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Mental health provision in Ghana struggles with investment

A 15 year old with mental health problems is chained to a chair in Freetown, Sierra Leone. Similar practices occur in Ghana because of lack of mental health care provisions / Fredrik Naumann - Panos pics

Religious and spiritual healers are stepping in to fill a gap in the treatment of mental illness in rural Ghana because of a lack of formal medical care. A new report into mental health treatment in Ghana claims families of people with mental health issues are increasingly seeking alternative treatment, which frequently includes beating and chaining the patients.

“Many families allow their relatives to be chained in order to provide treatment which is perceived to be in their best interests, and to control and punish difficult behaviours,” the report, Local Suffering and the Global Discourse of Mental Health and Human Rights, found.

Such treatment has elicited international outcry and a call for legislation to address these abuses. However, the authors, who interviewed 67 people, including 25 patients with severe mental health issues, 31 carers, three traditional healers, and three religious leaders, argue that such “top-down approaches” have little impact on people living with mental illness or their families. Rather, they argue it is necessary to engage with local communities to understand specific social, historical and cultural contexts in order to change the perception and treatment of mental illness in rural Ghana.

The burden of mental health

The World Health Organization estimates that around 14 per cent of the total global disease burden can be attributed to mental health issues. However, the report highlights the fact that 70 percent of African nations, including Ghana, spend less than one per cent of their health budget on mental health (in this study, mental illness refers to people displaying psychosis or schizophrenic behaviours).

In Ghana, psychiatric services tend to be concentrated in urban centres leaving people in rural areas unable to access treatment. Lack of adequate funding also means that hospitals are often under staffed, resulting in low patient care quality, according to the report.

“As access to psychiatric care is limited, families are left to carry the burden of mental illness,” says one of the report’s authors, Ursula Read, an anthropologist at University College London.

As the father of one of the patients explained: “When the illness first occurred, I took [my son] to Ankaful [a psychiatric hospital] for his brain to be examined… They didn’t explain anything and prescribed some medicine to give him. They told us when the medicine was finished we should go to Sunyani [the regional capital]. So when the medicine finished we went back for more. Yet still, the illness was getting worse, so we went to a prayer camp.”

Prayer camps and shrines

Rural families often bring their relatives to ‘prayer camps’ – where Christian pastors or Muslim mallams provide healing through prayer, fasting and deliverance from evil spirits – or to traditional shrines to see fetish priests or traditional healers. All frequently use chaining and beating as a form of treatment.

“At the time they brought him, it was very difficult,” explains Maame Grace, the owner of a prayer camp, talking about a patient. “He was very violent… So we had to put him in chains because if you leave him, he could harm somebody. We had it tough before we were able to chain him.”

Understanding social perceptions

The report stresses the importance of understanding how “madness” is perceived in Ghana.

“Madness is commonly seen by informants as punishment for transgressions and moral failing such as breaking taboos, stealing and adultery,” the report found. Some people also believe that mental illness stems from the use of sorcery or witchcraft.

“In line with this moral perspective on mental illness, chaining and beatings are used for punishment and discipline as well as restraint within prayer camps and shrines,” says Ms Read.

Engaging communities

The use of chaining and beating as a treatment is banned under Ghanaian law. However, the disproportionate burden placed on prayer camps and shrines to treat those with mental illness has left little alternative, the report says.

While human rights discourses are incorporated at a national level they are often inaccessible to the very people they are meant to protect, the report found.

“There remains a gap between the global discourse on health (one conducted largely in English, the language of power), which is echoed within the corridors and conference rooms of ministries of health within Ghana and other low-income countries, and the conversations and decisions around health care which take place at community level,” the report concludes.

The report suggests that interventions operating at a local level – working with those living with mental illness, their family members, and their healers – may have a greater potential to impact the treatment of those with mental health problems than legislation or investment in services alone.

Further information

Title: Local suffering and the global discourse of mental health and human rights: An ethnographic study of responses to mental illness in rural Ghana

Authors: Ursula M Read, Edward Adiiboka and Solomon Nyame

Email: u.read@ucl.ac.uk

Link to study: http://www.globalizationandhealth.com/content/pdf/1744-8603-5-13.pdf

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11/02/2009