Tag Archives: mental health

Unavailable and underfunded: mental healthcare in Ghana

The Accra Psychiatric Hospital only has a capacity for 600-800 patients, but currently houses many more.

Like much of the developing world, mental healthcare is lacking in Ghana. Mental illnesses are deeply stigmatized and widely misunderstood, and access to mental health professionals and infrastructure is limited. Although the recent passing of the innovative Mental Health Bill lays the legal framework for the required changes, steep challenges remain.

Ghana spends 2.58 per cent of an already small health budget on mental health. Accordingly, Ghana has only three publically-funded mental health hospitals. The hospitals are all old, overcrowded, and located in the southern part of the country. Consequently, they fail to provide adequate care for the estimated 250,000 people that need treatment in the country.

Pantang Hospital, the newest in the country, was built in 1975 and is located just outside Accra. Ankaful Hospital was built in 1965 and is located in Cape Coast, 150 km outside Accra. The largest hospital, the Accra Psychiatric Hospital, was built in 1906 and is located in the centre of the capital. It only has a capacity for 600-800 patients, but currently houses close to 1,000. It’s a condition that “compromises the comfort and general well-being of patients and constitutes an appreciable strain on [the hospital’s] resources, staff and funds,” according to the hospital’s website.

There are also only twelve psychiatrists working within the government system, many of which perform only administrative duties. There are fewer than 500 psychiatric nurses, more than half of which are located in the mental hospitals, leaving the rest of Ghana wanting.

The result of the widely unavailable care is that many rely on traditional healers, especially in the more rural and impoverished northern parts of the country. Their methods vary from prayers to exorcisms to human rights abuses.

“We’ve seen people who have cuts on their bodies that have festered into sores… It’s all under the guise of treatment,” said Peter Yaro, the Executive Director of BasicNeeds Ghana, an NGO that seeks to “ensure people with mental illnesses and their families live and work successfully in their communities,” according to Yaro.

“We have seen people who are shackled and left in the open, rain or shine for days. We’ve seen people who have been locked in rooms for days, months, and years. They ease themselves there, they eat there, and they sleep there. And nobody bothers to do anything about it until it’s reported to us,” he added.

The garden inside the Accra Psychiatric Hospital.

BasicNeeds has been operating in Ghana since 2002 and has since expanded to six out of Ghana’s ten regions. It strives to improve access to appropriate treatment, teach people with mental health conditions to support themselves, give people suffering from mental illness a political voice, and address the fiend that exacerbates all mental health problems in Ghana – the monstrous social stigma that surrounds the issue.

In Ghana, people with mental health issues are widely misunderstood and mistreated. People view mental illness as anything from a deserved consequence of a spiritual transgression to a contagious condition that will infect anyone who works in the field. As a result, they are discriminated against and marginalized, Yaro explained.

“The moment you are seen as mentally ill you are seen to be less human.… People think you can’t even feel,” he said. There is also little understanding of, or interest in, proper treatment.

“For those who know about the hospitals, they come and dump you there. For those who don’t know about the hospitals, they dump you at the traditional healer so they can move on with their life,” Yaro said.

The social stigma also affects the professionals who work in the field. Unlike other medical specialties, psychiatry is not prestigious. “It’s not attractive. It has no status, socially,” said Yaro. Because of this, and the fact that many people still think mental illness is contagious, few choose careers in the field.

The Mental Health Bill – the government’s plan to address these pressing issues – was finally passed on March 2, 2012. Originally drafted with help from the World Health Organization, the Bill meandered through parliament for eight years.

It emphasizes community based treatment over institutionalization. This is very important because up until the Bill was passed, the legislation that guided Ghana’s mental health service plan had changed little since the colonial Lunatic Asylum Ordinance made in 1888, explained Yaro.

“The national health policy under which mental health services are provided is not only arcane, but very bad,” he said. “We’ve come a long way towards understanding what mental health issues are and the law needs to be retrofitted.”

The Bill also introduces regulations for both public and private care providers need to adhere to, legally protecting patients’ rights. It also calls for a decentralization of care centers and and seeks to battle the stigma through public education campaigns.

It is estimated that more than 250,000 people in Ghana need psychiatric treatment.

The passing of the Bill marked the ratification of the UN Convention on the Rights of Persons with Disabilities. Ghana was one of the original 80 countries to sign the convention in 2007 and activists and mental health care professionals eagerly awaited its ratification since.

“I don’t know how to express my joy. Eight years of anxiety, apprehension and patience- that is how I can describe my feeling now. If we knew that the bill would be passed today, we would have come here with buses full of people and thereafter paraded through the streets of Accra to exhibit our joy and appreciation,” said Dr Akwasi Osei, the Chief Psychiatrist of the Ghana Health Service, at the time of the Bill’s passing.

“The way the Bill is drafted means a revolution,” said Yaro. Although the Bill received Presidential Assent on June 8 and became law, the revolution is still coming.

The massive investment required for the full implementation of what is in the Bill seems unlikely in the near future. Ghana is a Lower-Middle Income country and its economy is largely dependent on foreign aid, which makes up 11.7 per cent of the country’s GDP, according to the Organization for Economic Co-operation and Development. Its public health care system battles both corruption and a “chronic shortage of funding,” according to a 2008 Austrian Centre for Country of Origin and Asylum Research and Documentation (ACCORD) report.

“We have to be optimistic, however one should not lose sight of the [challenges],” said Yaro. In the meantime he is happy with the progress made so far and will continue working with BasicNeeds as Ghana moves forward with its mental healthcare policy.

Remodel to rehabilitate – The need for mental health aftercare and rehabilitation treatment in Malawi

A build or remodel is not typically what the doctor ordered to stave off chronic stress and depression; the process risks construction anxiety and expense and according to Walter A. Brakkelmans, an associate clinical professor of psychiatry at UCLA, “on a scale of 1 to 10, 10 being the death of a child and 1 a fender-bender, a remodel rates a 6 in terms of stress.”

But in Malawi there is a shortage of doctors with orders, and for Flomina Mawindo, a single mother of five in Che Mboma village, rebuilding a dilapidated house is her best shot at ensuring her own rehabilitation to home life after being discharged from Zomba Mental Hospital.

Mawindo was admitted to Zomba Mental Hospital after familial and financial stresses set off a downward spiral into anxiety, insomnia and ultimately mental illness – she struggled with a husband who, until his death in 2004, encouraged thieves to steal from her to ensure she did not have the means to divorce him, in-laws who cursed her and her children and a son who stole from other villagers and skipped town leaving her to answer to the authorities and pay outstanding debts.

She began walking the streets at night, talking to herself and became increasingly violent when her children attempted to restrain her, and after initially being turned away from the Queen Elizabeth Central Hospital primary health care facility in Blantyre was admitted to the mental hospital in November of 2011.  She was discharged in February of 2012, and is able to recall, with a shaking voice and haunted eyes, her experience at the hospital as one of “trouble and pain.”

“In the first ward, it was not good at all,” Mawindo remembers.  “There were four or five patients in one room.  The others would bite me, abuse me, and grab my food.  I could not protect myself.”

Mawindo said the problems that made the hospital “like a prison” were caused by a shortage of doctors and nurses, an issue that was confirmed by a nurse at the hospital who said “the nurses are always there, but for example today we are only two nurses, and we have got 53 patients… For one or two nurses to look after 50 patients and provide the quality of care that they need?   It’s impossible.”

Due to the shortage of doctors and nurses, psychological treatment has not been institutionalized and instead the provision of drugs takes priority.

Mawindo has been prescribed sodium valproate, a mood stabilizer which causes side effects which include fatigue, shaking and sedation and are immediately obvious in Mawindo.  She is no longer strong enough to walk to the market to do business and has not returned to work since being discharged.  Her eldest daughter Tadala absconded from primary school to care for the family until the Jacaranda School for Orphans stepped in and hired a caretaker.

Beyond the caretaker and maize meal donations provided by Jacaranda, Mawindo said she is not aware of any community-based services to help support her and her family.

 

In the absence of government-funded community-based aftercare and rehabilitation services, Mawindo said she plans to make repairs to a dilapidated house on her property and open it to renters or turn it into a chicken farm.  She said with the supplementary income she will feel less stress about paying debts and providing food for her family.

 

She derives her motivation from the time spent at the mental hospital – not from therapy and positive learning but the fear of return.

“I was going through trouble and pain at that hospital,” she said.  “I’ve decided I will never go back there again.”

***

According to Draft III of the Malawi Health Sector Strategic Plan for 2011-2016, in March of 2011 when the plan was published there were no mental health activities at community level, primary health care units did not provide mental health services, the treatment services provided by tertiary institutions were mainly for people with severe or acute mental health problems and the provision of psychological rehabilitation was limited.

The same report found that in 2011 only 1.5 percent of the national health budget was being spent on mental health and except for one or two districts, most districts spent none of their budget on mental health services apart from the procurement of drugs.

Barriers to mental healthcare in Ghana’s Northern Region

Mami Sandow started hearing voices when she was nine years old.

“She used to roam, talking anyhow, climbing some kind of trees, ” says her brother, Fatawu Sandow. ” You asked her to stop, but she wouldn’t stop. She would just run and hit anything [and fall] down. ”

Mami is 16 years old now and is being treated for epileptic psychosis at Tamale Teaching Hospital She pulls down the left shoulder of her screen-printed dress to show deep scars on the shoulder blade. Her left ear is mangled; the lobe tattered and hanging loosely. Her injuries are self-inflicted; when she hears voices she throws herself at walls to get them to stop.

Seven years ago, when Mami first started exhibiting unusual behaviour, her family thought she was just misbehaving, says Fatawu. The severity of her symptoms increased until they realized she needed medical treatment.

“We thought it was jokes [but] it came to a time, we had to send her to the hospital,” says Fatawu.

Psychiatric drugs in Ghana

Some of the drugs prescribed to psychiatric patients at the Tamale Teaching Hospital.

When Mami first became sick, the family sent her to a hospital in Bolgatanga, about 150 km north of Tamale. A private hospital, her treatment cost over 3,000 GHC ($1,500 CDN). To pay the hospital fees, the family had to sell off property and rely on remittances paid from siblings in Accra.

“We sold everything, just to take care of her,” says Fatawu.

Mami needs around-the-clock attention, to prevent her from injuring herself or others. Fatawu is the sole caregiver, because his mother and father are too busy to help. Staying at home as come at a personal sacrifice to Fatawu.

“It’s even effected my education,” he says. “I was attending [the Tamale Islamic Senior High School] … but because of the sickness, I must come home to take care of her.”

Mami’s epilepsy is treated as a psychiatric illness because of the stigma attached to her behaviour, explains community health nurse David Agyarwa. He says poor understanding of mental health issues stops patients from getting treatment.

“Most people think that when somebody suffers from mental illness it is due to sin an individual committed or the individual is demon possessed,” says the native of Accra.

Agyarwa says there is a great need for psychiatric care in Tamale, yet the hospital does not have a ward. Today he’s conducting interviews in examination room 52; an overcrowded room that houses urological, pediatric and orthopaedic appointments on different days of the week.

“We are compelled to sit at any place [in the hospital] that we can get and do our [patient] history taking,” he says.

Agyarwa says this is problem for psychiatric patients with delicate temperaments. Also, if appointments are conducted in open waiting areas, it violates patient privacy.

The Tamale Teaching Hospital unveiled a new wing on April 30, with maternity, intensive care, neo-natal, radiology and surgical wards, but no provisions for psychiatric care. The $54 million CND building took two years to build and was funded by the Dutch and Ghanaian governments.  Psychiatric patients will be housed somewhere in the new facility, says the hospital’s public relations officer Gabriel Nii Otu Ankrah.

“Because of the importance we attach to psychiatric care, the space will be created for them in the new building, temporarily,” says Ankrah. “[But] the original plan didn’t include space for the psychiatric unit.”

The Ghanian government is prioritizing mental healthcare after the March 2 passage of the country’s Mental Health Bill. The bill promises to de-centralize treatment from the three mental hospitals in southern Ghana, to community hospitals across the country.

Unaware of the government’s new mandate on mental healthcare, Fatawu is simply grateful for his sister’s new course of treatment. Mami hasn’t had a psychotic attack for one week, he says.

“Now it’s good [since] we started coming here, collecting the drugs,” he says. “Now [the illness is] no more [affecting] her, so now she is free.”

International Mental Health Day: Rewind. Repeat. Play. Stop.

Last week, Ghana commemorated International Mental Health day on October 10th.

By the close of the day, parade floats that had been driven through the main streets of Accra were quietly parked; podiums were taken down; advocates were appeased for the moment; and few good stories were filed.

That’s pretty much how it goes in most countries, and ever since the Ghanaian government completed a promising Mental Health Bill in 2006, similar events have taken place each year.

Very similar, in fact.

Here’s an article from this year.
Here’s another from 2010.

Aside from the allotted news coverage for this special day and appeals to the Government to move faster, gentle reminders in the local news make up mental health coverage the rest of the year.

Here’s a recent reminder. (Warning: disturbing image)
Here’s another one. (Warning: graphic descriptions)

So, here’s a little follow from last week.

Mental Health day is recognized internationally and reminds participating Governments, advocates and citizens about an issue that can get lost in the vacuum of rights violations and ineffective policies of equal importance in developed and developing nations.

That isn’t the most galvanizing statement, mind you, but those are the facts.

Then there are the figures.

The World Health Organization (WHO) estimates that over 2 million Ghanaians are suffering from moderate to mild mental disorders.

Further to that: 650,000 people in Ghana are suffering from severe mental disorders.

Advocates at Basic Needs Ghana – an international NGO that advocates for the rights of the mentally ill in the country – are encourage by what’s happening in Ghana.

According to Peter Yaro, the Executive Director: “Ghana has come a long way from having lunatic asylums that just arrested people who exhibited mental illness and kept them in hospitals with minimal management, to [now having] a level where it is taught that mental health should be integrated into the general health system.”

But the issues remain. Here they are:

  • The Mental Health bill completed in 2006 has not been passed.
  • There are still stigmas around mental health.
  • There are not enough facilities in the country. (There are only three in the entire country, in fact).

On October 10th, local media reported that Ghana’s minister of health, Mr. Joseph Yieleh Chireh said that Government has made mental health one of its priorities. He explained that the Bill had already gone through the second reading in Parliament and there was every indication that it would be passed by the end of the year.

Mr. Yieleh Chireh assures Ghanaians that the passage of the bill was imminent. After that new policy based on the new Act would need to be drawn and a strategic plan to execute the policy put in place.

Of all this however, no timeline was made available about when the bill would be passed.

Full stop.

There is an air of change here in Ghana, but it doesn’t begin and end on Mental Health Day. Not-so-sexy follows to the issue certainly have a role to play as well.

According to Yaro, though there are a few well-managed community psychiatric units dotted around the country in various regional hospitals and district hospitals, these services are largely concentrated in the mental health hospitals

And what’s happening as you read this post?

“Right now, many people cannot access mental health services.”

Right now – and until this bill is passed – millions of Ghanians cannot access mental health services, because of stigma, because of a lack of awareness about what mental illness is and, in many cases, because the nearest specialist is on the other side of the country.

Big aspirations, small budgets – and disenfranchised mental patients

Epilepsy, depression, schizophrenia and bipolar disorders are some of the top mental afflictions in Malawi. Photo by Blantyre News Limited.

According to the World Health Organization (WHO), mental health problems are already the fourth leading cause of the global health burden, representing a third of all years of healthy life lost to disability among adults.

By 2020, they will rank second, behind ischaemic heart disease.

In Africa, regional WHO studies show that mental health issues such as epilepsy, depression, psychosis, mental retardation, substance abuse, and other psychotic disorders, are among the top ten causes of disability in the region.

But in Malawi, one of the poorest countries in the world, where health policies and development goals are primarily centered on the prevention of HIV and AIDS, the reduction of maternal mortality, tuberculosis, and malaria, mental healthcare is – at best – an afterthought.

Case in point, the Ministry of Health has no solid data on the nature and the extent of those suffering mental illness.

Its National Mental Health Policy Plan admits that in the absence of research on mental health patients, it has had to rely on studies done in neighbouring countries.

Based on these studies, health officials estimate that at least 10 per cent of Malawi’s 15 million people are affected by a mental health problem, also meaning that mental health afflictions are as common as infectious diseases.

And yet, given these dire statistics, the Ministry of Health’s Strategic Plan for 2011-2016 recognizes that the government’s budget for the health sector is “inadequate.”

Health places third in budgetary allocation, (at 10.2 per cent) after education (13.7 per cent) and agriculture (18.9 per cent).

Only 1.5 percent of the national health budget is spent on mental care.

In 2007 and 2009, respectively, Malawi signed and ratified the United Nations Convention on the Rights of Persons with Disabilities and its Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care.

Among the guiding principles of this Convention are accessibility to facilities and services, the right to health, as well as habilitation and rehabilitation services and programs.

Likewise, article 30.2 of the Malawian Constitution, addresses the right to development, declaring that the State commits itself to “take all necessary measures” to guarantee “access to basic resources, […and] health services.”

But with such a tight budget, intentions can only go so far.

Mental patients have to deal with public mental healthcare institutions that suffer chronic shortages of essential drugs, inadequate if not, deteriorating facilities, insufficient and overworked nurses and doctors, and no access to counseling.

For instance, the psychiatric section of the Queen Elizabeth Central Hospital (QECH), the largest hospital in the city of Blantyre, has been out of essential drugs, (like Chlorpromazine and Modecate, which are used in the treatment of conditions such as schizophrenia, psychoses and manic episodes) for over a year, while the one at the Bwaila Hospital in the capital, Lilongwe, has lacked medication for 10 months.

Based on hospital records, six out of 10 patients are relapsing due to the lack of drugs at QECH.

“There’s no hope for many patients,” says one of the psychiatric nurses from QECH. “It is a very sad situation to see – and we can’t do much about it.”

The little the nurses can do is to use substitute drugs if possible. But sometimes they have to turn patients away if there are not adequate drugs to treat their specific needs.

“We feel very sorry to tell the patients who have walked for many hours to get their medication that we don’t have any,” says another nurse from Bwaila Hospital.

As if the lack of essential drugs were not enough, there is also the issue of the scarcity of mental healthcare workers.

For instance, QECH has just one psychiatrist and 18 nurses to attend an average of 2700 patients a year. Bwaila Hospital does not even have a psychiatrist. It is entirely run by five nurses who attend about 200 patients every day.

Two years ago, Dr. Rob Stewart, the head of the psychiatric unit at QECH decided to shut down admissions of patients because the rooms lacked windows and toilets.

One of the nurses from QECH, when asked what improvements she’d like to see in the mental healthcare system, said having a computer would make a big difference, as patients’ records are still handwritten and usually get lost or mixed with other papers.

“The only piece of technology we have here is a telephone, “ she says.


Autism in Ghana part II: Battling stigma and education youth

Seletay Pi-Bansa, 8, learns to read at write at AACT, a special school for autistic youth in Ghana. Photo by Angela Johnston.

A group of students gather in a circle around a blackboard in a small Accra classroom. Eight-year-old Seletay Pi-Bansa holds a piece of chalk. He begins to sketch letters on the board and his classmates clap in a rhythmic beat to encourage him.

“Let’s hear for Seletay,” the teacher says at the Autism Awareness, Care and Training Centre (AACT).

Seletay’s mother, Evelyne Pi-Bansa, sits outside. She says this autism centre is helping Sel learn better than other schools he has attended in the city.

The autism centre is one of only a few places here that work with autistic children, in a country where no official statistics exist about the number of people with autism.

And that lack of resources for families with autistic children has some calling for more to be done in a country where stigma about the disorder remains high.

Seletay’s mother says many people here do not understand his behaviour, like throwing tantrums or running around—she says people often think he is spoiled. And she says it was hard for her to hear Seletay’s diagnosis.

“It just hit me like a tornado,” she says, “I was in denial, and for a long time we started going from place to place.  Somebody would say, let’s go see this pastor.  Let’s go to this church, and pray.”

Now, Pi-Bansa is emphasizing the activities that make Seletay happy—like jumping on trampolines, sight-seeing and swimming.  And she says she hopes one day, he will be able to enjoy another typical childhood experience—attending a properly resourced mainstream Ghanaian school.

“We all have rights,” she says, “If the government is providing [education] for the everyday child who goes to everyday school, I should also have, because I pay tax.”

It’s a fight Serwah Quaynor has also taken up. She runs the centre, which offers speech and language therapy, life skills training and functional academics.  About 40 students attend every day.

Though Quaynor opened the centre more than a decade ago, she says understanding about the disorder remains low.

“People are locking some of their children in because nobody wants to know,” says Quanor. “Even in families, people don’t want to be with you. Friends shun you . . . and you find yourself rather alone.”

Quaynor says the government needs to train teachers to help children with autism and also increase support in rural areas.

Dr. Ebenezer Badoe, one of Ghana’s leading experts on autism, also says more can be done. Parents need to band together he maintains, and start demanding more from government.

“We need to hear them time after time, putting pressure and then the resources will start to come,” he says.

The deputy director of the Ghana Education Service, Stephen Adu, told Ghana’s Citi FM that no specific programs exist in Ghana’s public schools for autistic students. Teachers refer cases to health specialists—but are often on their own in the classroom.

Back at the centre, Evelyne Pi-Bansa says she is already thinking about Seletay’s future.  She says she wants him to develop a skill—such as cooking, or IT expertise—and be independent. And she is optimistic about his future.

“We don’t have any doubts that he will be the best in his field, and we want that,” she says.

Yes they can: Obama Biscuits employs autistic adults in Accra

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Video and Text by Robin Pierro

Nortey Quaynor sits at his station in Accra’s United Biscuits factory. His hands move swiftly sealing bags of freshly baked cookies with Barack Obama’s face pressed into them. Large machines fill the warehouse with a deafening drone while the sweet aroma of fresh baking wafts in the air. Nortey remains undistracted by the hundreds of people working around him. It’s his seventh month at the biscuit factory and the other workers no longer look at him like he’s different.

Nortey has lived with autism for 28 years, and for the first time in his life, he has a job. He doesn’t know exactly who President Obama is, but he does understand that he has a task to do: seal biscuit packages. His caregiver, Abiku Grant, who works for the Autistic Awareness Care and Training Centre (AACT) in Accra, stands off to the side exhibiting a proud grin.

AACT is the only centre in Ghana that works specifically with autistic people, and the high demand for support only allows them to care for people up to 25 years old.

Grant says the training program at the biscuit factory was established to teach autistic people skills they can use to find work once they leave the centre. However, setting the program up wasn’t easy.

“There is so much stigma surrounding autism and disabilities in Ghana, people look at them and think that they are mad,” says Grant. “They don’t think they can be taught the skills to work.”

In light of April being autism awareness month, a conference was recently held in Accra to bring together the West African autism community for the first time.

Dr. Emmanuel Badoe, Director of the Neurology Developmental Clinic at the Korle Bu teaching hospital in Accra, was a presenter at the conference. He says there are no statistics on how many people have autism in West Africa and there are only a handful of professionals who work with developmental disorders in the region. Beyond that, he notes a lack of information for Ghanaian families about autism; many people don’t even know the disorder exists.

This lack of public awareness has made it difficult for people with autism to be accepted into regular society, let alone gain employment.

“This is a real way forward,” says Dr. Emmanuel Badoe, speaking about the work program. “People with disabilities need to be integrated back into society. This is a great thing for our country.”

Nortey was the first member of AACT to be placed in the biscuit factory, where six other autistic men and women are also employed. Nortey works in a spaghetti factory too, and AACT is hoping more companies open their doors to autistic workers.

Thorugh his work, Nortey is slowly changing the perception of autism in Ghana. When his mother, Serwah Quaynor, founded AACT it was out of a need that was not being filled by other facilities. She knew Nortey could not be the only one with autism in Ghana and opened the centre, but never expected to get to a point where her son could be employed.

“People are finally realizing what autism is,” says Quaynor. “Now the workers in the factories look at Nortey like he is a normal person.”

Nortey will continue to do his part in changing the public view towards people with autism, one Obama biscuit package at a time. Yes he can.

Alternative Medicine in Ghana Part Three: The Crime of Killing Yourself

Dr. Sammy Ohene, left, says people who attempt suicide should be treated in hospitals, not jails

As if being depressed to the point of trying to commit suicide isn’t bad enough, imagine being arrested and locked up for it.

Attempting suicide is illegal in Ghana according to Section 57 (2) of the 1960 Criminal Code, which classifies efforts to take one’s own life as a criminal offence. It’s a sanction that only aggravates the problems that lead patients to self-harm in the first place, according to Dr. Sammy Ohene, Head of Psychiatry at Ghana Medical School.

“The pressing issue should be dealing with your depression, not furthering your woes by prosecuting you for being ill,” he says. “I think it’s absolutely wrong. It shows a lack of understanding in the mechanisms behind suicide attempts.”

Dr. Ohene says he’s seen people imprisoned from six months to two years for trying to take their own lives. The stigma of imprisonment adds to the shame of attempting suicide in a country where it’s a taboo subject.

“They can even feel they deserve punishment,” says Dr. Ohene. “One thing you feel when you are depressed is guilt. It might worsen their symptoms or make them more likely to feel that there is indeed no hope for them.”

The law criminalizing attempted suicide was inherited from colonial British rule and Dr. Ohene feels the time has come to take if off the books. He’s one of several mental health professionals who make up the Network for Anti Suicide and Crisis Intervention, a group lobbying the Minister of the Interior to repeal the law.

Currently, however, the campaign faces challenges from traditional Ghanaian culture. Suicide is a dirty word in this country, to the point that it’s not used as a cause of death by coroners, who opt for the more palatable euphemism, “unnatural causes.”

Patients are often too ashamed to admit they have suicidal thoughts.
”They are even not very likely to talk about it with a doctor,” Dr. Ahene says. “You have to drag it out of them because they believe it’s totally wrong to even think about the subject.”

That makes it difficult for the medical community to know how grave the problem of suicide is in Ghana, but it appears serious. One study recently surveyed 4,500 students in three Accra secondary schools. It found that one third of the students have considered suicide as a way to escape their problems.

Dr. Ohene was surprised by the results.
”I didn’t imagine that for so many people, this was a considered option,” he says.

The treatment of mental diseases in Ghana is decades behind that of the developed world, which treats it as a mental health issue, not a criminal one. Ghana’s justice system has been slow to realize that people with mental health problems need treatment, not jail time.

Dr. Ohene and his colleagues are pushing to update Ghana’s laws to bring them closer to a modern understanding of suicide and mental illness in general.

“That’s a world of difference between treatment and going to jail for being ill,” he says. “I think it’s completely uncivilized that if someone is ill, we should punish them.”

Alternative Medicine in Ghana Part One: Sorcery versus Psychiatry

The mentally ill are often chained up in Ghana, like this woman suffering from depression

A young woman stands with her left foot chained to a tree in rural Ghana. Her wrap-around traditional cloth hangs loosely at her hips, and her breasts are exposed.

“Cover yourself,” Atete Atempon yells at the girl I’m now staring at.

The woman smiles a doped-up smile as two servants rush to unchain her. They know I’m quizzically wondering why she’s tied up and how she got there. They work hard to unshackle her so they can shoo her away before I start asking questions.

“She is not well,” says Atempon, as he orbits his hand around his ear to imply she’s lost her mind. Atempon is an herbalist at the prayer camp where the woman is being treated.

Finally, she is covered up, unchained and led away screaming.

In Ghana, schizophrenia, bipolar disorder and depression are conditions rarely diagnosed. What is diagnosed, however, is the condition of being possessed by evil spirits. The belief in witchcraft and spiritualism is very much alive here. For someone to simply be mentally ill is not. As a result, most mentally ill end up in prayer camps such as this instead of receiving psychiatric care.

As treatment on the camps, they’re often given herbal mixtures or physically beaten until the demon is believed to have left the body. Or, they’re left secluded under a mango tree for weeks, as is the case with this nameless woman.

Her family left her here because she began exhibiting strange behavior after her former boyfriend reneged on his promise to marry her. What might be cured in Canada with a vat of ice cream, a session with a shrink or an anti-anxiety pill is treated a little differently in Suhulm, Ghana, where patients are chained up or fed herbal remedies until they’re no longer possessed—or broken-hearted.

As resident herbalist, Atempon treats patients with his special concoctions. He offers to show me his workspace and I eagerly agree. We cross the threshold of his laboratory of blood-red oils, leafy soups and bottles of herb-infused moonshine, to be ingested by or smeared on patients, and I ask him if he has a background in mental health.

“I know how to cure anything,” he says, averting the question. He tells me he not only cures AIDS, but also makes the insane sane. He looks at the tree where the woman was shackled. “In two weeks, the girl that was there will be fine.” His claims are lofty, but Atempon’s Ralph Lauren shirt and stacked gold rings tell me people pay him big for his work.

Dr. Akwasi Osei, chief psychiatrist at the Accra Psychiatric Hospital, has a different approach to mental illness. He believes in mainstream psychiatry that assesses a person’s mental state and considers any contributing social factors to their condition before suggesting treatment. According to Osei, about 2.4 million Ghanaians are living with mental illness, many of whom suffer quietly on the peripheries of society, in fringe communities like Suhulm.

Spiritual churches, prayer camps and other unorthodox institutions treating the mentally ill are rampant in Ghana. It’s a cheaper option than going to the hospital, and often the only option for most families who make less than $1.50 (CDN) a day. Dr. Osei laments that he and the World Health Organization, which also supports mainstream care, face a barrage of opposing views from the public in their battle to erase the stigma attached to mental illness.

But how do you convince an entire society that someone is not possessed but instead depressed, suffers from a chemical imbalance or simply has a case of the breakup blues in a country where a belief in witchcraft is so deeply engrained?

One way might be through legislation. In 2006, the Disability Bill was passed in Ghana to prevent mistreatment of the mentally ill, but abuses still abound and proper care remains widely unavailable. As it stands, Dr. Osei says only two per cent of people suffering from mental illness have access to adequate treatment.

There are a meager nine practising psychiatrists in all of Ghana, and they are stifled when it comes to reaching even half of all cases. What’s more, many are discouraged from becoming practising psychiatrists, according to Dr. Osei, because their peers believe gods and spirits rule the psyche of a person. Chemical imbalances seems obtuse to many in a country where the mental state of the individual is often put down to sorcery, not psychiatry.

That’s why this girl is chained to a mango tree. Patients waiting to see Atempon barely blink an eye at the chained insane. There is an undercurrent of acceptance; people in the waiting area sit like an audience ready to applaud at the wonder of the herbalist — seemingly making it a Gordian-knot of a problem to solve.

As I leave the compound, I hear the girl screaming as she is doused with cold water and barked at by her two keepers.

Atempon waves goodbye as his gold rings catch the sun and blind my gaze.