conditions in which she was found. She said lonelyness can upset people. "Thanks to the prayer I have been saved!" she said, adding that twice to week she goes to make the controls to the hospital and, indeed, the examinations are improved” she siad.

At a first sight, the camp looks in very basic. Conditions in prayer camp is very awful: most of the mental patients due to their aggressive nature  are chained by their ankles to trees in open compounds, where they slept, urinated, and defecated and bathed. People stand on the ground all day long. The absence of concrete floor means that when it rains falls the floor will be mudy everywhere. Feeding patients it is often a real problem and hygenic conditions are very precaroius most of all for the presence of 10-14 years old children.

The Ghanaian government has done little to combat such abuse or to ensure that these people can live in the community, as is their right under international law.

Ghana’s 2012 Mental Health Act, which went into effect in June 2012, creates a system through which people with disabilities can challenge their detention in psychiatric hospitals.

The government should create community-based support services, including housing and healthcare that enable people with mental disabilities to live in the community.

The government should also ensure that people are not forcefully detained in these facilities or in psychiatric hospitals and that they have access to mechanisms to challenge any violations of their rights.

Even Ghana Health Service’s chief psychiatrist  Dr. Akwasi Osei was said to “pop champagne” when he heard the announcement.

“It is my expectation that five years from now there will be no mad persons roaming the streets of the country, since they will be effectively treated and integrated into society,” Dr Osei told the Daily Graphic.

It was a sentiment shared by Ankaful Psychiatric Hospital Medical Director Dr.  Kwaw Armah-Arloo.

As one of only 13 qualified psychiatrists practicing in Ghana and the head of one of the three psychiatric hospitals, Dr Armah-Arloo has been a central figure in shaping the legislation. And, he said, were he present when the bill’s passage was announced, he had no doubt he would have joined his colleagues in jubilation.

At its heart, the passage of the bill into law will enable the shift from institutional to community-based care for most mental health patients.

The new law will establish a Mental Health Board independent of the Ghana Health Service, which means it will be able to source external funding from NGOs. It also allows for greater integration of mental health services by establishing district committees to ensure access to care is more uniform nationally.

It is the first significant overhaul of mental health since legislation was first introduced in Ghana in 1972.

Above all, says Dr Armah-Arloo, the establishment of the Mental Health Board and the shift to community-based care will ensure better use of available resources. That, he said, would not only benefit patients but the government and all taxpayers.

“The biggest problem until now we have emphasised on institutional care, especially the three big psychiatric hospitals, which unfortunately are all in the southern part of Ghana” Dr Armah-Arloo said.

“So that has been the practice in the past -- just dumping people in psychiatric hospitals.

“What we want to do new is shift the emphasis into the community. So we are shifting from institutional-based care to community-based care.”

While this shift would not spell the end for psychiatric hospitals, Dr Armah-Arloo said it would end many years of frustration for mental health professionals.

Until the enactment of the bill, mental health care, excluding the cost of medications, makes up a paltry proportion of the overall GHS budget, between 2 and 2.5%.

Too much of this funding, Dr Armah-Arloo said, was wasted on things like feeding and cleaning up after inpatients rather than actually treating them.

“Before I actually moved into psychiatry, I was a general practioner for a long time, I didn’t really think in those terms,” he said.

“When I joined psychiatry in 1998, I looked at the huge investment the government is making just feeding people.

“Here at Ankaful we have more than 350 inmates and we are feeding them morning, noon and night. This could be moved into the community. The government will not need to spend all this amount of money on secondary expenses like food.”

Last year, the Ghana Health Service spent 600,000 Ghana  cedis on maintaining patients before factoring in their treatment costs.

The key improvements the passage of the bill brought, Dr Armah-Arloo said, would be to “prune down the number of patients in psychiatric hospitals; open psychiatric wings in regional and district hospitals; and, education”.

The number of inpatients in Ghana’s three psychiatric hospitals stands at about 1,000.

“If we can even halve this, that will be savings to the government,” Dr Armah-Arloo said.

“If you look at the cost of maintaining patients in hospitals, it’s huge. With the new law they will be living with their own parents.”

Echoing his colleagues’ sentiments about the end of wandering lunatics, Dr Armah-Arloo said: “Most of our problems are that people are treated. They return home, but they are not integrated into their communities. Therefore, they walk the streets.

“But if you have systems in place, if you are able to monitor them, a lot of times this can be avoided.”

He said Community Mental Health officers, new roles created by the new legislation, would make regular visits to mentally ill people at their homes to make sure they were taking their medicines and getting the support they needed. These officers would also act as key liaisons between the various stakeholders in a patient’s treatment. For instance, they would ensure police officers in the local community were aware of a mentally ill person’s condition so they could treat them appropriately.