Scores of people took to the streets in Cape Coast last month to celebrate the dawn of a new era in mental health care and understanding in Ghana.
The long-awaited Mental Health Bill finally passed parliament on March 6. Its passage came several days earlier than expected, eliciting shouts, in a joyful abandonment of House protocol, from those lobbyists present to hear Michael Quay make the announcement.
First introduced to parliament in 2004, the Ghana Health Service originally expected the Mental Health Bill to become law by 2006. The wild applause was a natural response for the health, legal and human rights workers who had been lobbying, negotiating and agitating for it for more than eight years.
Even Ghana Health Service’s chief psychiatrist 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 Kwaw Armah-Arloo.
As one of only 13 qualified psychiatrists practising 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.
While it will take six months to become operational, already changes can be seen.
The march in Cape Coast followed a similar one in Accra and is all part of a concerted effort by the mental health reform architects to educate people about the realities of mental health.
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 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 changes to the 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.
Better liaison and integration, as well as improved access to care throughout the country, and a concerted and ongoing education campaign, which has already got under way (see editorial), made Dr Armah-Arloo confident that in five years the sight of a wandering madman in Ghana would largely have been consigned to history.
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