Restoring mental health’s dignity

On December 31, 2016, a few hours before the New Year, a 28-year-old man allegedly ended his life.

Media reports during that period indicated that the young man in his productive years committed the act at Akyem Hemang in the Fanteakwa District of the Eastern Region.

Days later, a 14 year-old teenager and a 32-year-old man also took their lives in Accra. Two taxi drivers, one at Half Assini in the Jomoro District and the other at Achimota in Accra, also joined the suicide statistic of the country within the same week.

But what alarmed the country the most were the preventable deaths of Level 400 Agriculture & Consumer Science student of the University of Ghana and first year Chemical Engineering student of Kwame Nkrumah University of Science and Technology (KNUST).

These young women with great potentials ended their lives under circumstances their families are finding difficult to come to terms with.

“As of now, I have tried hard to find answers to the puzzle as to why my daughter could die in such a tragic manner because we provided everything for her and made sure she was always happy. She was my best friend,” a parent of one of the deceased is reported saying.

“One thing I have learnt from the death of my daughter is that this unfortunate incident could happen to anybody or any family and that as parents we need to constantly pray for our children in school so that such things do not befall them,” he adds.

Dr Akwasi Osei, Chief Executive Officer (CEO) of the Mental Health Authority (MHA), describes the trend, particularly among students, as very worrisome, adding that the occurrence is as a result of the lack of attention given to mental healthcare in the country.

He said there are more unreported cases of suicide in the country because according to him, in every single reported case of suicide, there were four unreported cases of suicide.

The country records about 1,500 reported suicide cases annually, thus, bringing the number of unreported cases to about 6,000 every year. This figure translates to about seven percent loss of the Gross Domestic Product (GDP) of the country.

He explains that those who commit suicide do so as a last resort and not because they wanted to end their lives.

“Even though they are happy when their attempt fails, they are likely to do it again if they do not get the needed interventions,” he says.

Causes

Suicidal behaviour is a complex one and may be difficult to explain why someone engages in the act, but research into this behaviour in Ghana, however, continues to show various psycho-social factors and in some cases mental illnesses which are strongly associated with these behaviours (especially among the youth).

Dr Osei says attesting to this fact notes that about 95 percent of people who attempt or complete the act have some traces of mental disorders.

Giving the breakdown of the constitutes of the 95 percent, Dr Osei says 80 percent can be attributed to depression, while 15 percent is because of various mental illnesses, including bipolar disorder, schizophrenia, acute stress reaction, alcohol and drug abuse.

The other five percent, he says, is due to decisions based on politics or religion and the decision of a person suffering from a chronic ailment such as cancer, HIV or diabetes, for instance, to end it all.

Depression

The World Health Organisation (WHO) has identified depression as the leading cause of ill health and disability worldwide.

Depression is a common mental illness characterised by persistent sadness and a loss of interest in activities that people normally enjoy, accompanied by an inability to carry out daily activities, for 14 days or longer.

In addition, people with depression normally have several of the following – a loss of energy, a change in appetite, sleeping more or less, anxiety, reduced concentration, indecisiveness, restlessness, feelings of worthlessness, guilt or hopelessness and thoughts of self-harm or suicide.

The latest estimates from WHO points to the fact that more than 300 million people are now living with depression, an increase of more than 18 percent between 2005 and 2015.

WHO Director-General, Dr Margaret Chan, states, “These new figures are a wake-up call for all countries to re-think their approaches to mental health and to treat it with the urgency that it deserves.”

Depression is an important risk factor for suicide, which claims hundreds of thousands of lives each year. “A better understanding of depression and how it can be treated, while essential, is just the beginning,” Dr Shekhar Saxena, Director of the Department of Mental Health and Substance Abuse at WHO, says.

What needs to follow is sustained scale-up of mental health services accessible to everyone, even the most remote populations in the world.”

In the lead-up to World Health Day on 7 April, WHO launched its year-long campaign dubbed ‘Depression: Let’s Talk’.

The overall goal of the campaign is that more people with depression, everywhere in the world, both seek and get help.

“The continuing stigma associated with mental illness was the reason why we decided to name our campaign ‘Depression: Let’s Talk,” Dr Saxena says.

“For someone living with depression, talking to a person they trust is often the first step towards treatment and recovery,” he adds.

Bottle Necks

Stigmatisation, traditional beliefs, poorly financed mental health facilities and the framing of the law concerning suicide acts are obstacles that hinder the accessibility of mental healthcare and stops many patients from opting for early medical attention.

The Accra Psychiatric Hospital, for instance, since its establishment in 1904, has seen very little major renovations and, therefore, continues to grapple with financial, material and other resource allocations that are needed for its smooth operation.

The hospital has been in the media on many occasions for lack of basic logistics like gloves, detergents, syringes and food items leading to temporary halting of services and sometimes forced reintegration of admitted patients.

The Criminal Code 1960 (Act 29) Section 57 (2) also criminalises suicide act. The law says “whoever attempts to commit suicide shall be guilty of a misdemeanor”. Meaning, a person who fails a suicide attempt will face trail and subsequently when found guilty, jailed.

The Medical Director of the Accra Psychiatric Hospital, Dr Pinaman Appau, is concerned about the stigma and lack of attention given to psychiatric hospitals in the county.

“Our neglect of mental health and mental health issues makes it difficult for us to get data on mental health including suicide,” she adds.

“This same neglect has also led to inadequate mental health personnel, lack of funding and non-passage of the legislative instrument to back the mental health act 846 which was passed in 2012”.

The Ghana Psychological Association feels the manner in which the media reports such cases indirectly creates further problems, as mentally distressed persons in society may simply copy the behaviour of troubled people in the suicide stories the media carries.

“Uncensored published stories of how some people planned and killed themselves may simply help those on the verge of suicide, to consider ending their lives as well. This is called ‘copycat suicides,” the association says.

Dr Akwasi Osei Dr Akwasi Osei Urgent Need for Investment

In many countries, including Ghana, there is no or very little support available for people with mental health disorders or mental health facilities.

Even in high income countries, nearly 50 percent of people with depression do not get treatment.

On average, just three percent of government health budgets is invested in mental health, varying from less than one percent in low income countries to five percent in high income countries

The WHO says investment in mental health makes economic sense because every US$ 1 invested in scaling up treatment for depression and anxiety leads to a return of US$ 4 in better health and ability to work but failure to act is costly.

A WHO-led study which calculated treatment costs and health outcomes in 36 low, middle and high income countries for 15 years, from 2016-2030, low levels of recognition and access to care for depression and another common mental disorder, anxiety, result in a global economic loss of a trillion US dollars every year.

The losses are incurred by households, employers and governments. Households lose out financially when people cannot work. Employers suffer when employees become less productive and are unable to work. Governments have to pay higher health and welfare expenditures.

Decriminalise Suicide Attempt

The MHA and the Ghana Psychological Association (GPA) say decriminalising attempted suicide in the statutes of Ghana is the way to go if the fight against suicide is to be won, because the move will make it easier for suicide survivors to open up about their struggles and receive help.

They are, in turn, advocating a national policy that will provide the framework for suicide prevention in the country.

“Attempted suicide is not a criminal issue. Neither is it a moral issue or spiritual problem. It is simply a cry for help to resolve psycho-social issues and, therefore, more appropriately is a medical problem,” Dr Osei mentions.

Dr Osei also called on legislators to pass the Legislative Instrument (LI) to the Mental Health Act, 2012 (Act 846) to enable the Mental Health Authority to start massive public education and mental health promotion.

Help Line

The MHA established a temporary helpline as a short-term measure in response to the current spate of reported suicide cases in Ghana.

Since its launch a few weeks ago, over 30 calls from different parts of the country have been recorded, with the number increasing.

Dr Osei says the number of calls shows that “there is a real need out there and we are mapping out strategies to deal with it.”

He says some of those who called were counselled and given re-orientation because they just needed a hearing ear, while others were directed to the nearest health facilities where there were psychiatric units or psychiatric nurses.

It is his hope that the helpline will assist people will mental disorders and, thereby, help prevent suicide attacks in future.

It may not be easy to conclude that an individual is suicidal, but the Ghana Psychological Association states that if you notice that a student suddenly becomes a lot more reserved than they usually are, it should raise a red flag, and they may be doing some good service to the person if they contact the counselling service in their school or call the Mental Health Authority on 0206814666/0503444793 for a session with an expert.