The official language is English but there are about 100 linguistic and cultural groups in Ghana, and English only accounts for 36.1% of the population’s primary language. The 2010 GDP, purchasing power parity, was $38.24 billion dollars, with one-third produced agriculturally. Gold, cocoa, and timber are the country’s main exports and recent oil production is expected to heighten economic growth. Twenty-eight and one half percent of Ghanaians live below the poverty line and 11% are unemployed . Ghana’s health expenditure is roughly 4.5% of the Gross National Product, compared to 15.2% in the US . Ghana is divided 10 regions and 170districts. Due to the proximity to the University of Ghana, Legon Campus, interviews were conducted in the metropolitan capital city, Accra , and in the surrounding Greater Accra Region, which lies on the south-east coast. In order to gain first-hand information and opinions on the current mental health situation in Ghana, 1.5-3 hour interviews were conducted with prodigious psychiatrists and a mental health NGO during spring of 2011. The first two interviews were with Dr. Akwasi Osei, the acting Chief Psychiatrist of the Ghana Health Service and Administrative Head of the Accra Psychiatric Hospital, the oldest and main psychiatric hospital in Ghana. In addition to holding these positions for the past six years, Dr. Osei is also a senior lecturer, researcher, and spokesperson for Ghana’s mental health care. The first interview dealt with matters based on Ghana’s mental health system and the stigma of mental illness, while the second interview addressed the logistics and condition of the Accra Psychiatric Hospital. Dr. Anna Dzadey, a psychiatrist from Poland, was the second interviewee. She has been the Medical Director and Psychiatric Specialist in charge of the Pantang Mental Hospital since 2005. Dr. Dzadey provided ample amounts of information on the Pantang Hospital, one of the three psychiatric hospitals in Ghana.

One of the most prominent mental health NGOs in Ghana, MindFreedom, was also interviewed to learn how they are helping to improve the care available to the mentally ill, and to see if they are noticing signs of advancement. The interview with MindFreedom involved Janet Amegatcher, Nii Lartey Adico, and Dan Taylor,plant growing trays the executives and founders of the NGO.In all of Ghana, there are only three public psychiatric hospitals and four private psychiatric hospitals. The three public hospitals, Accra Psychiatric Hospital, Pantang Hospital, and Ankaful Psychiatric Hospital, are all located in the South, with two in the Greater Accra Region and one about three hours away in Cape Coast in Ghana’s central region. Treatment for mental health care in government hospitals is free and is funded by the Ghana Health Service, which allocates a mere, debatable 0.5–3.4% of the health budget to the mental health sector. There are also four private psychiatric hospitals, two in Kumasi, one in Accra, and one in Tema . Although Kumasi is not along the coast, it is still in the southern half of Ghana. The private hospitals are criticized for being too expensive, and it is said that their patients usually end up at a public hospital once their resources are drained. It is uncertain whether the quality of care at a private psychiatric hospital is superior to that of a public hospital, but there are most likely better accommodation, less congestion, and more doctor-patient contact time. The Accra Psychiatric Hospital offers in-patient and outpatient services, limited counselling and therapy, and clinical training for doctors, psychologists, and psychiatric nurses. Technically, all services are free to the Ghanaian public, but some small fees are charged in order to help keep the hospital running. New patients are obliged to pay four Ghana cedis for a hospital records folder, ID card, and some forms. Patients are also asked to pay about 80 pese was for their medication, which can cost up to 400 Ghana cedis. In turn, this helps the patient to value the medicine on top of providing money for the hospital.

Typically two psychiatric nurses and two aids work in each ward on a daily basis, taking care of an unbelievable amount of patients by dispensing medication, noting observations, feeding, washing, and offering group therapy if there is any time or motivation left. The nurses write down the progress of each patient almost every day, but when asked how often the doctors review these notes, the nurses laughed and encouraged me to ask the medical director of the Accra Psychiatric Hospital. Although doctors should be checking in on their inpatients every day, in actuality, it happens about every two weeks due to the overload of outpatients and inpatients. A nurse will usually only report to a doctor if the condition of the patient has become very poor or if they believe the patient is well enough to be discharged. The Pantang Hospital, the largest of the three psychiatric hospitals, was commissioned in the rural Pantang Village in the Greater Accra Region in 1975 in order to reduce the congestion at the Accra Psychiatric Hospital. It was planned to be a regional psychiatric hospital with a 500 bed capacity, but in addition to the original psychiatric services, the hospital now offers primary health care, reproductive and child health services, and, under the National Health Insurance Scheme, HIV counselling, screening, and ART service. The psychiatric services are free by description, but similar to the Accra Psychiatric Hospital, Pantang asks patients to pay a small fee for their folders and medication if they can afford it. Nurses, nursing students, Health Assistant Training School students, and Community Health Mental Officers also gain clinical psychiatric experience at the Pantang Hospital. Community mental health care exists in Ghana, however, it is not well developed. A Community Psychiatry Nursing Programme began in 1975, and there are currently 120 Community Psychiatric Nurses working in all ten regions, but some regions may have just one or two CPNs. The nurses are not distributed evenly throughout the country, and only 70 districts out 170 are covered by at least one CPN. To become a CPN, a psychiatric nurse only has to train for three to six weeks after their completion of the mental nursing program but soon there will be an official degree program that spans over one or two years. Dr. Osei believes that there should be at least 2,000 CPNs working in the country in order to provide adequate community based psychiatric care.

CPNs are responsible for identifying and managing cases, referring cases to the next level of care, counselling, providing after-care services , and creating awareness and promoting mental health in the community. In addition to institutional care and community mental health, another key component of treatment is traditional healing. Due to the nation-wide presence of unorthodox healthcare and the Ghanaian belief that mental illness is caused by spiritual forces, traditional and spiritual healers tend to the largest sum of mentally ill sufferers in the country. Even urban people who live near the three psychiatric hospitals frequently visit spiritualists. Dr. Osei believes that traditional or faith healing, which uses herbal preparations and/or spiritual incantations/invocations, could be valuable if the administrators recognized their limits. Minor disorders like anxiety, minor depression, neurosis, phobias, or OCD, which might not require medication for treatment, can sometimes benefit from the therapy provided by healers. A healer is typically well trusted and has considerable influence over one’s emotions, so a patient might subsequently change their way of thinking after treatment, or receive reassurance that whatever provoked the problem has been removed in a spiritual manner. However, except for the occasional use of anti-psychotic herbs prescribed by herbalists,rolling grow tables traditional healers generally cannot help a person suffering from a severe mental disorder. It is well reported that abuse of the mentally ill occurs at prayer camps. In a documentary released by Mind Freedom Ghana, the mentally ill are chained to trees, exposed to the sun and rain, deprived of food and/or water, and even chained or flogged in an attempt to exorcise the supposed demons. The violations of a mentally ill person’s human rights have yet to be curbed because there are no laws governing mental health care outside of the psychiatric hospitals. Nonetheless, seeing a faith healer is seemingly less stigmatizing than visiting a psychiatric hospital. A mentally ill person is usually shown some sympathy from the community if they attend therapy from a traditional healer while no empathy is given to one who visits a mental hospital. The executives of Mind Freedom encourage a balance between faith healing and physical treatment when necessary, agreeing that seeing a traditional or faith healer brings fewer stigmas and is more convenient transport wise. Because of this, the normal pattern for Ghanaians involves utilizing traditional care first and then going to a psychiatric hospital if the problem was not cured. Twenty to thirty percent of the Accra Psychiatric Hospital’s patients try spiritual or traditional healing before a family member or the court brings them to the psychiatric hospital. About 20% of patients use faith healing after leaving the hospital for spiritual reinforcement. Patients at the Accra Psychiatric Hospital and Pantang Hospital travel from all over the country and surrounding countries such as Togo, Cˆote d’Ivoire, Benin, Burkina Faso, and Nigeria. On an ordinary day at the Accra Psychiatric Hospital, around 100 to 400 outpatients are seen, ten patients are admitted, and nine patients are discharged from the hospital wards. Dr. Osei extrapolates that about 40,000 outpatients were seen in 2010, but this number might not be very accurate due to faulty forms. Outpatient attendance has reportedly shown an increasing trend since 1995. The number of inpatient admissions is no longer increasing because the hospital’s psychiatrists are now more stringent on their criteria for admittance. Patients are admitted into a ward if they are a danger to themselves or others, if they require medication that cannot be administered on an outpatient basis , or if they are ordered into a psychiatric hospital by the court. The maximum occupancy of the hospital is 600 but there are currently 1,000 inpatients living in the wards, and there were 1,200 inpatients in January 2011. Table 1 and Table 2 reveal the numbers and ages of patients admitted and discharged in the year 2010. In 2010, Pantang Hospital assessed 18,503 psychological outpatients; 9,143 were male and 9,360 were female.

There was a 4.9% increase in outpatients from 2009, when only 17,636 patients were seen. According to data collected from 2004 to 2010, the hospital sees on average a total of 33,410 outpatients per year for both general and psychological causes, with just 15,894 of that number owing to psychological purposes. A range of 20 to 100 psychological outpatients can be seen a day. One thousand five hundred and thirty-nine patients were admitted into the Pantang Hospital in 2010, which reveals a 5.9% decrease in the number of inpatients from 2009. Usually, the number of patients admitted increases between 2.2% to 33% from year to year, though a decrease in attendance was also observed between 2006 and 2007. Over the past seven years, the hospital on average admits 1,371 patients per year, and about ten to twelve patients a day. Table 3 shows the number of patients who were admitted, discharged, and died according to each year. The dashes symbolize a lack of information. It is hard to tell whether there has been an increase in the number of diagnoses of a certain mental disorder within the past decade. The rise in numbers could be a result of increased awareness or a larger population. In addition, it is difficult for Ghanaian psychiatrists to ensure uniformity in diagnosis because of different backgrounds in training and cultural perspectives. Several years ago, the Pantang Hospital, along with the other two psychiatric hospitals, began using the International Classification of Mental and Behavioural Disorders— Tenth Revision , which groups mental disorders into categories and subcategories and assigns each disorder a code number. Even though the ICD- 10 helps systemize and standardize diagnosis, speeds up the digitalization of record, and simplifies comparisons between years, hospitals, and countries, many Ghanaian medical professionals have not been consistent in their usage of the classification system. Old patients should also be re-diagnosed using ICD-10 but because of the additional time this takes, it rarely happens.