Feature Article of Tuesday, 21 March 2017

Columnist: The National Forum

Fighting mental cases

By: The National Forum

The Prince Emmanuel Seventh-Day Adventist Church, PESDAC of the Southern Ghana Conference of the Ghana Union last Saturday, March 18, 2017 embarked on an evangelistic outreach programme to the Accra Psychiatric Hospital at Adabraka in Accra.

Noted for their work in Healthcare delivery in Ghana, the PESDAC members organized the visitation, according to an elder of the church, as part of a Global Youth Day activity ushering in a weeklong meetings of prayer all over of the world.

TNF Special Desk scouts who followed the Adventists into the hospital found out from workers in the facility that there appears to be a gap between policy, and policy makers on one hand and the implementers and tools needed to work with on the other.

Apart from the poor state of infrastructure at the hospital, the employees who preferred to remain anonymous complained of the introduction of levies and fees at the centre which is discouraging patients to seek assistance or gain admission. In-Patients, who number about 1,117 as per the 2016 end of year report of the Hospital, have to pay monthly fees to be maintained or kept there after paying the admission fee of GhC500.0

The recent occurrence of a number of suicide particularly among young people in their formative years is giving rise to the question of how well the nation deals with mental health issues. Ghana's history of mental healthcare dates back to 1888 when On February 4, 1888, by a legislative instrument under the signature of the then Governor, Sir Griffith Edwards the old High Court at Victoriaborg was converted into the first lunatic asylum in the Gold Coast.

Before this period, the mentally ill were found roaming in towns, villages, bushes and some locked up either in their homes or restrained by native doctors. With the enactment of the ordinance, those who were found to be mentally ill were labelled "insane", arrested and put in a special prison in the capital Accra. By the beginning of the 20th Century, this prison had become full and therefore a facility named. The Lunatic Asylum, presently known as the Accra Psychiatric hospital was built in 1906.

According to a publication in the Ghana Medical Journal 2012 Sep; 46(3): 158,162 "unfortunately, records are not now available to give any information as to the number of patients who were first kept under the new system of custodial segregation. In 1904, we learn that the number of inmates had risen to 104. During 1905, there were 80 patients at the hospital consisting of 61 males and 19 females. Of these, eleven males and three females died, and four males were discharged improved by the end of the year. On the first of January 1906, there were 72 patients in hospital. During the same year, there were 33 new admissions, raising the total patient population to 95, 76 males and 19 females. Fifteen males and four females died during the year, and 13 patients were discharged improved.

The staff of the Asylum at that time consisted of 1 Chief Attendant, 1 Assistant Chief Attendant, 9 Attendants (male), 1 Matron, 1 Gate keeper. By 1st January 1907, there were 63 patients in the Asylum. Today, the asylum has 8 doctors aside the Other Prescribers made up of 6 Physician Assistants, 3 Clinical Psychiatric Officers, 800 nurses and some 50 casual workers.

During these early years, the function of the asylum was purely one of custodial segregation. No treatment was given and the main function of the staff was to supervise the feeding of the patients and report on their physical health to the appropriate authority.

TNF’s Research Desk found some quite interesting revelations about a longstanding vision for dealing with mental health issues documented yet not followed by successive governments. From the research documents, the Accra Psychiatric Hospital was seen as small and incapable of dealing with mental cases which are mainly caused according to a 2002 report as shown below:

1. Schizophrenia 599;
2. Substance Abuse 1101;
3. Depression 736;
4. Hypomania 629;
5. Acute Organic Brain Syndrome 495;
6. Manic Depressive Psychosis 343;
7. Schizo Affective Psychosis 284;
8. Alcohol Dependency Syndrome 215;
9. Epilepsy 191;
10. Dementia 131.

The Ghana Medical School started in 1962 with the inclusion of psychiatric undergraduate training. There are currently three psychiatric hospitals in the country namely; Accra psychiatric hospital, built in 1906 with a capacity for 800 beds but currently accommodates 1200patients; Ankaful psychiatric Hospital built in 1965 in the central Region of Ghana with a capacity for 500 beds but has 150 in patients now. The reduction in the number of in-patients is due to dwindling number of nurses and doctors.

The Pantang hospital was hurriedly commissioned in1975 to decongest the Accra Psychiatric hospital. The original intention of the then Head of state Dr. Kwame Nkrumah who initiated the building of Ankaful and Pantang was to provide a Pan- African Mental Health Village for Research. It was a grandiose project that would have recruited experts from Africa. Currently the hospital has a capacity for 500 beds but accommodates 450 patients. It has a vast land with a number of uncompleted wards, bungalows and junior staff accommodation left in the bush.

In Accra, there is one private mental hospital Valley View Clinic which was built by the Seventh-Day Adventist Church.

Among the challenges facing the work of mental health personnel beyond the poor remuneration is the risks associated with handling in-patients. To-date, no mechanism has been put in place a risk allowance regime for the workers. Some of the casual workers have been on casual employment for the periods of five to seven years contrary to the Labour Law.

The Career or Occupational Therapy Centre which specialist believes helps rebuilding or healing the mental infirmities of patients has broken down for so long and there are no attempts to reconstruct it. A morgue at the premises which could have helped in fundraising for the Centre is also in ruins.

The Ministry of Health has a huge responsibility to revisit the various plans on dealing with mental health in Ghana as it appear to be a part human life apart those who inflict it unto themselves.