A report from MindFreedom Ghana in 2005 about conditions of mental health systems there, and building their organization. Thanks to Linda Morrison and Krista Erickson for digitizing this report.
MIND FREEDOM GHANA
“Free Minds At Ease”
REPORT OF PSYCHIATRIC SERVICES IN GHANA
ACTIVITIES OF MIND FREEDOM GHANA
MIND FREEDOM GHANA (MF-Gh)
“Free Minds At Ease”
REPORT OF PSYCHIATRIC SERVICES IN GHANA
ACTIVITIES OF MF-Gh
In Ghana there are three major psychiatric hospitals namely the Accra Psychiatric Hospital, the Ankaful Mental Hospital and the Pantang Mental Hospital. There are however, psychiatric wings or units attached to all the regional general hospitals and the Polyclinics and these have contacts with the Accra Psychiatric Hospital which is the oldest and the main one. The Accra Psychiatric Hospital, which is almost a hundred years old, has twenty-four wards with about one thousand, one hundred and sixty two patients currently on admission. The Accra Psychiatric Hospital, was built like a prison by the then British colonial Government to house patients who were wild and/or uncontrollable. The high walls and other symbols of prison still remain as painful reminders of how mentally ill were treated during the colonial days. Ankaful and Pantang Hospitals are forty and thirty years respectively.
Ironically all the three hospitals are located in the southern part of Ghana. In the circumstances, all patients have to be brought from the middle and northern parts of the country for treatment.
Many Ghanaians believe that when you have psychiatric problems, it means you have offended the gods. They therefore run to shrines or spiritual camps for treatment before coming to the hospital. Illiterates and literates alike do that. They often overlook the fact that stress and too much work cause depression and various other types of mental illnesses. People in the fashion and designing work break down a lot during festive occasions or seasons like Christmas. This is because of the over-time and strenuous work that they do to beat deadlines for their clients’ sake. A little psychological problem affects other areas.
Psychiatric services are free. A patient only pays for his/her folder, which costs about one dollar and can be used for about ten years. Medication is free. There are however some drugs, which are relatively more modern than those supplied by the hospital. Some patients prefer to have the prescription written out for them and get their relatives abroad especially in Europe and the US to purchase the drugs over there and sent down to them. Others who are well resourced buy the drugs locally at very high prices. It is instructive to state that all the drugs supplied at the hospitals are the standard ones in use for many years.
Community Programmes For Psychiatric Users:
Free clubs have been formed in some schools and among the Moslem women in the slums. Community Psychiatric nurses go to these clubs to give them talks on mental health and mental hygiene. They are taught how to talk to people in ways that would not affect them mentally or push them into worse mental states. For example they are taught not to meet aggression with aggression and as much as possible voice out their problems rather than keeping same to themselves.
Mental hygiene is an important area that is handled carefully because dirt affects one’s personality. The way one is dressed up makes people respect or disrespect him. The community psychiatric nurses also speak to the clubs about drug abuse. There are some role plays and drama staged to sensitize the people in the community. Radio and television programmes, coupled with newspaper articles about signs and symptoms of psychiatric problems are employed.
There are community psychiatric nurses who visit the homes of the patients to talk to relatives and to teach them how to relate with the patients. There are social welfare officers who help to manage the funds and bank accounts of the patients. This often happens in situations where the patients are unable to make any meaningful decisions about their material resources.
Typical Situation Of Patients:
When there are shortages of drugs, patients refuse to buy them elsewhere. Where the patients seem to be alright, they neglect to take their medication. Non-compliance with instructions concerning the drugs causes relapse. Some ignore their conditions till they get very bad before they go to the hospital.
Sometimes relatives chain the patients and send them to fetish shrines or spiritual camps where they are placed in the scorching sun when they get uncontrollable or wild. The chains sometimes cause wounds which when not treated in time cause tetanus infections and in some cases get gangrene. These then may culminate in amputation or even cause death of the patient.
The hospital has to foot the bills when the patient has to be sent to physician specialists for special treatment. Sometimes some groups and individuals give donations in cash and in kind to the hospital. Some of these funds are used to pay for the bills of such patients when the need arises.
Patients on admission are fed three times a day with fruits being added to their diet. It is however sad to relate that most often due to inadequate funds, the hospitals are unable to provide enough food and the fruits to satisfy the patients. In the circumstances relatives/friends have to bring along some to supplement what are given.
Those who do not have any relative seeing to their welfare tend to force their way out or sneak out to look more food items to supplement that given them while on admission.
The hospitals have to give out different types of clothing to some patients whose relatives fail to provide some when they are admitted. These occur mostly to warm clothing for their upkeep. What pertains sometimes is that when the clothing are not available, patients have to go about almost naked and sometimes in tattered ones.
Malaria being a pandemic disease in the tropics has to be prevented. Most often the hospitals are unable to provide either insecticides or bed nets to ward off the mosquitoes, which cause the malaria. Consequently most patients contract the disease and when treatment is not expedited, it can result in complications or death.
It is pathetic to relate that owing to insufficient beds in the wards, some patients have had to sleep either on the bare floor or on mats spread thereon. In some cases when there are no spaces in the wards, patients have inevitably had to be made to sleep on the balcony and this exposes them to the vagaries of the weather and deadly mosquito bites. Aside these woeful situations, patients have had to live with pests such as rats, mice, cockroaches etc.
Major Characteristics Of Patients:
Most often women come to hospitals with depression due to marriage, family, work, financial problems etc. There are a lot of patients who come with epilepsy. There are drug and alcohol abusers who come in for help. There are also the schizophrenics who sometimes are rounded up by the local authorities and sent for treatment at the hospitals. Sometimes the patients trickle in on their own accord.
There have been occasions when the local authorities had wanted to rid the streets of the schizophrenics on the way side and have sought the assistance of the hospital to help bring them in. However no funds are provided for their up-keep and this tend to put a lot of pressure on the hospital staff. At the OPD there are neurotics and those in their menopause. The OPD patients are given alternatives for treatment so that they will not feel impelled to do what they do not want to do. Many a time they are counseled on steps to take to ameliorate their situations.
Working Conditions Of Mental health Workers:
In the hospitals, there are different categories of workers ranging from doctors, nurses, clinical psychologists to ward orderlies. Due to unfavourable working conditions, some of them leave for other jobs.
Working tools are not appropriate and modern to enable them perform satisfactorily. Considering the attitudes of mentally ill people, some preventive tools are unfortunately not available to protect the workers from harm and attacks.
The workers are exposed to all manner of risks which sometimes threaten their lives. There has been an instance of a worker at Accra Mental Hospital going blind in one eye after being hit with a metal by a patient. In the face of these risks, there are no insurance schemes in place for the staff thereby making them feel insecure.
LOCAL/NATIONAL USER ASSOCIATION
Name of Association – Mind Freedom Ghana (MF-Gh)
Slogan : “Free Minds At Ease”
Postal Address : P. 0. Box CT3415, Cantonments – Accra, Ghana
Tel : +233 20 211 2228 / +233 277 483 188 / +233 277 421 207
Fax : +233 21 760 142
Mrs. Janet Amegatcher – Executive Director
Mr. Nii Lartey Addico – Executive Director
Mr. Dan Taylor – Executive Secretary
This group started in September 2004. Two gentlemen, Mr. Nii Lartey Addico & Mr. Dan Taylor and a lady, Mrs. Janet Amegatcher started it. The two gentlemen were trying to start an association and made contacts for guidance from a group in Scotland called Highland Users Group. The group in Scotland, led by one Mr. Graham Morgan contacted Ms. Tina Minkowitz who referred the matter to Janet to check out the group. After making contacts with the two gentlemen, Janet thought it wise and prudent to join the two gentlemen to start the association in Ghana.
MF-Gh obtained its formal statutory certification to operate as an NGO in Ghana in November 2005.
At the moment our membership is fifteen. Our outlook for this year is to get as many people joining our ranks.
The total efforts of the organization shall be directed towards improving the mental health and lives of sufferers and survivors in Ghana.
a) MF-Gh seeks to foster and strengthen links with analogous minded organizations both locally and internationally to harmonize their operations and explore diverse forms of cooperation and assistance geared towards helping the mentally ill.
b) MF-Gh seeks to develop and facilitate the provision of rehabilitative schemes that would ease the re-integration of the mentally ill into the society and hence assure them of means of dignified sustainable livelihood.
a) Support and assist mentally ill people in their treatment regimen wherever they found themselves.
b) Create and provide a forum for addressing the needs and concerns of the mentally ill.
c) Support and assist in rehabilitative schemes for the cured mentally ill.
d) Promote activities and schemes that would make the mentally ill have a sense of belonging and acceptance into the larger society.
e) Seek to improve upon the social, moral and economic conditions of mentally ill people and deal with the stigma they suffer.
f) Develop and embark upon educational activities meant’ to avert various conditions that precipitate mental illness.
– Organizing public sensitization forums on mental illness for societal attitudinal change towards sufferers and survivors
– Providing counseling services to persons with mental illness.
– Providing material assistance and other relief services to mentally ill persons and their families.
– Formation of “Friends of Psychosocial Sufferers Clubs” in schools and communities.
-Reaching out to the public with information through research, articles and publications on mental illness.
-Promoting rights and dignity of persons with mental illness. Organizing community preventive education outreach on mental illness.
-Facilitating provision of occupational therapy for survivors.
Geographical Spread In The Country:
Owing to financial constraints, MF-Gh is at the moment based and operating in Accra, the capital city of Ghana. We project to spread our operations nationwide as and when our financial position improves.
– Survivors of psychiatry are vulnerable to relapse when they are not fully accepted back to their homes or tend to have nothing to do with themselves after treatment.
MF-Gh intends in the short-term to identify with such persons by reaching out and fighting for them to be re-admitted to their previous workplaces or facilitating their employment into new jobs. MF-Gh will be a strong advocate for the human rights of people with psychosocial disabilities.
– We project as a long-term programme to start a day center where members can come and have recreational facilities and occupational therapy. There will be a library and farming activities. It must stated that provision of transport facilities will be made to make it easy for users to get to and fro to the centre.
This forms part of our integration scheme for survivors will ultimately see other survivors using facilities available to engage themselves in vocational skills such carpentry, basket weaving, sewing and needlework etc.
Serving as a recreational centre as well, the users shall have access to library facilities, computer centre, indoor games and other forms of entertainment. As much as possible, the centre shall not be residential. In extreme cases, consideration will be given to any user(s) who has genuinely lost touch with his/her relatives.
-Exchange and study visits to other analogous organizations both locally and internationally to gain and share experiences,
– Newsletter (MF-Gh journal to be published every quarter)
-We have had some success in counseling some people who were depressed and managed to get them out of their sullen mood and downward trend.
-Capacity building of users and survivors of psychiatry.
-Recognition from the Government.
-A good working relationship with the professionals.
-Collaboration and networking with local and international organizations in the field of disability work.
-Participation in local conferences of disability movement.
-There are many challenges especially financial and social. There is a lot of stigma attached to mental illness and this affects the attitude of people pertaining to the society and that of the mentally ill.
-Users/survivors are reluctant to join the organization for fear of being tagged as mentally ill persons.
-Paucity of funds and other logistics has made our work very difficult and not too smooth to undertake.
– Transportation — This will be used to undertake our outreach programmes and supplement that provided by the hospitals to convey cured persons to their places of abode. MF-Gh has projected to have a mini-bus that carries about 12 persons.
– Office Accommodation – Our present offices (size of 15ft x 5ft) are lacking in space thereby taking in just four persons at any given time. We will need an office with about three rooms that can also be used conveniently for our meetings.
– Office Equipments – At the moment, we don’t have any office equipments as a result of which all our secretarial work are done outside at a designated
business centre before being finalized at the office. What we’ve projected to make our offices complete are five computers, two printers, one fax machine, two photocopiers, two scanners, telephone lines and receivers and other related equipments.
– Our future focus will be on human rights and dignity of Psychosocial Disability and occupational therapy for the mentally ill.
– Ensuring that the general public is fully committed with the issues and concerns of users and survivors of psychiatry.
– Raising funds to facilitate and smoothen the activities of MF-Gh.
– Making sure that the abilities and skills of users and survivors are acknowledged and used in proper ways.
As much as possible, a vivid picture has been painted about the state of mental health in Ghana taking into consideration our situation as a developing country.
Our strong conviction is that the necessary support and assistance will be forthcoming to enable MF-Gh achieve its objectives and hence assuage the situations aforementioned juxtaposing what our projections are.
Janet Amegatcher (Mrs.)
EXECUTIVE DIRE TOR
Nii Lartey Addico (Mr.)
Dan Taylor (Mr.)
Reviewed, edited and submitted by the MindFreedom Global Committee for electronic posting on MindFreedom website – November 4, 2006.