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Regional News of Sunday, 10 October 2021

Source: Pascal Landindome Navelle, Contributor

Mind ‘N’ Health Foundation marks World Mental Health Day on the theme: The Mental Health Inequalities in Ghana

World Health Organization(WHO) logo World Health Organization(WHO) logo

In 1948, the world Health Organisation defined health as "a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity."

To the World Health Organisation, health is not just being sick-and positive. Mental health has been noted as a requirement of overall health. This definition was reaffirmed in the declaration of Alma Ata in 1978. As commonly said, "there is no health without mental health" (WHO,1954).

The WHO further defines mental health as "a state of wellbeing in which an individual realizes his or her own abilities, can cope with normal stresses of life, can work productively and fruitfully, and is able to make contributions to his or her community".

The prevalence and social distribution of mental disorders have been well documented in high-income countries. While there is growing recognition of the problem in low- and middle-income countries, a significant gap still exists in research to measure the problem, and in strategies, policies, and programmes to prevent mental disorders.

There is a considerable need to raise the priority given to the prevention of mental disorders and to the promotion of mental health through action on the social determinants of health (WHO, 2014).

Research by Ofori- Atta, (2010) demonstrates the inequalities in the provision of mental health care in Ghana including insufficient numbers of mental health professionals, aging infrastructure, widespread stigma, inadequate funding, and inequitable geographical distribution of services.

Ghana has an estimated population of 30.9 million (Ghana Statistical Service) with a medium human development index (HDI rank of 138) and a life expectancy of 64.1 years [UNDP, World Bank). In terms of the Sustainable Development Goals (SDGs), Ghana has an index score of 65.4%, with a global ranking of 100 out of 166 countries (UNDP).

Regarding Ghana’s burden of disease, research shows that, although medical/physical health conditions (e.g., malaria, HIV/AIDS, etc.) constitute the leading causes of premature deaths, mental health conditions (e.g., depressive disorders) are in the lead for years lived with disability (YLDs) in the country (Sipsma et al, 2013).

For example, lower respiratory infections, malaria, HIV/AIDS, stroke, ischemic heart disease, protein-energy malnutrition, neonatal sepsis, road injuries, preterm birth complications, and neonatal encephalopathy are the top 10 causes of premature deaths in Ghana (Institute of Health Metrics and Evaluation).

The top 10 leading causes of years lived with disability have been identified as depressive disorders, lower back and neck pain, iron-deficiency anaemia, sense organ diseases, and skin diseases. Notably, it has been observed that, comparatively, “depression continues to be a major contributor to Ghana’s burden of disabling conditions and was responsible for three times more YLDs in 2013 than malaria” (Institute of Health Metrics and Evaluation).

Ghana has the most comprehensive mental health legislation within West Africa (Esan, 2014; Walker, 2015) however, the county's mental health system faces many severe challenges, including infrastructural constraints, acute human resource (workforce) shortage, social services challenges, organizational, legal and judicial, research and information system and financial challenges, as well as considerable institutionalized stigma (Reads, 2012; Roberts 2014).

In terms of access to mental healthcare by the public, only 2.8% of mentally ill persons are able to access treatment, with most mental health patients unable to receive professional care (Roberts, 2014).

Relative to the WHO benchmark of one psychiatrist/100,000 population, Ghana’s psychiatrist to population ratio is 0.058 per 100,000 population, and 0.065 psychologists per 100,000 population (WHO Global Health Observatory Data Repository).

Ghana’s psychiatrist/population ratio is comparable to what exists in neighbouring Togo (0.054/100,000), Burkina Faso (0.039/100,000), and Ivory Coast (0.130/100,000), even though all are less than enough (WHO Global Health Observatory Data Repository).

The key evidence is that, compared to the physical/medical health sub-sector, the mental health sub-sector of the country remains under-served and under-resourced, and continues to be less prioritized on the national development agenda by government (Asare,2010; Roberts 2014).

As a society, we are aware of the mental health difficulties and inequalities so many people face but we might not always be aware of the role inequality plays in the experience of mental health problems, services, or getting better.

The Covid-19 pandemic has exposed the world to the inequalities of mental health to include but is not limited to loneliness, stigma, Inadequate funding, inadequate staffing, and mental health facilities discrimination, and many others.

Some groups of people have far poorer mental health than others, often reflecting social disadvantage. In many cases, those same groups of people have less access to effective and relevant support for their mental health. And when they do get support, their experiences and outcomes are often poorer, in some circumstances causing harm.

This ‘triple barrier’ of mental health inequality affects large numbers of people from different sections of the population in the country.
Currently, mental healthcare and allied care activities in Ghana are regulated by the Mental Health Act, which was passed in 2012 (Doku, 2012; Walker, 2015).

A study has clearly shown that mental health care is no longer the domain of psychiatrists, but is now a responsibility of primary care providers, community health workers, educators, law enforcement, and other diverse stakeholders, championing the engagement and the development and delivery of services.

There is a need for robust policy implementation in addressing the mental health inequalities by all stakeholders within the country.