analysisBy Helena Selby
Mental health in Ghana is one thing the government does not really give priority to. It seems to be content with the situation in the psychiatric hospitals in the country, despite the insurmountable problems they face.
Even though the state of mind of every country's citizens has a reflection on its economic productivity, there still seems to be no attention for them on the side of the government. If the research of the World Health Organisation's (WHO) official figures indicates that about 10% of Ghanaians suffer from mental disorder, then mental health is an issue worth looking into by the government.
As the poor people with mental illness in the developing countries have a higher risk of being deprived of life's chances, then Ghana, being a developing country, must give priority to its psychiatric hospitals to have a safe future, and if any step needs to be taken, then the Accra Psychiatric Hospital should be their first and foremost step toward the upgrading of mental health hospitals.
Psychiatric hospitals in Ghana
The Accra Psychiatric Hospital is about 100 years old and obviously, one of the oldest mental hospitals in Ghana. Its long years of existence has however, not caught the attention of the various government who come and go out of power since the regime of the first President, Osagyefo Dr. Kwame Nkrumah. The lack of innovation and attention has resulted in this hospital being rated as one of the worst in the country. The Director, Dr. Akwasi Osei, might be doing his best to turn things around however, the reluctance of the government, even to pass the mental health bill, makes it evident that the government, in every way, is not very much bothered about the wellbeing of the inmates, making the Director's efforts invisible.
According to research, more than two million of Ghana's population fall within the category of mental illness and need urgent attention. The number might be a disbelief for many people, however, it must be put into consideration that these mentally ill people are spread throughout the regions of the country, as some are left on the streets, other find themselves in prayer camps, shrines, herbalists, and the rest in psychiatric hospitals. A psychiatric hospital, for many Ghanaians, is one of the trusted ways of treating mental illness, apart from the medication being free. In Ghana, research indicates that there used to be about 11 psychiatric hospitals, but unfortunately, the number has gradually reduced to three, which can be found in the Greater Accra, Eastern and Central regions. Among these three hospitals, the Accra Psychiatric Hospital is in the worst state, and ironically has the most number of patients.
Inside the wards
A visit by this reporter into the ward indeed, proved how dearly the hospital needs help. It was a hospital though, with beds, nurses, a few doctors to attend to the inmates, and cleaners to clean the place. Some sections looked like a hospital, and others looked so different, way below the likeness of a hospital. The hospital has about 22 wards, but only a few looked like wards in a hospital. The outlook of the rest, indeed, proved that the inmates were being taken advantage of by the government; it shows how extremely they are exempted from the sharing of the national cake. Surely, the medication is free, but the atmosphere and most parts of the environment don't look free enough, considering the situation of these inmates, the environment and atmosphere create a kind of cage, coupled with the lack of freedom for these inmates.
Most of these wards, despite the fact that the hospital is a clinic, look almost exactly like the normal situations of the mentally ill people on the streets, the difference being that in the clinic they are fed, given medication and sometimes, given a bath. Their place of abode is very unfavorable, in the sense that it might even hinder the progress of their recovery. They sleep in wards which look like a wide open public bath house, which according to the nurse, during the night, takes about 100 inmates per room when they are using their mats. According to him, the lack of wards has compelled the hospital's administration to convert some of the bathrooms into wards. The wards have canals into which the inmates urinate into during the night. The number of inmates in the wards, and the number who urinate into the canal, makes the place really stinky, even after being scrubbed with antiseptics or disinfectant. All the inmates are told to sit outside during the day, with no enough recreation or sheds to sit under. Some choose to have a nap, sometimes on the bare floor; those whose cases are fresh, and find it difficult to do the right thing, choose to sit in the scorching sun in the ward, until a nurse comes to tells them to leave.
During the visit of this reporter, the female rehabilitation ward, which has 17 beds, had 15 patients at that time, and according to the nurses in that ward, the high level of congestion has made the hospital to receive all stages of mental health patients in that ward. In admission Ward 1, there are 17 beds but 130 patients, in Ward E, there are 14 beds 106 patients, in Ward C, 25 beds 100 patients. According to the nurses, those without beds or mats sleep on the bare floor, exposing them to the risk of getting pneumonia. The situation become worse during the rainy season, apart from them getting a conducive place to stay, when it rains during the day, they also have to face the trauma of sleeping in wards with broken windows through which mosquitoes invade the place.
The Occupational Therapy Department
After thorough treatment and therapy by the hospital, patients who seem to be getting better are referred to the Occupational Therapy Department (OT Department). In this department, patients learn all sorts of craft and vocations to enable them take care of themselves and not become a burden to the family or the society, when discharged. Patients, who already have an idea of craft and other vocations, are helped to better them, in order not to forget their skills. The existing craft and vocations in the hospital at the moment include carpentry, tailoring, ceramics and cane weaving. One of the main ideas behind the creation of this department is to help patients stay focused and not misbehave.
As good as this project sounds, during the visit of this reporter to the hospital, this department seemed to be non-functional, as the only part which seemed functional was the carpentry section, which at that moment, had only 12 patients. The cane weaving section had almost collapsed due to the lack of raw material, the tailoring department was so pathetic, in the sense that not only was the room extremely congested, but also the section had only two tailoring machines to teach patients who are referred there. As for the ceramics section, thanks to Mr. Jojo Peter Abdullah, a product of the University of Ghana, Legon and an inmate who has almost recovered, is making use of his talent. It is his creative skills and talent which has beautified the ceramic section.
According to the nurse, who took this reporter around the arts of Mr. Abdullah, his works are sometimes sold and he is given 10% of the amount for his efforts. He said the OT Department has about 50 patients, however, since there is not enough material to use to teach them, most of the inmates resort to the playing of games to occupy their minds. Apart from the playing of games, some of the patients sometimes go to the library to read, however, it is a shame that the library does not exist anymore, and there seems to be no trace of it coming back to life again. At certain points too, patients occupy themselves in group therapy or therapeutic community, that is they gather themselves in groups to share their problems, give advice to each other, and sometimes, they even have discussions about their medication.
The OT Department helps patients recover quickly to face life once again, but due to the lack of enough material the teachers find it difficult to teach, resulting in the department deteriorating daily.
Challenges of the hospital
Disclosing one reason for the congestion in the male ward, the nurse noted that inmates brought by the police with a court order, are abandoned in the hospital. He said inmates brought by court order are supposed to stay in the clinic between to two weeks to six months at most, but the refusal of the police to go for feedback about the condition of the inmates, and the inefficiency of the country's system, makes the inmates stay in the hospital for between 7 to 20 years, hence making the place overcrowded, since the number increases almost every day. The hospital does not have the facilities to separate the wild inmates from the calm ones, so they end up mixing them up, and one is only locked alone in a room when he becomes too aggressive and violent. The hospital has the problem of insufficient water suppy, and not enough food to feed the inmates. Most of the nurses complained that they always have to write a memo to the authorities before they get water.
Apart from this problem they face, they as well have problems locating the families of patients once their treatment is over. It is unfortunate that some relatives, due to reasons known to themselves, do not come to visit their wards once they are put on admission, or even come for them when they have been discharged. The hospital, therefore, refers them to the Department of Social Welfare to find their families, as most families who do not want to be stigmatised by society give wrong addresses to the hospital, making it difficult locating them when the patient is fine, however, if the patient is able to remember the whereabouts of his family, then the hospital allows him to go home by himself.
It has always been the dream of many stakeholders on the mental health bill that once the bill is passed into a law, situations in the mental health will change for the better, however, looking at how severe the situation is in the Accra Psychiatric Hospital, one can hardly tell how things will change for the better when the bill is enacted into law.