By Jamila Akweley Okertchiri
In 1982, Bernard Akumiah, together with his older brother, built a two-in-one apartment on a plot of land they bought with profits they had made from a business they started.
“My brother brought the capital and I the knowledge and expertise for the business,” says Bernard, 56, and now a user of the psychotropic drugs.
Things started going wrong just a few months after they moved into their new building at Dansoman.
“My brother would go and drink and then come and insult me and mistreat me in front of his friends and people that I am older than,” he says.
Bernard says that his brother’s behavior towards him depressed him.
“It all started when I began to hear sounds like that of what the mosquitoes make in my apartment,” says Bernard. “When I slept I felt like someone was testing my hearing impulse to see if I was alive, so I couldn’t sleep. I would open my eyes and also notice that the light in my room was being regulated, they would dim and brighten, but there was no one in my room.”
He was also hearing some unusual voices, people speaking to him in a language he couldn’t understand.
Fear, Bernard says, was his number one symptom. “If I am in a vehicle and I happen to sit by the door it feels like the door will open and I will fall out of the moving vehicle.”
He notes that he started perceiving everybody was after his life. “As we are sitting down here I would begin to think you are planning to kill me,” he says.
After living with the situation for about six months, he was taken to the psychiatric hospital for treatment.
“At first I didn’t understand myself. I would usually lose my memory, but now I can remember a few things with the medicine I am taking.”
Bernard says he has been to the hospital a couple of times after his admission for review and with the help of his doctors medications; he was able to regain self-consciousness.
“All I do now is to take my medicine at night to enable me sleep,” he says.
Stigmatization
Bernard is now a volunteer at the Mental Health Society of Ghana (MEHSOG), and helps represent the needs and interests of people with mental illnesses. He is still discriminated against.
He says people’s attitudes towards him haven’t changed.
“At first I had a lot of family support, they would even bring me food so I didn’t eat the food prepared at the hospital but when I was discharged, there was something like discrimination.”
He says some of his friends and family would avoid seeing him even though he was not violent.
“When they have grouped and I am coming and they see me they will disperse so when I also see that I do not go near them,” he says.
Bernard says the stigma he encountered from his friends and some family members didn’t help with his recovery.
But with the care and love shown him by his church members and some faithful friends, he was able to endure and undergo a successful treatment period.
Dr. Akwasi Osei, director of the Accra Psychiatric Hospital, says stigmatization of mentally ill people and their caregivers is quite high.
“There is stigmatization about the condition, stigmatization around the person with the condition and stigma is attached to the people who work in the area of mental illness,” Dr. Osei says.
“We don’t have enough mental health personnel all over the country, because of this discrimination people don’t want to enter the field. You need to be really interested in mental health to practice it in Ghana,” he says.
Dr. Osei attributes stigmatization of mentally ill persons to the fear of the unknown.
“People don’t know exactly what mental illness is and what causes it, and if you don’t know what is causing it then they have reason to fear it,” he says, “People assume a person with mental illness is dangerous.”
He says that because people are credulous beings and want to believe something that they don’t know, they turn to associate superstition with mental illness which further sinks in the attitude of stigma.
This, Dr. Osei says, hinders the treatment of the illness as people with that condition would not want to come out openly and seek treatment because of stigma.
Even after patients have been discharged they often don’t come for review because of the stigma.
But the stigma is not as high as it once was, says Dr. Osei. “If it were to be ten years ago and people saw you entering this place, they will assume you have mental illness but that is not the case now.”
He says there is the need for proper systems to be put in place to educate the public about the illness in order to further reduce the stigma and enhance support for mental patients.
Mental Health System in Ghana
There are three mental health facilities in the country that are only located in the southern regions. “Up north, where the bulk of the patients come from, we don’t have any mental health facility,” says Dr. Osei.
The facilities are institutionally based and, according to Dr. Osei, receive insufficient funding from government, the sole financier of the mental healthcare in the country. “Our system for mental healthcare is quite poor,” he says.
The government spends one per cent of its budget on mental health care. Dr. Osei says it should be increased to at least seven per cent.
“Mental health takes about nine per cent of the burden of disease in the country so why should it have only one per cent of the budget?” he asks.
The current situation coupled with lack of practicing psychiatrists, which number 12 in Ghana, and the refusal of family members to come for their relatives after they have been discharged, has over burdened the healthcare system.
The Accra psychiatric hospital used to have 1,200 patients with only 500 beds. That number has been reduced to 800 patients through the hospital’s program to return treated patients back home.
A nurse, who wants to remain anonymous, says that the hospital has a new 72 hour ward where new patients are kept and assessed before making a decision on whether that patient should be admitted or discharged.
Dr. Osei says that although the government bares the cost for the purchase of the medicines, it is expensive, and supplies remain limited. Risperidone Conste, which is taken every two weeks by the patients, costs GH¢150.
“There are no rapid results when it comes to treating mental illness,” says Dr. Osei. “Treatment can take years so when you don’t get rapid results people don’t feel too encouraged and so take their relatives to prayer camps where they are sometimes chained and their human rights abused.”
Dr. Osei also express concern over the remuneration of the workers in the psychiatric hospital taking into consideration the threat of attack they face in their line of duty. “You ask yourself, ‘Do I want to spend the rest of my life in this facility? No, I would rather go to a place that is more homely,” he says.
Eric, a health assistant at one of the wards at the Accra psychiatric hospital, says he was once attacked by one of the patients when he was on duty.
“I was going to the urinal when I realized one of the patients was behind me, when I turned I saw his hands in the air like he wanted to slap me so I dodged and with the help of some other patients, we took him to came and assisted me to take him to circulation and stabilized him.”
He says he was lucky not to have been injured but some other workers who are not fortunate get wounded by attacks from patients. “Working here is dangerous, sometimes you get wounded and if you are not careful things will not be the same for you.”
The health assistant adds that the workers are always on their guard because of the unsuspected that might occur.
“You must be very careful when you are working here,” Eric says.
Mental Health Bill and the Future
Ghana is yet to pass the Mental Health Bill which is part of the group of health bills currently before Parliament.
The Mental Health Bill was first put before Parliament in 2006. It has gone through its first and second readings and is now at the consideration stage.
Sulemana B.B Bening, Principal Health Planner at the Ministry of Health is confident the mental health bill will soon be passed into law.
“For the mental health bill, I can stick out my neck that before the end of the first quarter of the year, the president will assign his signature to it,” Sulemana says.
Humphrey Kofie, executive secretary of MEHSOG, also says the health committee of parliament has assured the society the bill will be passed by the end of March 2012.
Dr. Osei believes it is a major stride for mental health care.
He believes that with the passage of the bill, the current situation of mental health care will be reversed.
“Healthcare will be community oriented instead of institutionalized, a mental health board and a trust to collect funds for mental healthcare will be established, it will also provide the enforcement power to end rights abuse of mental patients and a department for public education to further reduce stigma and train as well as monitor traditional healers will be established,” he notes.
Dr. Osei adds that the problem of funding will also be solved once the bill is passed.
“The moment the bill is read, the ministry will make an amendment to create the mental health fund and when this is done, most of the problem will be solved” Sulemana says.
He notes that after the bill is passed it will move to the legislative committee who will work alongside key stakeholders and experts in the field to develop alongside with experts to develop the Legislative Instrument.
However, Humphrey believes if the law is passed without a legislative instrument to enforce it, it might end up like the disability law, which has not been enforced for six years for lack of an LI to implement it.
“The future is the legislative instrument,” he says.
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