It’s a habit Raphael Armah just can’t quit.
For the better part of the past decade, Armah has been in and out of Accra’s psychiatric hospital for smoking marijuana. Although he believes the answer is institutional care—it does not mean Armah enjoys hospital life.
“I don’t like staying here,” he says, “Because when I’m here, I don’t feel like myself.”
In an open-air courtyard at the hospital, a TV blares for patients. Some men pass time by playing nonchalantly games. After a two-month stay, Armah says he is ready to go, and his mother is going to pick him up soon.
Armah is one of hundreds of patients slated to be “repatriated” from the Ghana’s chronically overcrowded psychiatric institutions. The exercise is a story I first worked on about six months ago—and a program that was scheduled to take about as long.
But as I recently discovered—officials are now forecasting massive delays. Doctors are now estimating the exercise may not wrap up until the middle of next year.
One such man set to go home is 86-year-old Samuel Adu Armah from Accra. He says he his fifth-born daughter brought him here because he was preaching too intensely.
“I want to go,” he says, “I want to go home, because I am okay.”
Back in January, hospital officials touted plans to send home 600 patients in six months from the Accra hospital, which at times had more than double its capacity. But as of mid-July, only 200 patients had returned home—a far cry from the original plan.
For chief psychiatrist Dr. Akwasi Osei, the exercise is happening too slowly. He says massive congestion means some patients sleep on mattresses on the floor.
“If you go to the wards, the condition is more like what you expect to be seeing in prison, or concentration camps,” says Osei, “That is obviously not good enough. So we want to decongest such that patients will then feel comfortable and feel that we are at a hospital and not a prison.”
There are a number of reasons for the delay.
One includes the high cost of travelling to some of Ghana’s more remote regions—at times almost 3,000 cedis (approx. $1,900).
“That is a serious drain on our resources,” says Osei, “But the point is that it’s still much cheaper than if we were to maintain [the patients] here.”
Other reasons include administrative backlogs causing repatriation trips to happen every three weeks instead of two, and the need for more support staff on the trips (which means fewer seats on the bus for patients).
Osei says there are plans to cope with the massive delays. One is to set up an observation ward at the hospital, where all new admissions will be monitored for three days before being admitted.
Osei also says he’s hoping the country’s health ministry will supply an additional bus to the hospital, which would mean two teams could head out at any given time.
Of course, simply getting patients home is not the end of the story. Osei says he knows the right supports in Ghanaian communities do not necessarily exist. For example, while every district should have at least ten psychiatric nurses, some have none at all. There is no such thing as a half-way home in Ghana.
Still, Osei says the rationale for the repatriation exercise is to reduce stigma surrounding mental illness in Ghana. World Health Organization estimates suggest at least 2 million Ghanians are living with some form of mental illness.
“The current trend all over the world is community care, rather than institutional care,” says Osei, who has long advocated for the passage of the country’s mental health bill which would formalize community care.
As for Raphael Armah, he says he’s happy to be heading home. He wants to get back to his music career, where he raps and sings about issues like religion and kinship. As for staying off the marijuana, he says he’s hoping finding a good church to keep him on the right path—rather than returning to the psychiatric hospital.