MENTAL HEALTH IN GHANA ( Editorial)

Anyone who breaks their arm should be locked up in a government facility, and the key forever thrown away.

If that sounds disturbing, good. It is. Just like a mental health care system that only institutionalises ill people or, worse, chains them up in illegal prayer camps, is disturbing.

It would be hard for anyone in 21st century to argue that “just dumping people”, to use psychiatrist Kwaw Armah-Arloo’s words, with mental illness a psychiatric hospital or – worse – in one of the prayer camps that rob so-called “mad” or “possessed” people of their fundamental human rights and dignity is preferable to helping them manage their conditions.

With the right support, people with all sorts of mental health issues can live full and productive lives in the bosom of their families and communities.

That is why the passage of the Mental Health Bill into law eight years after it was first tabled in parliament is nothing but a good thing.

Little wonder the champagne corks went flying as those who had been agitating for reform for year heard Michael Quay announced the passage of the Mental Health Bill in parliament four weeks ago.

Hurrah!

However, the shift in emphasis from institutional to community mental health care will, inevitably, throw up new and unforeseen challenges. That happens whenever, wherever, new laws are passed and new institutions and bureaucracies created.

The trick, as they say, will be the way these challenges are dealt with. As with almost every other facet of human interaction, the key to dealing with these effectively, with compassion and understanding for all affected, is education.

To emphasise; the key to the effective implementation of the Mental Health Bill is education. Education, education, education.

That is why it was so heartening to see scores of people take to the streets, in a long march from Ankaful to town (CHECK), celebrating the passage of the bill and challenging common misconceptions about mental health, on Tuesday, March 20.

“Mental illness: it could happen to U”, “stop stigmatizing people with mental health problems”, “stop human right abuse”, “send the mentally ill to hospital” and “seek early treatment” were just some of the messages the marchers brandished on placards.

This demonstration of celebration and education was no accident. A spontaneous outpouring of emotion by those at the frontline of mental health care provision lauding the passage of the bill it was not. Rather, it was part of a concerted effort, or action plan, drawn up by the architects of the bill.

Speaking just days after the bill passed on March 6, Ankaful Psychiatric Hospital Medical Director Dr Armah-Arloo, a key figure in establishing the new mental health framework, said while they awaited the formality of presidential assent to the bill and the funding to be in place, the work on education would begin immediately.

The education campaign would be three-pronged and ongoing. Dr Armah-Arloo and his colleagues have identified three target groups to receive tailored education: mental health care workers; the general public and key stakeholder groups, like the police.

“We are starting the education campaign with our own people, our own personnel. Then the second stage is when we educate the general public; and the third is where we are going to pick certain stakeholder groups, like the police, schools, church groups, and tailor the education to match where they feed into the legislation,” he said.

Perhaps one of the biggest challenges will be changing some of the more archaic cultural beliefs surrounding mental illness still prevalent in many parts of the country.

In addition, it is not simply relatively uneducated people living in rural and remote communities who need their preconceptions challenged.

In another win for mental health campaigners in Ghana last month, it was ruled that people with known mental illness should not be excluded from the biometric voter registration going on throughout the nation in the run-up to December’s election.

In an article on Ghana Web, mental health NGO Basic Needs lauded this decision. However, the article attracted comments from online readers, three out of five of which were quite negative.

For example, one commenter going by the online moniker deEvans wrote: “I thought a provision of the 1992 constitution says that the voter-eligibility criteria is: citizens of 18yrs and above and who are of SOUND MIND. Alternatively, has there been an amendment to that provision?  Someone should please educate me!”

That these comments, though anonymous, are made by literate, and supposedly educated, who care enough to post their thoughts online is quite shocking.

A person with bipolar disorder is not a person of unsound mind, far from it. With the right medication, their massive swings from mania to depression can be kept in check. It is quite possible to work with someone, even in the professions, and never realise they have a problem.

To disenfranchise them because of their condition is abhorrent.

It would be akin to taking the vote away from all those who previously, currently, or perhaps sometime in the future might, break their arms. Even if people with bipolar were insane, which they are not, they are still human beings and stakeholders in the community. As Ghanaians over the age of 18 they have every right to have their say at the ballot box. Bipolar disorder does not exempt someone from paying taxes.

With only three dedicated psychiatric hospitals in Ghana, and all of them situated in the south of the country, authorities can hardly act with surprise that so many people seek help for loved ones afflicted by mental illness from traditional healers and prayer camps.

As part of its educational campaign, the work of the soon-to-be Mental Health Board should ensure that those likely to encounter people suffering with mental illness, such as police, teachers and church leaders, handle them sensitively and get them the treatment they need.

In fact, that is why the establishment of a new breed of mental health professional, the community mental health officer, is so important. They will be the liaison between patients, their families, and key officials in their communities, so that all those involved in managing people with mental health issues know what they need to know about it.

Dr Armah-Arloo and his colleagues are only too aware of the problems of cultural attitudes and misconceptions in the effective, humane, and legal, treatment of people with mental health disorders.

He said health authorities would rather work with the prayer camps to change them than go after them with the full weight of the law. Health authorities wanted to educate prayer camp leaders about human rights and the new legislation and institutions that they must refer any person admitted to their care to.

“It will be a big job. Look at the number of prayer camps. In Central Region alone there are a lot – at least 10 or 12 of them,” he said.

If prayer camp leaders continued chaining up and otherwise maltreating people entrusted to their care, then, he said, they deserved to be arrested. Adapt or face prosecution is the message.

“First of all we are going educate them (camp leaders). First of all, they (the patients) have human rights. So we will tell the prayer camps ‘this is what you can do, this is what you can’t do and you have to do it in partnership with health services’.

“We will give them a grace period. If they continue chaining people, then you can prosecute it, as it is illegal to do this.”

Dr Armah-Arloo said it was an exciting time for mental health in Ghana – even if it meant he and his colleagues would not get much rest, especially during the next six months, as they got busy making all the provisions in the mental health bill a reality.

With such leadership and the right education, Ghana is well placed to make community-based mental health care a great success.

Many mental health issues in countries that have already undergone the transition to community-based mental health care are brought on as a result of the isolation and social dislocation people feel as part of Western consumerist cultures, where family and other social bonds are not always as strong as they once were.

So long as people are educated, these issues might yet be avoided in Ghana.

A British mental health care nurse, who is currently serving as a Projects Abroad volunteer, said the primacy of familiar bonds she has witnessed during her stay meant Ghana might avoid some of the problems with community-based care witnessed in the UK.

Writing as an obruni (I feel very akwaaba in Ghana – medase) native of Australia and resident in the UK, who has reported on health issues in both nations where the shift to community care has been made. While it is possible I may be romanticising the reality of life in Ghana, I am inclined to agree with my fellow volunteer.

However, prevailing social attitudes towards mental illness in Ghana must change.

Moreover, they will – provided the authorities get the education, education, education right.

Using last month’s March as a bellwether, the early signs are promising that this will be achieved.