Global and National Statistics on Mental Health
It is estimated that worldwide, mental health disorders account for 14 % of the ‘Burden of Diseases’. This is according to the International Journal of Mental Health Systems (IJMHS). In Ghana, the prevalence of mental health disorders is about 13 % of the adult population. The Mental Health Society of Ghana (MEHSOG) puts the figure at one (1) in every five (5) Ghanaians with a mental health disorder.
Clearer picture of Mental Health in Ghana
Founder of Imagine Ghana, Essie Quakyi, in a paper titled ‘Unspoken and Unheard: Mental Health in Ghana, 2017’ observed that “mental health is a seldom-discussed topic in Ghanaian culture. It makes people uncomfortable. When mental illness is talked about, the conversation is lacking in ways that raise awareness, foster advocacy and lead to meaningful change. Even government spending on mental health reflects the priority attached to the issue, with a mere 1.4 percent of the total health budget allocated to mental health. Isolated, understaffed, and poorly-maintained psychiatric facilities is the only picture of mental health that most are familiar with in Ghana.”
Mental Health in the Upper West Region
In the Upper West Region, the situation is not any different. While the situation with the number of Mental Health Officers may have marginally improved over the past few years, the numbers still do little to address the ever so present mental health needs of the close to a million Ghanaians residents in the region. Mental Health Officers are stretched thin across all 11 Municipalities and Districts in Upper West.
Living in chains for 20 years
More than two decades ago in a relatively small community called Owlo in the then Nadowli District (now the Daffiama-Bussie-Issa District) of the Upper West Region, the lives of Madam Augustina Mgaadaa and her family of 6 (excluding the husband) were about to take a dramatic turn; which they least expected and yet one that will impact them for the rest of their lives.
When Madam Mgaadaa’s first son, Agoroo Mgaadaa, began exhibiting ‘strange’ behaviour, the family attributed it to youthful exuberance. As time passed, Agoroo became increasingly violent and unstable. The family not knowing how to handle the situation began locking Agoroo in the room. This was so that he would not cause problems for the family when he left home. Eventually, under the unwilling and yet watchful eyes of the matriarch of the house, Augustina Mgaadaa, her first son had to be put in chains in an attempt to subdue him and the ever-growing violence.
Sometime after putting Agoroo in chains, a Mental Health Officer, more than a decade ago, in a community visit learnt about Agoroo and began working with the family to restore Agoroo’s health and reintegrate him into society. According to Madam Augustina Mgaadaa, it was not long when the Mental Health Officer (whose name has been long forgotten) told the family that the situation would be better handled at either the Pantang Psychiatric Hospital in the Greater Accra Region or the Ankaful Psychiatric Hospital in the Central Region. The cost of transportation, feeding and the possible medical costs involved deterred the family, who only depended on subsistence farming to survive, from giving Agooro the medical attention he desperately needed.
The family began to feel the burden: feeding went from thrice a day to twice and then down to once and then eventually none at all for days. No more baths, no more clean clothes and the room he was chained in became less and less sanitary. To quell the hunger because of the neglect, Agooro eventually began digging up dirt, mixed with faeces to eat.
Agooro’s younger brother John Disaaba recalled that so much money and time was spent on Agooro that he had to eventually drop out of school at age 6. Essentially, he became the man of the house at an early age because of the death of his father, the waning strength of his mother, the incapacity of his older brother and the inability of the extended family to support him.
Agooro’s situation could be described as extremely inhumane. In 2019, during community visits by Mental Health Officers, attention was drawn to Agooro’s plight by Community Health Volunteers.
Together with the family, and the Centre for Empowerment and People’s Right Initiatives (CPRI), Agooro’s meetings with the Mental Health Officers became frequent. Agooro’s chains were cut off, three (3) square meals were provided by the family under strict supervision from the Mental Health Officers. Agooro, while still restricted in movement, would now receive cleaner clothes, regular visits from the family and more sanitary materials to keep him clean.
With a careful medical regimen and continuous counseling, Agooro has now become a part of his family, no more chains. For Augustina Mgaadaa and John Dissaba, the reintegration of their son and brother into society is very refreshing and marks “a clean start and hope for the future”.
Today, they have become advocates for mental health, sharing their story to any and everyone who will listen.
Other stories from DBI
The story of Agooro Mgaadaa is only one of the many people who have suffered inhumane treatment due to their mental health conditions. Luise Banoe-Mulee recounted to GBC’s Mark Smith that after his Junior High School Education, the family had no funds to further his education. He thus had two options: to stay in Daffiama to farm or head south to engage in a more profitable ‘Galamsey’ (illegal mining).
Mr. Banoe-Mulee recalls that due to the extremely physical nature of the job at hand, he resorted to alcohol to calm his nerves, the use of marijuana to make him energetic, and the use of many other illicit drugs to help him focus and maintain the strength to work and make money. After months of using these drugs, sleep began to elude him. The hallucinations also started. His friends returned him to Daffiama.
Back home, Mr. Banoe-Mulee also had to be chained for three (3) years.
He, like Agooro Mgaadaa, was spotted during community visits to the area.
Many months after, Mr Banoe-Mulee no longer smokes or drinks, he no longer uses any illicit substances and engages in farming.
Mental Health Officer’s Perspective
The Mental Health Focal Person for the Daffiama-Bussie-Issa District, Anacetus Banakoma, said Agooro Mgaadaa was diagnosed with Schizophrenia while Luise Banoe-Mulee was diagnosed with Substance Use Disorder. He explained that both of these situations could be managed easily through the use of drugs, regular counseling and family support.
He explained that while Mr Banoe-Mulee has recovered fully and attends to his daily farming activities without any help or assistance, Agooro Mgaadaa still needs a little help every now and then to be able to function properly. At the time of GBC’s visit, Agooro refused to interact with the news team. The Mental Health Focal Person explained that this could be due to the presence of the news team and the equipment.
Mr Anacetus Banakomas said as an outfit, they have enhanced the community visits to ensure that the many others who have mental health challenges and have been locked away would be treated and reintegrated into society. He observed that the involvement of family in the treatment of persons with mental health disorders is key. “This is because if these persons who are recovering do not receive support, they would relapse.”
What the DBI Health Directorate is doing
According to the DBI District Director of Health, Emmanuel Sanwouk, mental health treatment has become more accessible to the people of the area. The Health Directorate now has 5 Community Mental Health Officers along with 4 Clinical Nurses in all 4 Health Centres and the District Polyclinic who help to diagnose Mental Health Conditions.
Mr Sanwouk explained that the major success of the DBI District Directorate of Health is that through innovation, Mental Health treatment has moved from the offices of the Health Directorate into the homes of the community residents. He says while his outfit is doing the best they can; there are still cases of stigmatisation.
Prescription of Drugs used for treatment of Mental Health Conditions
The DBI District Director of Health, Emmanuel Sanwouk, acknowledges that while counseling plays an integral part in the treatment of persons with Mental Health Conditions, psychotropic drugs are key to the rehabilitation of persons with mental health, but there is challenge. Mr Sanwouk explained that due to the accreditation levels of the CHPS Compounds and Health Centers, caregivers in these facilities, although qualified, are unable to prescribe drugs under the National Health Insurance Scheme (NHIS) for the treatment of clients because they would not be reimbursed.
This means that for drugs under the NHIS, clients would have to travel far distances to visit the only Polyclinic in the District to access them.
The CPRI intervention
Under the Centre for Empowerment and People’s Right Initiative’s (CPRI), Maternal Mental Health Project, 364 people across the Upper West Region have been treated for various Mental Health conditions. In the DBI District, 42 people have been treated for a number of Mental Health conditions and given some livelihood support.
A Programme Officer with CPRI, Dominic Wunigura, explained that after treatment, the beneficiaries are given between ¢500 to ¢1,000 to start businesses of their own. These businesses range from animal rearing, crop production, trading among others.
Impact
Mr Wunigura explained that due to the economic empowerment of such persons, stigma has reduced. He said before treatment, persons with Mental Health conditions are not valued but once they are treated and are able to begin to contribute to the economic wellbeing of their families, society recognises them as people with value.
“They are able to buy certain things for themselves. They are no longer burdens on other people. For example, being able to buy soap to keep themselves clean, being able to acquire medication. After the support, some beneficiaries are able to pay the school fees of their children through the businesses that they do,” he explained.
Beneficiary at Bussie
One of the beneficiaries of CPRI’s Livelihood Empowerment Program is Madam Justina Dapilah. Madam Dapilah was diagnosed with Seizure Disorder. Before undergoing treatment, she used to be indoors all the time with little contact with her community. Months after treatment and with immense support from her husband, Madam Dapilah was supported by CPRI and now runs a profitable grain business at the Bussie Market.
Her husband, Louis Dapilah, speaking to GBC’s Mark Smith was grateful for the support from CPRI. He said now because of the wife’s income, the financial situation of the family of six has improved tremendously.
Conclusion
Government must do well to streamline and improve access to Mental Health whilst making sure that the needed medicines are readily available for treatment irrespective of one’s geographical location.
Story filed by Mark Smith.
