Despite Ghana’s challenges, much progress has been displayed through Mind Freedom and BasicNeeds’ community and awareness work, Dr. Dzadey’s implementation of therapy and creation of the Drug Rehabilitation Unit, and Dr. Osei’s repatriation of the Accra Psychiatric Hospital. Though Mind Freedom commended the repatriation of patients, Basic Needs is arguing that there should have been a half-way home or reintegration centre set up to prepare the patients, who might have spent 20 or more years at the hospital, to live an independent life before being returned home. That would have been ideal; however, it is unrealistic because it would have taken a long time to create the rehabilitation centre and the hospital needed to be decongested as quickly as possible. The Castle Road Special School, built in 1968 and directed by Isaac Ben Roosevelt Gadoter, is the only special needs school in Ghana that is located in a Psychiatric Hospital. The school provides hands-on therapy, art, reading, music, outdoor activities for the mentally ill or disabled in the Children’s Ward at the Accra Psychiatric Hospital. The teachers there represented one of the very few instances when I saw true compassion for the mentally ill/disabled during my time in Ghana and one of the even rarer instances when I heard that someone loved their occupation at the psychiatric hospital. After volunteering at another special needs school for children with autism, learning delays, hearing and speech problems, SENCDRAC, I luckily witnessed even more sympathy and care for the unique children in Ghana. There are 14 other registered special needs schools in Ghana, and they are at the forefront of displaying empathy for the mentally ill and disabled in the country.

Hopefully, this sympathy will spread to mainstream schools and then to the entire public. The infrastructure of mental health services is reliant on satisfactory funding and allotting sufficient finances to allow for the delivery of notable mental health services,grow cannabis in containers the effectual training of staff, and the development of collaborations and consultations which will make mental health service much more accessible. Though the health sector in general is underfunded, it is imperative that the Ministry of Health allocates funding to community mental health care and that the financing of the psychiatric hospitals becomes based on need, rather than unjustified ceilings, due to the vulnerable nature of the mentally ill. The Mental Health Bill will guarantee that at least eight percent of the total health budget will be apportioned to mental healthcare. The government is responsible for addressing the needs of its citizens by formulating suitable legislations and the Mental Health Bill offers the government a chance to enhance the delivery and accessibility of mental health services. The World Health Organization is calling the bill one of the best mental health laws in the developing world and believes that when it is passed it can serve as a model for other countries. The bill needs to be passed in order to avoid the collapse of a currently unstable mental health care system. The Mental Health Bill, Dr. Osei, MindFreedom, and BasicNeeds all promote the extension of psychiatric services into community district and regional hospitals. Integrating mental health services into primary care has shown to be more cost effective than institutional care. This integration will also help improve access to mental health services in remote areas where patients presently travel a great number of miles for psychiatric treatment. Currently, care is mainly restricted to the institutional administration of psychotropic drugs instead of preventative or rehabilitative psychosocial interventions, due to the dearth of allied mental health personnel and the limited number of community psychiatric nurses. An accelerated, specialist training program should be locally established in order to increase the number of allied mental health personnel.

The problematic brain drain of staff could be alleviated by providing satisfactory remuneration and incentives to encourage trained personnel to stay in Ghana or to return home from overseas. If a mental illness goes untreated, there are three possible consequences for the victim. The first is living with the sickness and underachieving or having low productivity because the person is not performing properly or to their highest potential. Secondly, the untreated person could engage in social vices such as drugs, armed robbery, and paedophilia. The third possibility is to die from complications of the illness, i.e. committing suicide due to depression, engaging in risky activities due to bi-polar disorder, not eating because of schizophrenia, or dying from a tumour that initially caused the illness. Each day that the bill remains before Parliament, Ghana is officially allowing the rights of the vulnerable to be abused by placing patients in overly congested institutions with little doctor-patient contact. A society of acceptance makes a much more favourable environment for recovery from mental illnesses, with stigma representing a large barrier to recovery. Even in developed countries, people who are misinformed about mental illnesses can respond negatively to a friend or relative’s mental illness. Mental illness is not caused by poor decisions or by offending the gods, but can affect anyone no matter what ethnicity, background, age, or gender. The mentally ill can benefit from psychotherapy, group therapy, medication, self therapy, rehabilitation, and the acceptance and understanding from friends and family. Programs that encourage understanding and awareness of mental health issues and demystify mental illness should be forcefully undertaken for communities to further tolerate and acknowledge the mentally ill. Overcoming these widely prevalent traditional myths on mental illness will help lead more patients to seek professional treatment early on. Public health officers and the health promotion unit should integrate mental health into their awareness and advocacy programs.

Mental health needs to be recognized and integrated into both primary and secondary care, social and health policy, and health system organization. The delivery of mental health care can also be improved by concentrating on currently active programs dealing with the prevention and treatment of tuberculosis, malaria, HIV, domestic violence, and maternal care. This should spark the interest of the government because advancing the mental health system could help the country reach the Millennium Development Goals which address HIV/AIDs, malaria, tuberculosis, child mortality, maternal health, and the empowerment of women. It has been consistently reported that HIV is associated with poor mental health due to psychological trauma and the causing of neuropsychiatric complications such as depression, cognitive disorder, mania, and dementia due to effects on the central nervous system. Strong evidence from developed countries also shows that depression,pot for cannabis alcohol and substance abuse disorders, and cognitive impairment negatively affect adherence to antiretrovirals. In the US, those treated for depression for six months showed improvement in HAART adherence compared to those who did not take antidepressants. Some studies have also shown that the incidence of tuberculosis infection is high in people with serious mental illnesses or substance use disorders. Heavy drinkers had double the risk of being infected with tuberculosis compared to non-drinkers, according to a study in the US. Though there is little evidence, depression might also cause low adherence to anti-tuberculosis medication, which makes it very difficult for a country to control the disease. With gynaecological health being greatly affected by depression, anxiety, sexual and domestic abuse, and substance and alcohol use, many studies have also linked reproductive morbidity with mental illnesses. Depression is more common among women, especially poor women, due to domestic violence and lack of autonomy. Maternal psychosis increases the risk of infant mortality while maternal schizophrenia can result in low birth weight or premature delivery. Postpartum depression also leads to poor mother-infant interaction and little devotion to the health of the child. Mental disorders increase the risk for transmission of infectious disease and the development of non-communicable diseases and communicable diseases, while other sicknesses increase the risk for mental illnesses. Because of this co-morbidity, mental health policies should be integrated into different levels of care, with primary care physicians trained in treating mental disorders. Current community and public health programs or campaigns should become familiar with mental disorders in order to help improve both the physical and mental health of their targeted patients, which will lead to lead to quicker recoveries. If general physicians and prominent health-related NGOs start to increase awareness and encourage or participate in the treatment of mental disorders, a great deal of pressure will be taken off of the limited mental health staff in Ghana .

DIFFICULTY ADHERING TO LONG-TERM antiretroviral regimens is a well-established and primary cause of treatment failure among individuals living with human immunodeficiency virus . Fundamentally, patient behaviors are paramount to effective HIV management such as establishing optimal lifelong adherence to medications , and consistent attendance at HIV clinic appointments . These adherence-related behavioral requirements often occur in the face of stigma-related distress and negative affect and/or aversive and unwanted side effects from the medications themselves . Indeed, the literature is rife with data indicating that ART side effects are strongly related to poor ART adherence . In addition, there is substantial evidence that negative affect is also associated with ART non-adherence . Accordingly, an inability to tolerate negative affect may interfere with ART adherence and persistence. Given the enduring prevalence and clinical significance of sub-optimal ART adherence among HIV infected individuals , examination of malleable transdiagnostic processes related to indices of HIV management is critical from an intervention standpoint.Here, and throughout the literature, distress tolerance is defined as perceived and/or behavioral persistence in the presence of unpleasant stressors or emotional/physical states . Distress intolerance is characterized by the tendency to rapidly alleviate or escape negative emotional experiences when in crisis or distressing situations, which interferes with engaging in goal-oriented actions . Distress intolerance has been established within various models of problematic behaviors and psychopathology ; hence its consideration as a transdiagnostic psychological vulnerability factor. Accordingly, in the context of HIV management, one’s ability to effectively tolerate distress is crucial because discomfort and/or distress are part of the treatment process and cannot be altogether avoided . Attempts to avoid discomfort and distress may lead to suboptimal ART adherence , with suboptimal adherence defined as less than 95% adherence to older regimens and less than 80% adherence to newer regimens . Suboptimal ART adherence may, in turn, lead to eventual increases in viral load and potential ART-resistant HIV strains . To illustrate, one may experience difficulty sustaining adequate medication adherence if unwilling to tolerate negative emotions resulting from being reminded of living with HIV when taking ART medications. Thus, low tolerance of unpleasant affective states or behavioral tasks may be a clinically addressable risk factor for poor ART adherence and HIV disease progression. In addition to recent work showing perceived distress intolerance to be associated with psychological symptoms among individuals with HIV , a study conducted by O’Cleirigh and colleagues revealed that greater perceived distress tolerance was associated with better self-reported ART adherence and HIV disease management. Although this work represents an important first step in the literature, there is a lack of data on the relation between distress tolerance and ART adherence using objective adherence measures or relying on a multi-method approach to DT assessment. As there is inherent difficulty in participants accurately identifying motives for their behavior, along with the potential for inflated correlations with shared method variance , reliance on only self-report methodologies for examining distress tolerance may be problematic. As such, it is recommended to include both self-report and behavioral measures when assessing distress tolerance . To evaluate the explanatory role of distress tolerance as a transdiagnostic vulnerability factor potentially underlying several indices of HIV disease management, the present study sought to evaluate the relation between distress tolerance and ART adherence using objective measures of ART adherence, response to ART, and immuno compromise and two measures of distress tolerance . Behavioral distress tolerance measures evoke distress “in vivo” thereby capturing one’s objective capacity for tolerating distress, whereas self-report measures capture one’s “perceived” capacity for tolerating aversive and unwanted psychological experiences . Given the evidence that poor distress tolerance is associated with negative affectivity , and negative affectivity and ART side effects are associated with ART non-adherence , we also sought to clarify the association between distress tolerance and ART adherence when controlling for negative affectivity and ART side-effect severity.