Mental Health in Ghana: What We Should Do With What We Know
by Ernest Armah
Globally, 700 million people are estimated to have a mental disorder and over a billion are likely to experience one in their lifetime, including 80% from low and middle income countries. An estimated 3.2 million Ghanaians are likely to experience mental disorder at a point in time.  These are worrying statistics especially for low and middle income countries like Ghana where the health system within which mental health is situated, is reactive.
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.  Currently, there are only three public psychiatric hospitals (Accra, Pantang and Ankaful), five privately operated ones and about five Psychiatrists to a population of approximately 25 million. Besides that, the Psychiatric hospitals are incapacitated to handle enormous cognitive and psycho-social disability cases across the country; significant under-investment, medication and requisite logistics are inadequate coupled with frequent strikes by Psychiatric Nurses due to unpaid salaries and other work benefits.
Considering what we now know, what should we do? Already there has been a remarkable impact on the ground through a 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. This is a results-based, highly effective intervention working within a curative paradigm. How about a preventive, cost-effective intervention?
Fig.1: Depression was the leading mental disorder in Accra in 2010. To a large extent, this disorder can be prevented through self-help groups, effective coping mechanisms and proper life adjustments
Somewhere in March 2015, a team of young professionals including myself in Ghana, UK and US including Psychiatric personnel from the Korle-Bu Teaching and Pantang hospitals organized a first-order, mental health intervention programme at a rural community in the Ga East district of Accra, to help people utilize their internal resources to make appropriate life adjustments in the face of stressors and also, to identify severe cases which require referral to mental health specialists. The extent to which mental health awareness and preventative mental health care have been reduced in importance in the Ghanaian setting was what moved us, in a rather significant way, to act. Not all of us are aware of our mental health needs and not all of us can afford treatment if diagnosed with a debilitating mental illness like clinical depression which often results in suicide.
The Government of India 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 Organization (2014). The Indian government decriminalize the act of suicide, ‘with the aim of improving possibilities for discussion and intervention around suicidality’. Suicide is criminal in Ghana. Act 29, Section 57 of Ghana’s criminal code states that “whoever attempts to commit suicide shall be guilty of misdemeanor”. 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.  Due to prevailing stigma of mental illness, people hardly report and that partly explains the statistic. But the overriding point is that we should not wait until suicide rates go through the roof before doing what needs to be done.
The economic and social burden of mental illness can be lighten through among others, the scaling up of interventions driving big impact like the PPP programme between the Ministry of Health and BasicNeeds and inclusion of mental health awareness and education into other health promotional activities. At the micro level, youth groups, religious organizations and other associations can make use of available life adjustment skills and mental health tools. To get the mental health system right in Ghana, we all have to get on board.
Victoria de Menil. (2015). Missed Opportunities in Global Health: Identifying New Strategies to Improve Mental Health in LMICs. CGD Policy Paper 068. Washington DC: Center for Global Development.
Human Rights Watch. (2014). NGO appeals to government to prioritize mental health service. Ghana News Agency, March 5, 2014.
Nkrumah, K. Dark Days in Ghana.
Quarshie, N., Osafo, J., Akotia, C., & Peprah, J. (2015). Adolescent suicide in Ghana: a content analysis of media reports. Accra: Department of Psychology, University of Ghana, Legon.
 Patel & Saxena (2014); De Silva & Roland (2014) cited in Victoria de Menil. 2015 “Missed Opportunities in Global Health: Identifying New Strategies to Improve Mental Health in LMICs”. CGD Policy Paper 068. Washington DC: Center for Global Development
 Human Rights Watch (2014); NGO appeals to government to prioritize mental health service. Ghana News Agency, March 5, 2014;
 Dark Days in Ghana by Dr Kwame Nkrumah
 Nii-Boye Quarshie, Osafo J, Akotia C & Peprah J. ( ). Adolescent Suicide in Ghana: A content analysis of media reports. Accra: Department of Psychology, University of Ghana, Legon.