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New Mental Health Act, Set to Fail?

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The passage of the Mental Health Act in 2012 was an important milestone for Ghana’s mental health

system, considering the system’s “lunatic” history. In the ensuing paragraphs, this article offers a

brief narrative about the history of mental health in Ghana, highlights certain important legislative

issues which needs to be addressed and discusses why the implementation of the Mental Health Act

will be an additional burden to an overwhelmed mental health system.

History of Mental Health in Ghana

Attempts to regulate mental health in Ghana date back to the latter part of the 19th Century. In

1888, the Lunatic Asylum Ordinance (LAO) was enacted under the governorship of Sir Griffith

Edwards. This ordinance was rather draconian, as it labelled the mentally ill “insane” and ensured

their arrest and imprisonment. Such was the zeal and fervour to carry out the provisions of the

Ordinance that by the close of the century, the special prison in which the mentally ill were reposed,

had become congested. This called for the construction of a “lunatic asylum” in 1906. This asylum is

the present Accra Psychiatric Hospital.

In 1951, the Accra Psychiatric Hospital had its first Psychiatrist in the person of Dr. E.F.B Foster, a

native of Gambia. He continued reforms undertaken by his predecessors Dr Maclagan (1929-1946)

and Dr. Wozniak (1947-1950) and furthered steps to eradicate the prevailing injustice and make the

facility more humane. He transformed the “lunatic asylum” into a hospital. Indeed, this semantic

transformation was an imperative response to the equity and justice question: if mental illness is just

like any other illness, then why should the mentally ill be treated differently from the others? Under

the leadership of Dr. Foster, more Doctors and Nurses were trained in addition to other initiatives to

improve the hospital. The Accra Psychiatric Hospital was the only established Psychiatric facility in

West Africa in the early 50s. Two additional psychiatric hospitals were built in 1950 and 1970

respectively.

After Ghana’s independence in 1957, part of a comprehensive plan for the health sector was the

construction of five new mental health hospitals supported by Psychiatric units to accommodate

about 1,000 people. At the time, Ghana’s population was below eight million.

The ordinance still remained enforceable until the enactment of the Mental Health Act 1972 (NRCD

30), which focused on institutional care taking into account the patient, the property of the patient

and voluntary treatment.In 1983, under the Provisional National Defense Council’s (PNDC) regime,

improvement of psychiatric services especially at the Accra Psychiatric Hospital became a concern. A

committee which was formed in this regard, saw the need to integrate mental health within the

larger health sector. Their recommendation led to the creation of a Mental Health Unit within the

Ministry of Health.

Currently, there are only three Public Psychiatric Hospitals (Accra, Pantang and Ankaful) in the

country, all located in the Southern part of the country with 1200 beds altogether. There are about

six privately operated ones. From 1957 to date, 59 years and counting, the strategic vision for five

new mental health hospitals is yet to be realised.

Challenges with the mental health law (Infograph by Odekro.org)

Mental Health Legislation: Inconsistencies and Illogicalities

In 2004, the mental health bill (now an Act) was introduced in Parliament. The bill took into account

modern trends, standards and best practices and also made provisions for the regulation of public

and private mental health facilities in the country. The bill spent eight (8) years on the shelves of

Parliament before being passed into law. Below are some legislative issues before and after the

passage of the bill into law:

Though the 1992 Constitution of Ghana, article 15, paragraph 2 states that

“no person shall…be subjected to

(a) torture or other cruel, inhuman or degrading treatment or punishment,

(b) any other condition that detracts or is likely to detract from his dignity and worth as a human

being,”

We have not yet included the offense of torture, as defined in article 1 of the Convention against

Torture and other Cruel, Inhuman or Degrading Treatment or Punishment, in our Criminal Code,

1960 (Act 29). Denial of adequate food, shackling to trees or metal objects and arbitrary flogging are

some of the cruel, daily experiences of some mentally ill persons. These practices are tantamount to

torture.

Human Rights Watch, in its 2012 report, “Like a Death: Abuses against Persons with Mental

Disabilities in Ghana” found that persons with mental disabilities in Ghana often experience a range

of human rights abuses in some prayer camps and hospitals. These patients are ostensibly sent to

these institutions by their family members, police, or their communities for help. Abuse takes place

despite the fact that Ghana has ratified a number of international human rights treaties, including

the Convention on the Rights of Persons with Disabilities (CRPD), which was ratified in July 2012. The

abuse includes denial of food and medicine, inadequate shelter, involuntary medical treatment, and

physical abuse amounting to cruel, inhuman and degrading treatment. The findings by Human Rights

Watch were similar to an earlier graphic narration of human rights abuse at the Accra Psychiatric

hospital by Anas Aremeyaw Anas.

The Mental Health Act provides for the establishment of a Mental Health Tribunal to oversee,

among others, human rights violations. However, implementation of this Tribunal is still in the

pipeline. For this Tribunal to function effectively we must train Health Lawyers to help interpret,

advocate and enforce the Mental Health Act, and to protect patients’ rights. But according to Doku,

Wusu-Takyi and Awakame (2012), "the law faculties of the University of Ghana and Kwame Nkrumah

University of Science and Technology, do not offer elective courses of study in Health law hence

lawyers trained in Ghana qualify without exposure to health law training, let alone mental health

law”. So the threat of non-fulfilment of the mandate of the Tribunal or breach of patients’ rights is

real.

Our Criminal Code, 1960 (Act 29) criminalises suicide. Section 57 of Ghana’s Criminal Codes states

that, “whoever attempts to commit suicide shall be guilty of misdemeanour”, making suicide and

corruption “criminal mates”. Meanwhile, a content analysis of media reports on adolescent suicide

in Ghana showed that from January 2001 through September 2014, a total of 44 adolescent suicides

were reported; 40 cases were completed suicide and four were attempted suicides. Barely three

months ago, a Police Officer in uniform, who is supposed to know the laws of the land better,

committed suicide after killing his mother-in- law and two children. If the criminalisation of suicide

serves to deter people from attempting the act, then it needs a second look; because suicide is the

product of clinical depression and destructive thinking.

In other jurisdictions, the illogicality inherent in the criminalisation of suicide has been recognised

and appropriate steps have been taken. For example, The Indian Government was moved to take

steps to reform its national health policy when the country’s suicide rate hit 258,000; the highest

number of deaths by suicide globally according to the World Health Organisation (2014). The Indian

Government decriminalise the act of suicide, ‘with the aim of improving possibilities for discussion

and intervention around suicidality’.

Another Burden?

There are fears that the aforementioned legislative issues will add to the catalogue of existing

burdens our mental health system is carrying. Already, 3.2 million Ghanaians are estimated to have

mental disabilities (disorders); 650,000 are reckoned to have severe mental disabilities. For the

treatment of both mild and severe mental disabilities, the country has 600 (demoralised and poorly

paid) severe mental disabilities. For the treatment of both mild and severe mental disabilities, the

country has 600 (demoralised and poorly paid) Psychiatric Nurses and 12 practicing Psychiatrists; all

contained in three under-funded Public Psychiatric Hospitals (all located in the Southern part of the

country).

Though the Mental Health Act seeks an orderly resolution of these heavy burdens, it is unlikely that

it will achieve this in the foreseeable future. Unless there is flexibility and innovation in our approach

toward mental health issues . A notable example is the Public-Private Partnership (PPP) between the

Ghana Health Service and BasicNeeds Ghana. Using the mental health and development model, this

partnership has made mental health care accessible; providing medicines and counselling in primary

care settings (homes) to 43,312 people with mental disorders and epilepsy in the Northern parts of

the country and, delivering economic opportunities to families affected by mental illness through

253 self-help groups.

Conclusion

In principle, the Mental Health Act is an essential document which keeps pace with modern

developments in the delivery of mental health services, protects the human rights of mentally ill

persons and ensures orderly conduct of public and private mental health facilities. But the reality is

that, to date, we have ‘mad persons’, male and female, roaming the streets of Ghana naked. Instead

of the proper treatment and rehabilitation of these persons, we have a Criminal Code which fails to

overtly prohibit all manner of torture against the mentally ill but puts them among tycoons of

corruption; and an educational system which cannot nurture Specialised Lawyers to serve as

advocates for their human rights.

Author of article: Ernest Armah is a Social Policy Researcher with passion for service, driving positive results and creating opportunities.

Email: ernestarmah18@gmail.com

References:

Doku, V.C.K., Wusu-Takyi, A., & Awakame J. (2012). Implementing the Mental Health Act in Ghana:

Any Challenges Ahead? Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645169/

Ewusi-Mensah, I. (2001). Post Colonial Psychiatric care in Ghana.

Human Rights Watch. (2012). “Like a Death Sentence”- Abuses against Persons with Mental

Disabilities in Ghana. Retrieved from: https://www.hrw.org/report/2012/10/02/death-

sentence/abuses-against- persons-mental- disabilities-ghana

Mental Health Profile (Ghana).2003.

Nyarko, R. K. (2016). Stop chaining, flogging mental health patients – Mental Health Society.

Retrieved from: http://www.myjoyonline.com/lifestyle/2016/July-25th/stop- chaining-flogging-

mental-health- patients-mental- health-society.php

 

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