A report into the Psychiatric situation in Ghana

The issue of health in Africa is big news. Billions of dollars are spent annually, to fight diseases such as HIV/AIDS, malaria, water-borne parasites and TB. These issues are rightly being targeted in efforts to improve the health of Africa, but one of the next challenges must be to change the attitudes regarding mental health across the continent. Psychiatrics is a specialism which African healthcare has tended to overlook.

In Ghana, government spending on mental health services represents just 3.9% of the total health budget (the equivalent figure in the UK is 12%). This funding is shared between Ghana’s three psychiatric hospitals, which are all clustered in the south of the country. There are only four psychiatrists currently practising in the public sector, all of whom are based in the south.

A serious lack of education also exists. A report published in the International Journal of Mental Health Systems found that 81% of community pharmacists in Ghana gave ‘inadequate education’ as their reason for not being involved in psychiatric treatment. Consequently, BasicNeeds, the foremost mental health NGO in Ghana, are working within a challenging environment.

BasicNeeds operates in the rural Northern regions of Ghana, and in the capital, Accra- where we visited the quarterly outreach programmes at Mamprobi and Kaneshi polyclinics. These clinics allow for outpatients to be reviewed and given medications, as well as providing an opportunity for new patients to see the psychiatric team for the first time. Demand for these services is high; when we visited the clinics, queues were long and resources stretched. Despite this pressure, we witnessed a careful approach being taken by staff, with a great deal of empathy and care being shown to each patient.

Many of the drugs used at these clinics are provided using BasicNeeds’ funds and the charity is working to extend the range of drugs available. In 2009, BasicNeeds spent about $911,000 on mental health services in Ghana, which has enabled them to help 17,400 patients. BasicNeeds also arranges health insurance for some badly afflicted patients, whose illnesses prevent them from working. To date, BasicNeeds has facilitated the registration of 960 patients for insurance, and for the 500 of those who do not qualify for free insurance, the charity covers the cost. They organize self-help groups and patient farming schemes which empower patients in their communities and highlight treatment successes, reducing the stigma of mental illness. BasicNeeds in Ghana is also highly involved in wider development of the country with respect to mental health. Directors met recently with the Select Committee of Parliament on Health, and are pressing for the proposed mental health bill to be passed as a matter of urgency. The main difficulty BasicNeeds currently faces is that of funding for expansion into the central regions of the country; if a strong NGO presence across the whole of Ghana could be combined with real political will to improve services, the progress would be rapid.

BasicNeeds is working hard to change the image of psychiatric care in Ghana, but the problem remains serious. The range of treatments available is limited and practices are frequently outdated. One concern to us was the way epilepsy is treated. There is a huge variety of drugs available to treat this neurological condition in the western world, and different approaches work better in different people; the range available in the Mamprobi clinic was limited to just three. The psychiatrist-on-duty, Dr. Odonko, explained that the childhood epilepsy drug, Valproate, was not available. This means children were treated with adult medication, which may impair their ability to learn and perform well at school. Furthermore, in the absence of affordable special schooling or parental training, strong neuroleptic drugs like Haloperidol were given if parents complain of behavioral issues in children with conditions such as autism, ADHD and Down’s syndrome.

Like many of the problems in Africa today, the key to improving Psychiatrics in Ghana is funding. That said, a fundamental requirement for facilitating any change in practice is a change in attitudes of people to mental health conditions. Without widespread education, extra funding would be less effective. The inspiring work of BasicNeeds should serve as a catalyst to developing the political and economic will for a revised approach to psychiatric care across Ghana; a change that is badly needed.

By James Edmonds and Josie Morley