The Accra Psychiatric Hospital, Ghana’s prime mental health care unit, has been in the spotlight for some time now. About three hundred mental patients may be released into our communities.
The present Accra Psychiatric Hospital wasn’t built until 1904. Beforehand, untrained attendants used to look after the “lunatics” as it was called a Lunatic asylum. It has a bed capacity of 600. It is however overcrowded due to its increasing population and this places ä huge demand on their limited facilities. The hospital is responsible for treatment, welfare, training and rehabilitation of the mentally ill.
Mental illness has vast examples with common ones in Ghana including; depression, bipolar disease, schizophrenia, Post Traumatic Stress Disorder (PTSD) and Post-Partum Psychosis.
Nurses have been said to abandon the place leaving some patients to lead their own. I understand why they have left. Reports have it that there are no sedative drugs to keep the patients under control when they have episodes. A person who is mentally unstable in an active state of the disease is much more dangerous than an armed man. They can get violent and very difficult to control. The infrastructure at the Accra Psychiatric Hospital isn’t anything to write home about. From a chat with people who have worked there the place is highly infectious and may need restructuring to ensure the safety of the patients and workers. The images I saw on the news reports didn’t say anything contrary. Their website however gives us some good angles.
How Costly is Mental Health?
In Ghana, a study conducted in 2013 at the Psychiatric unit of the Ho Municipal Hospital, placed the prevalence of mental illness at about 13%. It said that most patients are seen on outpatient basis and the treatment was an economic burden to the patient and their families. The household cost for a three month period was estimated at $ 34,518.27. This included direct costs like medical and non-medical costs as well as indirect costs like reported lost time by patients and their families. Both patients and their household were affected emotionally. Caregivers lost productivity because they eventually lost their jobs. The cost of drugs might as well be the highest contributor to this burden. See cost of mental care in Ghana.
The drugs commonly used in treating mental patients include; Carbamazepine, Diazepam and olanzapine. Government provides these drug to the facilities at no cost at all. The patients don’t pay for the medicines however there must have been a problem with their store keeping because why wait for medications to finish, from my bit on pharmacy management, a stock should have a minimum stock level and that means a requisition has to be made once the quantity on hand reaches that level. That’s none of my business.
The issue could be because the facility is solely government dependent. This means they can’t in anyway make money for themselves or charge for their services. If the MOH is occupied with other supposedly “pressing” issues, and therefore the mental facility could just be one of the many health sectors which would be ignored.
I found my way into talking to health workers who have worked in the Psychiatric Hospital before and some who are still working with the mentally unstable; and they have few suggestions for anyone who will listen.
The Accra Psychiatric Hospital Could be made Autonomous.
This is because they have seen rich families who have the capacity to afford care for their mentally ill family member, leave them there and never look back because government is in charge. Even if government does subsidize mental health, the families should be involved in rehabilitation process to enable the patient adjust to the outside well once they get better. If made autonomous, they hospital can make money and care for them properly.
Abolish “Custodial Treatment“.
This type of treatment has been found to be anti-therapeutic and may not necessarily help inpatient rehabilitation. See Community Mental Health.
In custodial treatment, rehabilitation centers hold people with mental illness for a life-time. This is not only a human rights. It has also been evidenced to fail by inadequate treatment services, repeated ill treatment to patients, inadequate inspection and quality assurance procedures and ABSORPTION OF LIMITED FINANCIAL RESOURCES FOR MENTAL HEALTH CARE. Most countries worldwide are working on terminating this custodial care as a form of treatment. Anyone who is admitted could be charged a fee to facilitate care. This will provide a source of capital to the facility and reduce dependence on government.
There could be a 1 cedi tax mental health levy on all government workers. This could go far to provide constant support for these facilities alleviating issues with provision of medicine and food.
I am not sure how the government provides support for these facilities but these ideas could be good enough to bring a great improvement in mental health care system in Ghana.