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Opinions of Sunday, 13 October 2013

Columnist: Ali, Chibaro

The New Mental Health Law, A Hoax or Reality?

I lumbered from the taxicab at the junction on Sunday morning and accelerated my strides in order to catch up with time at work since the morning was getting older. I was moved by an irresistible urge of sympathy and a little curiosity to assist this young woman and a boy who were struggling with a middle-aged man by the road side. The man demanded he be chauffeured home rather than in a passenger car because he claims he is a minister and must be given special treatment. I succeeded in establishing rapport and calmed this agitated man down but unbeknown to me, he had clenched his fist and hid them at his back as if an obedient child before his father, just waiting for me to move a step towards him to hit, but he was unfortunately sent down by the weight of his own blow after punching the air as I managed to swiftly dodge him. He bellowed from the ground upwards, cursing me of aiding his discharge in his previous admission on the ward. The woman told him I wasn't the one but he insisted that I was wearing a white shirt and wearing same today too... I finally advised them to go home and come the following day.

In another scene, Mr. x came crying, toting with his bag and baggage and complained bitterly of how he is being maltreated, insulted and discriminated in all things ever since he was discharged home and pleaded that he wants to stay on the ward and wouldn't go home again. Though his speech wasn't all that coherent, one could deduce from a professional observation that there was an iota of truth in what he was saying because there has been similar cases. How would you feel if you spot the patient you once cared for, took his mental status examination (MSE) and realised he exhibits no more psychotic symptoms, have good judgement and memory, orientated in all spheres and thought it wise that he or she could be managed at home on O.P.D bases and went forth to recommend his discharge, now feeding on garbage in a Zoomliom refuse container at the Agbogbloshie market or has erected his tent in the middle of N1 highway road, distracting vehicular movements or displaying some antics in the middle of Kwame Nkrumah Circle Roundabout. Do you feel self stigmatised as a psychiatric nurse? Do you even see the profession as a rightfully chosen one? Yes, I guess so, because "nursing is a call".

The passage of the Mental Health Act 2012 by parliament on the 2nd of March 2012 did not only register smiles on the faces of sympathisers and aficionados of psychiatric nursing in Ghana, but also an earnest expectation of a new face of nursing in the sector within the shortest possible time as far as the care of people living with mental illness are concern. The enthusiasm that greeted mental health practitioners across the country upon the passage of the law created an ambience of hope that the new law will prim mental health care in Ghana. It is the hope of all that the new law will address the perennial challenges bedevilling the sector since it contains some antidote in its provisions capable of mitigating those challenges including the protection of the fundamental human right of people with mental disorders in Ghana. The new law demanded that within a six month period of its passage certain structures be operationalized to give it full steam. Which means that the Mental Health Board would have been established within that time frame with the key function of overseeing the drafting of a legislative instrument to operationalize the new law. But nineteen months down the lane since its passage, has anything changed? Or maybe the good news is in the pipeline. Thanks to the late president, Professor John Evans Fiifi Atta Mills for appending his signature on the Mental Health law 2012 on the 31st of May 2012, just within two months of its passage.

Why the Mental Health Act 2012? (Act 846). According to the Mental Health Memorandum, the Bill has become necessary because the 1972 legislation is out of date and does not accord with the World Health Organisation best practice standard for mental health legislation. The WHO World Report of 2001 which concentrated on mental health, exposed the weaknesses in mental health care delivery in developing countries. The modern trend of mental health legislation is to protect, promote and improve the lives and well being of citizens with mental disorder. People with mental disorder are or can be vulnerable to abuse and violation of their rights. Progressive legislation which acknowledges the modern trend on human rights can be an effective tool to promote access to mental health care as well as to promote and protect the rights of people with mental disorder. The Bill adopts a human rights based approach in accordance with the objective of the U.N. charter and international agreements for the health care needs of a person with mental disorder. These are to prevent discrimination in all its forms and offer equal opportunities to people with mental disorder. Many human rights violations occur in private facilities, the new Bill includes the private sector in mental health as a novelty. Formerly, there were only state run institutions but that position has changed. Furthermore, the Mental Health Decree 1972, (NRCD 30) excluded traditional and spiritual mental health care. There has been a proliferation of charismatic churches since the early 1980s some of which specialize in the healing of mental disorder and there is a need to regulate these establishments by law. The Bill ensures that standard conditions and rights are relevant for all facilities in order to prevent the abuse of people with mental disorder including physical and sexual abuse.

As it has been the policy of the Ministry of Health Ghana, mental health treatment under the new legislation will be shifted from the only three state recognised psychiatric hospitals to the community level where persons with mental disorders will be readily identified and given prompt treatment to reduce the stigma attached in attending psychiatric hospital.This approach also reduces the cost of patient care and prevents the influx of persons to the three state run psychiatric institutions. To accomplish this provision under the new law, it will ensure the establishment of a 50-bed psychiatric hospital in each region across the country; provide four Drug Rehabilitation Centres and 20 bed psychiatric wards in each of Regional hospital. (see http://www.ghanabusinessnews. com/2012/6/journalists- schooled-on-new-mental-health-law)

Experts and analysts have outlined some challeges that are likely to impede the smooth implemention of this new law, these include: health system organisational challenge, mental health human resource challenge, social services challenge, legal and judicial challenge, mental health information system challege and financial challenge. With these possible challenges, how prepared and willing are the institutions concern in meeting these challenges? The Chief Psychiatrist, Dr. Akwesi Osei in an interview with Sodzi Sodzi-Tettey in 2012, seems to have answers to the Mental Health Human Resource challenge: “We have 14 psychiatrists now. In 5-10 years, we hope to train 80-100. We have eight Medical Assistants in Psychiatry now. We hope to train 50-80 in 5-10 years. We have three clinical psychologists in public health service now. We hope to train 50-80 in 5-10 years. We have no occupational therapists now. We hope to train 20 in 5-10 years. We have 600 psychiatric nurses now. We hope to train more than 4000 in 5-10 years. We will do this either through expanding existing facilities or establishing more or both”

The introductory scenes among others are clear caricatures of the status quo in various situations of the plight of mental patients across the country and the new law is the only apparatus that can salvage this situation. Ghanaians are therefore waiting patiently to see the full implementation of this "new dawn" and hope and pray that it will not be left fallow as it betided its previous laws.

The writer is a staff nurse at Ankaful psychiatric hospital.