Wednesday, February 22, 2012

STIGMA HOLDS BACK MENTAL HEALTH IN GHANA
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.
Five years of false hope?
Disabled still struggle after 2006 law

By Jamila Akweley Okertchiri

In 2006, there was hope for the disabled. A new law had been passed guaranteeing free education and training, accessibility to public places and accessible transportation.

However, five years after the passage of the law, disabled persons still cannot access all public places. They cannot get on a vehicle. And they are still discriminated against.

“The challenge we face is that of people thinking or feeling or believing that people with disability do not deserve to live, or to exist,” says Max Vardon, executive secretary of the National Council on Persons with Disability (NCPD).

The Persons with Disability Act (PDA) was supposed to make it possible for the disabled to fully enjoy the rights enshrined in Article 29 of the 1992 Constitution of the republic of Ghana.
It further called for the creation of disability desks at employment centers nationwide, as well as the creation of the NCPD, which is supposed to oversee the implementation of some national programs for disabled people.

However, some stakeholders have yet to implement the provisions, while others are moving at a snail’s pace.

Issues such as discrimination, making public buildings disability friendly, education, and employment, and funding are still pending clarifications and changes.
Discrimination

Section 4 (1) of the act states: “A person shall not discriminate against, exploit or subject a person with disability to abusive or degrading treatment.”
Section 2 of Article 4 of the act also states that employers shall not discriminate against a prospective employee on grounds of disability, unless the disability is relevant to the employment.



Nonetheless, George Amoah, who became physically challenged after suffering a spinal injury in an accident, believes a subtle discrimination still exists against persons with disabilities.
“Persons with disabilities are still discriminated against and categorized in a certain way,” says Amoah. “To a large degree, that’s the mindset of corporate Ghana.”

Amoah also pointed out that employers sometimes turn away qualified disabled persons.

“They don’t have to put it in a rude manner,” he says. “You can see for yourself that you can’t come.”

Discrimination can also happen outside corporate boardrooms. Emmanuel Joseph, paralyzed at age 22, lies on cardboard in Accra’s business district. He begs for alms from passersby.
Joseph lives with his brother but takes care of himself through begging. He starts his business of begging, which earns him approximately GH¢5 per day, from seven in the morning. He goes until sunset.
“Sometimes I get insulted,” he says. “Sometimes people also beat me.”

Mawutor Ablo, deputy director of Policy, Planning, Monitoring and Evaluation at the Ministry of Employment and Social Welfare, however, says there is an ongoing sensitization program to educate the public on the rights of persons with disabilities.

Accessibility to Buildings



Amoah, now an employee at a major bank, says even though he can access his present workplace, his previous place of work was not accessible.

“I had to be carried up the stairs by people, and that was risky for me because you can slip and fall.”

He says a lot of companies cannot afford the investment of making their workplaces accessible.
“You apply for a job, show up and you see it’s all staircases, no lifts. You can’t access the place.”

Isaac Tuggun, another physically challenged person who works as an Advocacy and Monitoring and Evaluation officer of the Ghana Federation of the Disabled (GFD) believes government’s slow pace in addressing issues pertaining to persons with disabilities has contributed to non-implementation of the provisions by stakeholders.

“We are still way behind so far as the implementation of the provisions is concerned,” says Tuggun.

He says the legislative instrument first drafted in 2010, which would give impetus to the implementation of some of the provisions of the Act, is still not ready.

He observes that not all provisions even require the legislative instrument.
“The 10-year moratorium for buildings to become accessible, as well as new ones, does not require the legislative instrument,” says Tuggun.

He notes that new structures are coming up, springing up here and there, with steep stairs and open gutters.

“Are we going to sit down and wait until the last day of the tenth year?” he asks.
Ablo agrees with the accessibility provision of the act.

“Certainly the law makes provisions that all public buildings should be made accessible to persons with disabilities in 10 years (from 2006),” he says.

He says the NCPD secretariat has actually taken that issue on board.



“They’re having discussion with key stakeholders, trying to sensitize them to make buildings accessible,” he says, adding that the ministry has taken the lead. “You can see that we have put up a disability ramp.”

Ablo is however unsure about other government ministries. The Ministry of Social Welfare is the only ministry in Accra Central with a ramp.

“They are all aware of the law. Attention is being drawn to that. But you also have to look at feasibility and whether there is space, I think in time you will see this issue addressed.”

Employment

The Ministry of Employment and Social Welfare has the responsibility of securing employment for persons with disability through the Public Employment Centre.

The act further explains that if the name of a person with disability remains on the job search list for more than two years, the ministry shall give the person appropriate training, provide that person with necessary working tools and assist the person to access loan capital to start a business.

Amoah, who got his present job as a result of an employment fair organized by a non-governmental organization, says his colleagues do not have the same opportunity.

“They don’t at all,” he says.

He notes the lack of jobs poses a difficult challenge.

“They have to depend on family. Some will have to find some menial jobs, and a few of them you see begging. Most of them do jobs that they are way above, but they have to survive.”

Ablo, on the other hand, says government is responsive to disabled job hunters. He says the department of social welfare has worked to train disabled people in vocations.

He says district officers also try to identify disabled people for the community based rehabilitation program.

“They identify some economic action at the various communities in terms of local resources, and then they train some disabled people with local resources so they can sell things in the market and make a living.”

He adds that government has also made provisions for private organizations who recruit people with disabilities.

“They will have some tax based incentives.”

Employers will get a rebate of one per cent of their taxable income for each disabled person they hire.

Education

It is mandatory for parents or guardians of children with disabilities to send them to school, according to the act. If a parent does not send such a child to school, he or she is guilty of a criminal offence.

The government has also agreed to provide free education for persons with disabilities and to establish special schools if such persons are unable to enroll in the formal schools.

In his view, Amoah wants government to be more proactive and create opportunities.

“With education, it has to start right from scratch,” he says. “If the person does not have skills, then they can’t participate in mainstream economic activity.”

Ablo stresses government has made provisions for free education for persons with disability, but Tuggun questions the level at which education is free for persons with disabilities.

“If it’s just the basic level, we are all entitled. So what level is a person with disabilities going to enjoy?”

Fund Allocation for Persons with Disability

In 1993, the Government of Ghana started the District Assembly’s Common Fund (DACF) as part of Ghana’s decentralization agenda.

Government in 2005 pledged two per cent of the DACF for persons with disabilities.
The Ministry of Local Government and Rural Development, Ministry of Finance and Economic Planning, and the administrator of the DACF are the duty-bearers.

The two per cent was to be used in areas including advocacy and awareness-raising on the rights and responsibilities of the disabled, strengthening disabled people through organizational development, training of employable skills and apprenticeship.

Other areas include income generating activities, some educational support for children, students and trainees with disability and provision of technical aids, assistive devices, equipment and registration of NHIS.

Tuggun says the allocation was an intervention to mitigate the suffering of persons with disabilities.

He however says most Metropolitan, Municipal and District Assembles (MMDA) have refused to allocate the money on grounds that there are no guidelines for its disbursement.

The act’s provisions established the NCPD, and, in 2010, it helped draft guidelines to improve the DACF situation. The guidelines entailed the setting up of account by the MMDA’s for the two per cent allocation.

But a year later, only two-thirds have set up the account. According to documents obtained by Daily Guide, the minister for Local Government and Rural Development, Honorable Samuel Ofosu Ampofo, in a letter dated September 14, 2011, addressed to the Accra Metropolitan Assembly (AMA), urged all assemblies to implement the provisions in the guidelines and asked for strict compliance with the various sub-headings.

Vardon says the council is aware of the non compliance by the MMDA’s but attributes their indifference to their lack of interest in disability issues.

“The bottom line is that they are not really interested in disability,” he says.

Daily Guide visited the Ministry of Local Government and Rural Development to find out the cause of the delays. The PRO refused to process the interview request because it was not delivered in an envelope. He then complained that Daily Guide had not shown up to an unrelated programme some days earlier. When Daily Guide said it would be forced to publish his refusal to process the interview request, he and a colleague began shouting.

Vardon adds that according to the World Health Organization, almost 15 per cent of Ghana’s population is with a disability. He says the two per cent of the fund isn’t enough to address the issues experienced by such a large portion of the population.

He says the council is doing its best to raise the visibility of the issue, but until they have representatives in all the 170 MMDAs there is little they can do to make the assemblies comply with the directives of the local government.

Tuggun says the GFD knows that, as of the third quarter of 2010, there was GH$85,350 in an AMA account. He figures the full 2010 allotment will reach GH¢100,000.

“What we plan to do is make sure this money will be properly utilized, so it will change the lives of persons with disability.”

The AMA says it is working toward assembling the required committee to disburse the funds according to guidelines.



Daniel Dzagbatey, chairperson for the committee set up in Tema to oversee the disbursement of the funds, says the community had received its yearly allocation for the three quarters and has distributed according to the guidelines.

“The amount we have received for the three quarters for the year 2010 is GH¢49,578.42.”
He says the money for the first two quarters was distributed to the 18 physically challenged persons and the deaf.

“We gave each GH¢500 to start up a business or open a shop which was in view of poverty alleviation.”

Blind people have also applied, and the committee is now deliberating on how to disburse funds to them according to the guidelines.