Ghana is a country with an approximate area of 239 thousand sq. km. (UNO, 2001). Its population is 21.377 million, and the sex ratio (men per hundred women) is 99 (UNO, 2004). The proportion of population under the age of 15 years is 39% (UNO, 2004), and the proportion of population above the age of 60 years is 5% (WHO, 2004). The literacy rate is 81.9% for men and 65.9% for women (UNESCO/MoH, 2004).
The country is a low income group country (based on World Bank 2004 criteria). The proportion of health budget to GDP is 4.7%. The per capita total expenditure on health is 60 international $, and the per capita government expenditure on health is 36 international $ (WHO, 2004). The main language(s) used in the country is (are) English. The largest ethnic group(s) is (are) African. The largest religious group(s) is (are) Christian, and the other religious group(s) are (is) indigenous groups and Muslim. The life expectancy at birth is 56.3 years for males and 58.8 years for females (WHO, 2004). The healthy life expectancy at birth is 49 years for males and 50 years for females (WHO, 2004).
Affinnih (1999) found that heroin and cocaine were the common drugs of abuse in a sample of 117 current and former drug users. The typical drug user was a 30-year old, who belonged to the working or lower socioeconomic class. Petty theft was common among male drug users. Community-based studies on chronic psychosis (Field, 1968) and schizophrenia (Sikanartey & Eaton, 1984) are also available. Turkson and colleagues have published a series of studies on psychiatric outpatients. In a sample of 131 depressed female outpatients, Turkson and Dua (1996) reported that the majority of patients were in the 20-40 years age group, were married with 5-8 children but with poor financial support from husbands and had limited education or employment opportunities. They often presented with somatic symptoms like headache and insomnia. Social stress was one of the causes for onset of depression. Turkson (1996) reviewed 7-year (1987-94) outpatient data on adolescents (n=454). Results indicated that only 59.3% had a psychiatric illness. In the subgroup with psychiatric disorders (n= 269), 32.7% had functional psychoses (more than half of these were depression), neurotic disorders (23.4%), personality disorders (20.4%) and organic psychosis (10%) were the other common disorders. Turkson and Asamoah (1997) did a retrospective assessment of 35 elderly (more than 60 years) outpatients seen between 1989-93. The commonest presentations were depression, dementia and paranoid disorders. Dementia was associated with the history of alcohol use and paranoid disorders with female sex, past history of a similar disorder and hearing and visual impairment.
Turkson (1998) studied the prevalence of psychiatric disorders in patients referred to the psychiatry outpatient clinics of a teaching hospital. Out of the 96 patients referred in 1988, 62.8% were referred by physicians and 14.9% by surgeons. Nearly half of these patients suffered from affective, neurotic and stress related disorders, 13.2% from schizophrenia, schizotypal and delusional disorders.
Behavioural disorders and drug use were common among the adolescent group. About 2/3 of the patients were treated as outpatients in the centre, whereas the remaining required admission in specialized centres or general hospitals. Turkson and Asante (1997) reviewed records of 130 criminal offenders seen as outpatients and found that the commonest diagnoses were psychotic states related to drug use, schizophrenia and drug use disorders (without psychosis).
MENTAL HEALTH RESOURCES
Mental Health Policy A mental health policy is present. The policy was initially formulated in 1994. The components of the policy are advocacy, promotion, prevention, treatment and rehabilitation. The mental health policy has been revised in 2000.
Substance Abuse Policy A substance abuse policy is present. The policy was initially formulated in 1990. On substance abuse there are three laws. The Narcotic Drugs (Control, Enforcement and Sanctions) Law 1990, PNDC Law 236 and Pharmacy and Drugs Act 1961.
National Mental Health Programme A national mental health programme is present. The programme was formulated in 1994. The national mental health programme was revised in 2000.
National Therapeutic Drug Policy/Essential List of Drugs A national therapeutic drug policy/essential list of drugs is present. It was formulated in 1986. Risperidone, olanzapine and fluoxetine are available in the open market but they are expensive.
Mental Health Legislation The NRC Decree (1972) is the current mental health law. Plans to revise this law to conform with changes in mental health delivery, particularly community mental care and human rights concerns are in an advanced stage. The latest legislation was enacted in 1972.
Mental Health Financing There are budget allocations for mental health.The country spends 0.5% of the total health budget on mental health. The primary source of mental health financing is tax based. The World Health Organization contributes to Ghana’s mental health budget. Admission to hospital is free to all patients, medication and tests are subsidized, but these are provided free to very poor patients. The country has disability benefits for persons with mental disorders. The benefits are primarily available to those employed in the public sector. Treatment, boarding and lodging in Government institutions are free.
Mental Health Facilities Mental health is a part of primary health care system. Actual treatment of severe mental disorders is available at the primary level. Trained community psychiatric nurses have been posted to regions and most districts.
Regular training of primary care professionals is carried out in the field of mental health. In the last two years, about 250 personnel were provided training. Community psychiatric nurses (CPN) have been trained since 1952. The Danish International Development Assistance provided additional support for the training of CPNs and medical assistants in the northern region. This programme significantly improved primary care psychiatry in the north. With WHO assistance, 228 volunteers and 160 providers have been trained for community care.
There are community care facilities for patients with mental disorders. Community psychiatric nurses are available. Trained volunteers are being considered. There are also ‘healing churches’ which help in community care; few halfway houses and charitable institutions also help in community care. Informal community care plays an important role in psychiatric management.
Psychiatric Beds and Professionals
Total psychiatric beds per 10 000 population
Psychiatric beds in mental hospitals per 10 000 population
Psychiatric beds in general hospitals per 10 000 population
Psychiatric beds in other settings per 10 000 population
Number of psychiatrists per 100 000 population
Number of neurosurgeons per 100 000 population
Number of psychiatric nurses per 100 000 population
Number of neurologists per 100 000 population
Number of psychologists per 100 000 population
Number of social workers per 100 000 population
One qualified occupational therapist and six assistants are present. The first asylum for mental health was opened in Accra in 1906. By 1960, it housed 1700 patients. There are 10 to 20 beds for psychiatric patients in three regional hospitals, but all other regional hospitals can admit and manage less severe mentally ill patients. Some patients are also managed in district hospitals. The military and police hospitals have no beds allocated to psychiatric persons. Patients are treated in medical wards or transferred to the Accra Psychiatric Hospital. The special wards meant for the mentally ill offenders are crowded and often lack proper infrastructure to support such a large number of patients. Many professionals who were sent for training abroad have not returned. There is also an efflux of locally trained staff to more lucrative work abroad.
Non-Governmental Organizations NGOs are involved with mental health in the country. They are mainly involved in advocacy. BasicNeeds, a British NGO, provides services in the northern region of Ghana. It supports quarterly outreach consultant clinical services and rehabilitation of patients. A club house for the mentally ill has also been provided in Tamale by this NGO.
Information Gathering System There is a mental health reporting system in the country. However, the data collected are not very reliable and are not utilized for system development. The country has data collection system or epidemiological study on mental health. Data is collected but not processed.
Programmes for Special Population The country has specific programmes for mental health for refugees. Mental health professionals are invited occasionally to manage such groups of population. A couple of private establishments provide rehabilitation and training for learning disability.
Therapeutic Drugs The following therapeutic drugs are generally available at the primary health care level of the country: carbamazepine, phenobarbital, phenytoin sodium, amitriptyline, chlorpromazine, diazepam, fluphenazine, haloperidol. Benztropine and benzhexol are available.
Other Information Traditional practices and spirituality play an important role in psychiatric care and are a source of community involvement. In February 2000, the Traditional Medical Practice Act was passed to regulate and codify the practice of traditional medicine. Ghana has also introduced a postgraduate Bachelor of Science Degree in Herbal Medicine.