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Opinions Mon, 24 Aug 2009

Mental illness, insidious enemy of development

A GNA feature by Clemence Okumah


Accra, Aug 19, GNA - A man who was travelling in the same bus with me from Accra to Cape Coast last January became furious when a woman complained that he had stepped on her toes while boarding the vehicle. Instead of apologizing, the man screamed at the woman: "Are you not a human being; are you God; are you better than other people who do not complain about minor issues like this?"


He was well dressed and spoke impeccable English but had a fierce look that deterred the other passengers from challenging his unruly conduct.


While some of them argued that the man was only bloated with ego and hot-headed, others said that they suspected that he was not mentally balanced.


As if to justify the man's behaviour, a woman whispered into the ears of another passenger: "Oh, this man, I know him; he stays in my neighbourhood in Accra. His house was gutted by fire and all his children and property were consumed by the inferno". One wondered whether the man was finding it difficult to cope with the trauma or stress caused by the tragedy.


In deed, some people feel worried, anxious, sad, or stressed when they ponder over a calamity, joblessness, marital problems, grief over the death of a loved one or fail an examination, which may be a temporary disposition of the mind.


But with mental illness, these feelings are permanent and severe enough to interfere with a person's life and it is not easy for the victim to meet and keep friends, maintain a job or enjoy a normal happy life.

Mental disorder can also be associated with poverty, social marginalization, injustice and tragedy. Hundreds of millions of people worldwide are affected by mental, behavioural, neurological disorders or and substance abuse. The World Health Organization (WHO) considers mental health critical to human development and defines health as: "A state of complete physical, mental, and social wellbeing and not merely the absence of diseases or infirmity."


Mental issues have therefore become an integral part of the health system of many developed countries.


In developing countries like Ghana, however, more prominence is given to physical health than mental health, which is considered by some societies as a curse or a taboo.


It is difficult for people to immediately decide what to do when someone is suffering from psychological problems because of the myth surrounding it.


Instead of reporting mental or psychological cases to the hospital for early treatment, some people prefer visiting churches, prayer camps and shrines to seek spiritual healing.


In most African societies, people refer to mental illness as madness or a cultural heritage while some religious authorities refer to it as demonic possession.


However, medical authorities do not consider mental illness as madness or demonic since any individual could suffer from one form or another of mental illness at any time.

These conditions include disorders such as depression, phobias, bipolar disorder and schizophrenia (a psychotic or mental disorder characterized by loss of contact with the environment). These are real diseases that nobody can wish away; but they are treatable using medicines and therapy to improve the life of most people afflicted by mental illness.


Mental, neurological and behavioural disorders are common to all countries and cause immense suffering to victims, who are often subjected to social isolation, poor quality of life and increased mortality.


What is more worrying is the staggering economic and social costs associated with mental health.


For example, WHO estimates in 20 02 showed that 154 million people globally suffered from depression and 25 million from schizophrenia, while 91 million people were affected by alcohol use disorders and 15 million by drug use disorders. A recently published WHO report showed that 50 million people suffered from epilepsy and 24 million from Alzheimer and other dementias.


Additionally, many other disorders affect the nervous system or produce neurological sequelae (after-effect of disease, injury or treatment).


Projections based on a WHO study showed that worldwide in 2005, 326 million people suffered from migraine, 61 million from cerebro-vascular diseases and 18 million from neuro-infections or neurological sequelae of infections.


The number of people with neurological sequelae of nutritional disorders and neuropathies (352 million) and neurological sequelae secondary to injuries (170 million) also add substantially to the above disease burden.

About 877,000 people die by suicide every year and some patients visiting a health service have mental, neurological or behavioural disorder but most of these disorders are neither diagnosed nor treated. Mental illnesses affect and are affected by chronic conditions such as cancer, heart and cardiovascular diseases, diabetes and HIV/AIDS. If left untreated, they could bring about unhealthy behaviour, non-compliance with prescribed medical regimens, diminished immune functioning, and poor prognosis.


The good news is that cost-effective treatments exist for most disorders and if correctly applied, cure could enable most affected people to become functioning members of society. Particular attention should be paid to children's mental health before they grow to become adults with serious mental problems that might require huge amounts of money and long periods to treat. Depression, anxiety, behaviour decoders and attention deficit hyperactivity decoders are some common mental health problems. Their symptoms are excessive anger, fear, and sadness, anxiety, exercising too much, hurting or destroying things. Without help, mental health problems among children can lead to school failure, alcohol or drug abuse, family discord, violence or even suicide.


Parents should contact health care providers if they have concerns about their children's behaviour.


Teenagers in particular also go through stress when the struggle to be liked, do well in school, get along with family and make big decisions which are unavoidable and worrying about them is normal. But feeling very sad, hopeless or worthless, very angry or worried, feeling grief, and thinking that the mind is controlled or out of control and use of alcohol or drugs are serious mental problems among teenagers. Teenagers facing such problems need the help of parents, school counsellors and health care providers.


Disorders such as depression, phobias, bipolar disorder, schizophrenia and many others are treatable and medicines and therapy can improve the life of most mental patients. But barriers to effective treatment of mental illness include lack of recognition of the seriousness of mental illness and the lack of understanding about the benefits of services. Policy makers, insurance companies, health and labour policies, and the public at large all discriminate between physical and mental problems.


Most middle and low-income countries devote less than one per cent of their health expenditure to mental health. As a result, mental health policies, legislation, community care facilities, and treatments for people with mental illness are not given the priority they deserve. Ghana is not an exception and there is the need to take drastic steps to tackle mental health in the country. Dr Akwasi Osei, Chief Psychiatrist at Accra Psychiatry Hospital, gives an adequate assessment of the country's mental health situation in a presentation he did on Mental Health and Poverty Project in Accra last year.


He indicated that six per cent of the country's health budget allocated to mental health was insufficient. Dr. Osei again stated that there were difficulties in recruitment and retention of psychiatry staff.

"Only six out of the 15 psychiatrists available in the country are in active service while 115 Psychiatry nurses would retire in the next five years," he stated.


Dr. Osei also drew attention to the fact that lack of psychotic medicines compelled psychiatrists to use traditional medicines that had negative side effects on patients. As a remedy to the situation, government would have to provide all health facilities in Ghana with psychologists or clinical experts to determine the mental state of patients. The country's mental health care policy should also be reviewed and the draft mental policy implemented to promote mental health. Legislation on mental health should seek to protect the rights of mental patients and acknowledge the role of faith and traditional healers.


It is significant to consider mental patients as vulnerable people who need special attention just as the physically challenged. There should be comprehensive treatment for mental health victims, including their rehabilitation.


The authorities should ensure the passing and implementation of the Mental Health Bill, which is expected to define the legal and regulatory framework for mental health practice in Ghana.


Something should also be done about the poor conditions at the country's psychiatric hospitals, including overcrowding and also no coverage of mental health under the National Health Insurance Scheme. Like physical health, individuals, organisations and government need to attach importance to mental health at every stage of life, from childhood and adolescence through adulthood, if Ghana is to achieve its developmental objectives.

Columnist: GNA