By Jeremiah Nutsugah
Mental health remains a significant yet often overlooked issue across Africa, and Ghana is no exception.
Despite growing awareness of mental health challenges, many African nations, including Ghana, continue to face severe obstacles in providing adequate care for individuals suffering from mental health disorders.
In Ghana, the situation is particularly dire, with countless people living with mental health conditions left to roam the streets of the capital, Accra, without access to proper care.
A growing concern on the streets of Accra
The streets of Accra have become home to many mentally ill individuals who face extreme hardship and neglect.
These individuals, some of whom are seen wandering stark naked, often drink from gutters, eat from rubbish dumps, and carry bags filled with waste.
These people are among the most vulnerable members of society, yet the country’s mental health system is profoundly inadequate to address their needs.
Picture credit: (Jeremiah Nutsugah) Mentally ill patient sleeping under the overhead bridge at Kwame Nkrumah Circle
The growing number of mentally ill people in the streets not only highlights the gaps in mental health care but also raises significant public safety concerns.
On October 10, 2023, the Mental Health Authority launched a project to remove over 6,000 individuals with mental health illnesses from the streets of Accra—the project aimed to provide these individuals with much-needed healthcare.
During the launch, Professor Pinaman Appau, the CEO of the Mental Health Authority, emphasized that mental health should be recognized as a universal human right, underscoring the need for the government to take action.
Picture credit: (Myjoyonline) Professor Pinaman Appau, the CEO of the Mental Health Authority.
She said, “Mental health as a universal human right recognizes that mental health is not a luxury but a fundamental right that needs to be protected and promoted for the betterment of individuals and societies.”
However, the situation is not without its consequences. The growing number of untreated mentally ill individuals on the streets has led to several incidents of violence.
In 2019, a report by GhanaWeb stated that a “ mad man” gruesomely murdered a 59-year-old property owner at Tunga near Dansoman in Ablekuma West in the Greater Accra Region.
Also, in August 2022, a ‘Mad Woman’ stoned a man to death at Kwame Nkrumah Circle.
This rising insecurity tarnishes the nation’s reputation and could deter foreign investment, making it clear that mental health must become a priority.
Underdeveloped infrastructure and limited access
To understand the full extent of this crisis, it is essential to examine the state of Ghana’s mental health infrastructure.
The country currently has only three psychiatric hospitals, Accra Psychiatric Hospital, Ankaful Psychiatric Hospital, and Pantang Hospital, serving a population of over 30 million.
These hospitals collectively provide just 1,171 beds, approximately 3.8 beds per 100,000 people.
According to the World Health Organization (WHO), this is far below what is needed to address the country’s mental health needs.
Even with these facilities in place, long-term care remains a critical issue. Many patients stay for years without proper support, leaving them vulnerable to neglect.
Mental health patients admitted to hospitals in Ghana primarily fall into three diagnostic groups: mental and behavioral disorders due to substance use (42%), schizophrenia (34%), and mood disorders (16%), according to the World Health Organization’s report on the mental health system in Ghana, 2020.
WHO estimates that approximately 13% of Ghana’s population suffers from some form of mental illness, with 3% experiencing severe disorders and the other 10% suffering from a moderate to mild mental disorder (WHO, 2007).
However, the lack of adequate mental health infrastructure leaves many individuals without care.
WHO has also highlighted that mental health services in Ghana are underfunded and not prioritized, which makes it difficult for many families to access even the most basic treatment.
Historically, the Government of Ghana has paid little attention to mental health care, leading to the collapse of services in the country’s psychiatric hospitals.
According to WHO, only 2.8% of Ghanaians suffering from mental illnesses have access to treatment, primarily due to a lack of specialized services.
Furthermore, the country faces a severe shortage of trained healthcare professionals, with only one psychiatrist for every 1.5 million people, a ratio far below the WHO’s recommended standard.
In response to these challenges, the Ghana government introduced the Ghana Mental Health Act in 2012.
However, despite this legislation, the mental health sector remains underfunded and largely ignored. As a result, the existing infrastructure remains inadequate, and individuals with mental disorders continue to suffer.
The Mental Health Act of 2012: A step forward, but still insufficient
The Mental-Health-Act-846-2012.pdf was a step toward modernizing mental health care in Ghana.
This new Act, which was drafted between 2004 and 2006 with the help of WHO experts and consultants from various countries, received presidential assent in May 2012 and became law on December 1, 2012.
The law aimed to improve access to care for people with mental illness, including epilepsy, and to safeguard human rights.
It also emphasized the integration and regulation of spiritual and traditional mental health practices in Ghana while promoting community care over institutionalization.
Despite the progressive nature of the Act, it has not significantly improved the situation. Epilepsy, although classified as a neurological disorder rather than a mental disorder, is treated by psychiatrists in Ghana due to local belief systems and stigma.
Additionally, the lack of funding and the continued neglect of mental health services have hindered the Act’s implementation.
While the law envisions decentralizing mental health care and placing more emphasis on community care, these goals remain largely unmet due to the underfunding of mental health services.
Insights from a Mental Health Practitioner
Picture credit: (The Vaultz News) Executive Director of BSK Health Advocacy Foundation, Mr Bismark Kwabla Kpobi
To gain a deeper understanding of the challenges faced by those working in the mental health field, we spoke to the Executive Director of BSK Health Advocacy Foundation, Mr Bismark Kwabla Kpobi, who also doubles as a Senior registered Mental Nurse Health Advocate from the Ghana Health Service.
Mr. Bismark spoke about various conditions of mental health in the country, noting that schizophrenia, followed by depression, mania, and epilepsy, are some of the most common conditions.
“Mental health conditions, some are schizophrenia, which is followed by depression, mania, and also epilepsy. They are not disorganized but stay at home,” he explained.
He also highlighted that stress and substance abuse are major causative factors of mental health disorders in the country.
When asked about the infrastructure in Accra, the practitioner emphasized the inadequacies of the existing mental health facilities.
“The mental health infrastructure is not enough. We have three mental health hospitals in Ghana, but two are located in Accra. While they are good in terms of infrastructure, they are old, and renovation has not significantly improved due to a lack of funding for mental health activities,” he stated.
He further stressed the need for improvement, calling for modernized structures to augment the existing ones.
“We need improvement and additional modernized structures that will augment the already existing ones,” he added.
He also urged both the government and individuals to allocate sufficient funding for mental health services, which would allow the Health Mental Health Authority to address these challenges more effectively.
“There should be mental health education, and although mental health services are running many campaigns, I think this should be more intense,” he emphasized.
The public expresses concern:
The public has expressed concern about mentally ill individuals roaming the streets of Accra.
They have, therefore, called for their evacuation and confinement at the appropriate places, like psychiatric hospitals.
Their concerns stem, for instance, from the fact that mentally ill patients have taken over some pavements and streets in the Accra metropolis, causing a nuisance to the commuting public and posing a security threat.
“These people, both young and old, use cardboard, papers, and filthy cloths as mats to sleep wherever they choose, such as the pavements and by the street,” the members of the public complained.
Derrick Sarpong, a 34-year-old driver, shared his thoughts: “They are becoming many, and the government must find a place to care for them.”
Similarly, Ma Gifty, a resident of Abeka, recounted her experience with a cousin who disappeared for five days, only to be found wandering the streets of Dansoman suffering from mental health issues.
“My cousin was very addicted to drugs, which were not good for his mental health. We advised him on several occasions, but he did not listen, and it became worse. We kept him indoors, but one morning, he was nowhere to be found. We later found him on the streets of Dansoman.”
“I think the government should do more and take people like him to Pantang Hospital,” she said.
Others, like a young man who was attacked by a mentally ill woman on the streets, highlighted the public safety risks posed by untreated mental illness.
“On my way from work one evening, a mad woman came at me with a stick and started chasing me. It was some worse experience, and if not for the residents who came to my rescue, I wouldn’t know what would have happened.”
“I call on the government to tackle this; the government should pay necessary attention to this growing trend of mental patients roaming the streets of Accra and provide adequate funds and build the necessary infrastructure, ” he recalled.
A commuter, Sarah Narh, who works in the North Industrial Area, said such people posed a danger to workers, especially those who go to work at night.
“Seeing them at lonely places at night puts fear in me as I don’t know when they will attack me. Sometimes, they attack and beat up people on sight,” she added.
Historical Neglect and Social Stigma
Historically, mental health care in Ghana has been marginalized.
During the colonial era, those with mental health issues were treated as criminals, with the Victorian Asylum in Accra being one of the first institutions to address the issue.
Unfortunately, conditions have not improved significantly since then. Individuals with mental disorders were often hidden away, subjected to harsh treatment, or sent to spiritual camps where they faced further abuse.
In many Ghanaian communities, mental illness is still viewed as a spiritual issue, leading to further neglect and isolation.
Even in psychiatric hospitals, patients often endure mistreatment, including inadequate food, poor medication, and physical abuse, compounding the country’s mental health crisis.
The path forward: Reforming Mental Health Care in Ghana
Ghana’s mental health system is in urgent need of reform. Addressing the care of mentally ill individuals, particularly those left on the streets of Accra, requires a multi-faceted approach.
Improvements in infrastructure, better allocation of resources, and enhanced training for healthcare professionals are essential.
Furthermore, it is crucial to reduce the stigma surrounding mental health through national conversations, encouraging societal acceptance, and empowering individuals to seek care.
Without immediate reforms, thousands of vulnerable individuals will continue to be neglected, and the mental health crisis in Ghana will worsen.
Ghana must act now to provide better care for those suffering from mental illnesses, ensuring that no one is left abandoned on the streets of Accra.
