The African world view about mental illness remains a challenge to any quest to deal with either direct or indirect stigma. Many educated elites do not exhibit positive attitude towards mental issues and those who suffer from it. If a problem cannot be solved or a situation cannot be transformed with known processes and procedures, they are branded an evil or witchcraft orchestration. It is a known fact that in Ghana, when mental patients are referred for extra general physician attention in hospitals, they are often turned away or not given the care required. This goes to express the understanding and behaviour of the educated towards mental health.
The African world view indicates that, disease of the blood is incurable. The beliefs, philosophies and values of the African are captured in their sayings, which are operational in everyday language. This is expressed in the book, African Religions and Philosophy, by Rev. Prof. John S. Mbiti, (Mbiti, 2007).
Each group of people in Ghana has derogatory vocabularies in their language(s), which are used to refer to mental patients and treated patients alike. In fact, there are doubts as whether mental patients ever get treated. There is the myth, though there is no scientific prove that, a mental patient who has ever ate food or anything from the ground cannot be treated. Again, there is the saying that, a mental patient treated and discharged will still possess what it takes to scare children. As well as, the belief that, no matter the treatment a patient receives, the fellow will be left with what it takes to go sky gazing on Fridays. Many a mother, in an attempt to prevent the child from crying, will try scaring the lad that, if he or she continues the 'madman' (the mentally ill) will be called in to take the child away. The above illustrated sayings and beliefs expose the attitude of the Ghanaian towards the mentally ill. This is not exclusive to the Ghanaian but, a view held across the continent.
Language is penultimate of every culture. Hence, the catch phrases about mental illness punctuated in African languages indicate that, the lack of thorough understanding for mental issues is culture related.
Mental illness is a critical issue in Africa which tends to influence a number of African social institutions, among them is marriage. Marriage in Africa is a union between families and not individuals. As a result, families enquire about the background of would be couples. Indeed mental illness is among the diseases that can contribute to a marriage being called off. Some other diseases include leprosy, epilepsy, blindness, deaf, and dump. A family that has such a history is not only stigmatized, but members are considered as susceptible to any of the diseases mentioned above. In other words, family members suffer indirect stigmatization. If a mentally ill fellow was married before he or she got sick, the marriage's survival will hang on a thread. Many at times, such marriages do collapse. This goes to inform why many families do not show much affinity to their relations when they are admitted to the Psychiatry Hospitals. Family members will not want to be associated with their own that has crossed the optimal line. Unfortunately, the wholesale stigmatization of families sometimes extends to a whole clan, family, village, community or ethnic group.
Nonetheless, this age old belief which lacks scientific bases due to the absence of research have affected and continue to affect the commitment of even the Ministers' of Health toward Psychiatry and related programmes. This exemplified the reason it took years for successive Ghanaian governments to pass the Mental Health Bill. To Ghana can boast of a Mental Health Bill, culminating in the coming into effect of the Mental Health Board to help regulate issues pertaining to mental health. The very faces that have been around all these years propelling mental health in Ghana remains the same. Sponsorship for the annual World Mental Health Day has always passed for searching for water on the desert. Many companies do not want to be associated to mental health issues, as these establishments do not want to associate their products to mental health programmes in Ghana.
Budgetary allocation to this health sector is nothing worth communicating. This is due to the fact that, many people, and even some educated persons do not want to be associated with mental illness for fear of being infected, which in fact smack of ignorance in the absence of education and research. This attitude has created difficulties towards the march to a mental health friendly environment.
Therefore, every effort is needed to ensure a transformation in language and the cessation of the use of some phrases that seem to entrench a negative attitude toward mental patients and the treated. What has to be drum home with all earnestness is the fact that everyone is vulnerable.
A lot of education is needed to demystify mental illness. The belief has always been that, mentally ill fellows are those who have stripped naked and dirty. However, extreme stress, anxiety and depression are all a medium of slipping over the optimal line. The education must be culturally based, where Traditional Authorities are the focus. This will enable these social influencers to positively affect their subjects and citizens to accept and co-habit with the mentally ill thereby aiding the treatment process. Community durbars can be employed in the educational mix, which will fully implement the Information, Communication and Education (ICE) procedure.
The Efforts of the Ghana AIDS Commission
The Acquired Immune Deficiency Syndrome (AIDS), though recent has equally suffered same stigmatization. Even though, stigma still hangs around people living with HIV, comparative to the past the present is an improvement. This is not to conclude that, stigma of people living with HIV/ AIDS is done away with, there has been mass improvement in their daily lives.
Additionally, funding, drugs, awareness creation and capacity building to empower Ghanaians have been strengthened over the years. Donor agencies are putting in so much to enhance the reduction of stigma, new and mother-to-child infections. Currently, the National AIDS Commission is under the office of the President of the Republic of Ghana. This has afforded the Commission a level of credibility, which positions their activities for greater sponsorship. The attention offered to this deadly disease has calmed nerves.
Many citizens are of the belief and some still hold to the idea that, AIDS is the disease of sex workers, sexually promiscuous and the cursed; while other citizens feel they were impeccable. However, as the years grew old, some Religious leaders, Politicians and influential people got infected of the virus, and this has forced many Ghanaians to believe that, everyone is vulnerable. Then billboards emerged with pictures depicting citizens from all facet of the Ghanaian society indicative of the fact that, everyone is exposed to HIV infection.
By dint of hard work, the Ghana AIDS Commission have on their part been able to get many infected personalities to crash their shells to take up responsibility as Ambassadors. There is Reverend Azuma, who has stepped forward to help in demystifying the deadly disease. Suffice to say that, in recent times there have been some controversies surrounding one of their many Ambassadors. In many ways the measures put in place by the AIDS Commission has and is working to the benefit of reducing stigma.
In spite, of the present successes and funding availability to the Ghana AIDS Commission, it had a past that was quite depressing. Ghanaians found it eke to get their heads around a disease which share similar symptoms with a person who is cursed. Traditionally, a cursed person manifests an emaciated body with protruding stomach. The fellow keeps reducing in weight till death. Hence, culturally, many citizens, and even the educated sometimes finds it difficult to distinguish the viral infected person from the cursed. In some instances, AIDS is considered, a spiritual disease that witches are capable of infecting people with. Again, there has been the belief and still held in some communities that, AIDS is a disease of the devil, this accounts for the difficulty in some communities to accept their own when they test positive for the Human Immune Virus (HIV). This accounts for the reason; many infected citizens refuse to make their status known to even their immediate families. As stated above, issues and challenges of health that defies reasoning are considered to be from the devil.
Ghana AIDS Commission Strategies
However, the Ghana AIDS Commission has been working round the clock to defuse this cultural deadlock. There are annual forums that are organised by the AIDS Commission; all to ensure stigma is given hard wash to fade. This is expressed in the annual HIV/AIDS conferences and dialogs that are held in Ghana with stakeholders. Such forums normally see dignitaries and traditional leaders gracing and pledging their support. But are these personalities and our traditional leaders aware that, as we are all vulnerable to the infection of HIV same applies to mental illness? The Ghana AIDS Commission has a yearly publication of national infections segmented into regional incidence. An interesting question that, arises is, where is the regional mental health annual report culminating to national incidence?
Another strategy the AIDS Commission has adopted and is adept at is the early morning talk on HIV at the Out Patients Departments' (OPDs) of hospitals in Ghana. Every morning a Trained Senior Nurse interact with patients on HIV at the OPDs. The Senior Nursing Office explains how HIV is contracted besides unprotected sex. Comments that come up during the discussions are indicative that, hitherto, many were of the belief that, every HIV positive fellow contracted the virus via unprotected sex. Other mediums through which HIV can be contracted are mentioned as, sharing of hair clippers at barbering salons, unsterilized pedicure and manicure kits, as well as sharing tooth brush, sharp edged metals such as razor blades, needles and the practice of being guy.
After the insightful interactive presentation, the Senior Nursing Officer allows questions. These are thoroughly answered. The medium of communication is Twi (Akan) interspersed with any other local language widely spoken in the locality as well as the English language. The Nursing Officer then request for those who wish to willingly submits themselves for testing. The responds are encouraging.
Mental Health Practitioners can also adopt
Mental Health Nurses or Officers can employ same strategies to discuss mental health and how one becomes ill at the OPDs of hospitals. The myth about how people get mentally ill can be explained at such platforms. This will help clear all the myth surrounding mental illness. In fact many belief mental illness is transferable. However, there is no scientific prove to this assertion or notion.
The Mental Health Authority has now come into effect; one of the duties that are expected of it is to operationalize the blue print of the Ghana AIDS Commission. This will require identifying treated patients to assume the role of Ambassadors. It will be more effective after the capacity and confidence of these treated fellows are built to enable them meet the general public.
The Mental Health Authority will have to educate the public about the fact that, mental illness is not infectious and not transferable. Billboards should be erected in concert with other media mix to ensure the education on mental Health sink into the social fabric wholly.
Institutions of higher learning, such as the Ghana Institute of Journalism (GIJ) should be given curricular to train Journalist holistically to aid positive reporting on mental health and illness. The Basic and Second Cycle Schools should be visited to enlighten these students regularly to alert them about mental health and illness. Easy to read materials on mental health should be supplied to the library of schools to facilitate reading and learning about mental illness.
Documentaries should be produced and aired regularly on a broad network to help in mental health and illness literacy. Features on mental illness and health should be encouraged to create columnist for both traditional and social media. This will include mental health bloggers. Community sketches as well as dialogues to broaden the educational base.
Fora that will ensure the gathering of Traditional Leaders should be established and not wait for the one off celebration of the World Mental Health Day. This day do not actually attract the patrons who are expected to attend. The National House of Chiefs and Queen Mothers are to be engaged consistently to explain and educate them on mental health. The Fetish Priest and the Prayer Camps are also to be handled with tact in the process of transforming the mental health environment.
The training of Mental Health Workers should be of paramount interest to both government and all stakeholders within the Mental Health fraternity, especially the Mental Health Board. The current state where after Diploma training of Mental Health Nurses there is no clear cut avenue for up grading themselves is a disincentive. Many Mental Health Nurses who go outside the country to train do not return, which remains a major problem to Human Resource in Ghana.
There is the need for stakeholders' forum to thoroughly take stock of challenges facing the Mental Health Sector of the Ministry of Health in Ghana regularly. There must be a concerted effort to transform the face and fate of both the mentally ill and the mental health environment as it's affected and battered by cultural beliefs.
Patrick Twumasi
(0209045931/0507031278)
(ayalolo4@gmail.com)
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