The authority’s scope of services and jurisdiction
- Institutional Care (IC)
Institutionalization of mental health services
Mental health care in the country has traditionally been hospital-based where patients spend months and years on admission. Mental health services subsist almost exclusively on doctors and nurses while other core mental health services like clinical psychological services, occupational therapy and social welfare services are almost absent.
3 Psychiatric Hospitals
Accra Psychiatric Hospital
Ghana’s premier psychiatric facility began as a Lunatic Asylum in February 1888, by a Legislative Instrument (LI) under the signature of the then governor, Sir Edward Griffiths. The construction of a new hospital at Adabraka in 1904 which has now become the present Accra Psychiatric Hospital, was commissioned in 1906 to accommodate some 200 patients.
Today, the hospital accommodates over 400 patients, having been downsized from the over 600 patients who were crumped in the facility. The Accra Psychiatric Hospital is responsible for the treatment, welfare, training and rehabilitation of the mentally ill in and around the central part of Accra and those from other parts of the country. The University of Ghana Medical School has a faculty established at the hospital for undergraduate training in Psychiatry and postgraduate training under the West African College of Psychiatrists (WACP). The hospital thus has a symbiotic relationship with the medical school.
Again, nurses from all over the country are affiliated to this hospital for their 6-month proficiency training in Psychiatry. This has however been spread to be carried out in the three psychiatric facilities in the country today.
Today, the hospital’s bed state stands at 300 patients at any given time. However, this has not been the case as the hospital continues to be over crowded with an increasing population and therefore a growing demand on the limited facilities. This has tended to compromise the comfort and general well-being of patients and constitute an appreciable strain on its resources i.e., working materials, staff and funds.
The Ankaful Psychiatric Hospital was the first to spring up after the Accra Psychiatric Hospital. It is touted as one of Nkrumah’s accomplishments built in the year 1965. The hospital was built to accommodate up to 500 patients, and admits patients from regions around the central region where it is located, namely Western and Ashanti regions.
Dr Sangmuah, Dr Sika-Nartey and Dr. Atsor were the pioneer psychiatrists. This was an attempt to decongest the hospital.
The Ankaful Psychiatric Hospital has seven (7) wards, males and females. It admits patients as inpatients and on OPD levels.
Over the years, the Ankaful Psychiatric Hospital has evolved through various stages and the status quo of paradigm shift is worth commending. The hospital has over time had to provide general medical services together with the care of the mentally ill because communities close to the hospital have not had facilities that provide such physical medical services.
The outpatient department now operates a 24 hour service. Other speciality services now incorporated include epileptic clinic, substance use clinic, diabetic and hypertension clinic and a general medical outpatient department (O.P.D) to take care of non-psychiatric cases. The hospital also runs a maternity unit which is highly patronised by the communities around.
Pantang Hospital is the third of the three psychiatric hospitals in Ghana. It is the largest and was commissioned in 1975 by General I. K. Acheampong. Pantang Hospital was built as a 500-bed facility with a Pan-African Mental Health Village in mind. The hospital is situated close to the Pantang village, about 1.6 kilometres off the Accra- Aburi road and 25 kilometres from Central Accra.
Headed by a Ghanaian Psychiatrist, Dr.Sika-Nartey after its commissioning, the facility has provided first class psychiatric care to several clients in and around the Pantang village, neighbouring Aburi and into the hinterland. Unfortunately, the dream to have a Pan-African Mental Health Village did not materialise as the visionary was ousted in another coup d’etat, and since then no government saw the need to complete the vision that would bring into being Africa’s all purpose psychiatric facility, which would spearhead the growth of psychiatric facilities and the development in mental healthcare within the sub-region.
This has left the numerous structures that were under construction to be overgrown by weeds to an extent that some of them have been rendered almost unusable. The volume of land acquired for such development has been overly encroached by private developers, and the lack of resources both materially and financially have crippled authorities of the hospital from taking the necessary action needed to safeguard what is left of the abandoned loot.
Just like the Ankaful Psychiatric Hospital, the Pantang Hospital has been compelled to provide general medical services together with the care of the mentally ill because communities close to the hospital have not enjoyed the benefit of health facilities that provide such physical medical services. One prominent feature the Pantang hospital has been well known for apart from its psychiatric care has been the mortuary services which is highly patronised within the catchment area. Again, the hospital runs a maternity unit from which it also derives some internally generated funds.
Strengthen community mental health services including rehabilitation
To build capacity for mental health care there is the need to train more staff, distribute them equitably, conduct regular in-service training for staff, provide avenues for professional development, motivate staff, and improve case management capacity of staff
Strategy 2.1: Build workforce capacity at all levels in the health system, among all categories of professionals through the following activities:
2.1.1 Expanding training institutions to increase numbers of mental health professionals
2.1.2 Encouraging tertiary institutions to train mental health professionals
2.1.3 Promoting private sector participation in the training of mental health professionals
2.1.4 Institute continuous professional development of existing staff
2.1.5 Organizing in service training for existing staff
2.1.6 Sensitization/orientation for health workforce including, Professional Nurses, Community health nurses, Medical officers, other Para-medics with regards to the new mental health act and care of mentally ill people
2.1.7 Train volunteers in the community, eg. teachers, traditional and faith based healers for use as informal community frontline workers
2.1.8 Establishing four new 40-50 bed capacity regional psychiatric hospitals in the middle and northern belts.
- Regional & Teaching Hospitals
Regional hospitals play a very vital role in mental health care in Ghana. Regional hospitals primarily form a secondary level of health care for their locations and are designed to provide services to a geographically well-defined area of a population of about 1.2 million. Presently, the four regional hospitals in Ghana have been robed in to form an integral part of mental health delivery within the various regions. This is to strengthen the integration of mental healthcare into the general health system, and thus make secondary mental healthcare available to all regions. This specialized care to be provided at the regional level involves skills and competence that may not be available at district hospitals. Being the next level of referral from district hospitals, it is the intention of the MHA to make available psychiatrists and specialized psychiatric nurses to provide services in these facilities. Regional hospitals will be expected to have 25 to 50 beds in their psychiatric wings or units.
Teaching hospitals are centres of excellence and complex health care. Governance of teaching hospitals is unusual because it involves many players, such as the MoH, the Ministry of Education, and university and political influences in the community; teaching hospitals have a high social and political profile.
The care at these facilities requires more complex, technologically oriented and delivered by highly skilled personnel. They have a high concentration of resources and are relatively expensive to run. They also support the training of health workers both pre-service and in-service.
Teaching hospitals basically perform the following functions:
Health care –They provide complex curative tertiary care. They also provide preventive care and participate in public health programmes for the local community and the total primary health care system. Referrals from districts as well as the regions are ultimately received and managed at the teaching hospitals. The teaching hospitals have a special role in providing information on various health problems and diseases.
Quality of care –Teaching hospitals provide a leading role in setting high-quality clinical standards and treatment protocols. The best quality of care in the country should be found at teaching hospitals.
Access to care –Patients might only have access to teaching hospitals through a well-developed referral System
Research –With the concentration of resources and personnel, teaching hospitals contribute in providing solutions to local and national health problems through research
Teaching and training –Teaching functions are one of the primary functions of the teaching hospital. They provide both basic and post-graduate training for health professionals.
From the above, the present mental health structure supports the three psychiatric institutions as facilities for Teaching hospitals for psychiatry, though at the moment, the Accra Psychiatric Hospital is the only center for Teaching and training of psychiatrists.
The other two facilities support in the training of psychiatric nurses and in research in mental health. They also offer the quality of care that the MHA believes should be offered to Ghanaians to reflect their middle income status as a nation.
- District Hospitals
District hospitals are the facilities for clinical care at the district level. District hospitals serve an average population of 100,000 to 200,000 people in a clearly defined geographical area. The number of beds in a district hospital is usually between 50 and 60. It is the first referral hospital and forms an integral part of the district health system.
A typical district hospital provides the following:
Curative care, preventive care, and promotion of health of the people in the district
- Quality clinical care by a more skilled and competent staff than those of the health centres and polyclinics
- Treatment techniques, such as surgery, not available at health centres
- Laboratory and other diagnostic techniques appropriate to the medical, surgical, and out-patient activities of the district hospital
- Inpatient care until the patient can go home or back to the health centre
- Training and technical supervision to health centres, as well as a resource centre for health centres at each district hospital
- Twenty-four-hour hospital services
- Accident and emergency services
With this structure, all district hospitals are expected to make provision for psychiatric wings, where they may adopt a number of beds in the wards temporarily. This is to help them admit temporarily patients who have been referred from polyclinics or health centers and need a day or two’s monitoring.
Should patients require longer periods of monitoring, they may be referred to the regional hospital where there are wings for psychiatric care. Psychiatric wings in district hospitals will be managed by Psychiatric nurses who will be supported by Community Psychiatric Nurses (CPNs).
- Health Centres & CHPS Compounds
These are the facilities in the communities and are usually the first point of call at the onset of a psychiatric condition. They will be managed by Community Psychiatric Nurses who live with the people in the communities and therefore are able to support them during such times or when patients have been reintegrated with their communities from the psychiatric institutions and therefore need help to complete the recovery process.
Health centers and CHPs Compounds commence the process of care and may refer to the district hospital should the patient need further care.
- Rehabs & Halfway Homes
Rehabilitation, effectively residential rehab is one of the most intensive forms of interventions available for the therapeutic and non-medicinal treatment for the mentally ill. It is an active ingredient of holistic care and can be a life-changing experience for the mentally ill patient who has developed a deficiency in life sustaining activities or skills including the skill of conveniently living with people in the community without necessarily being isolated or in some cases “feared”. An efficient and effective rehabilitation center provides a safe and understanding environment with 24 hour medical care and personalized treatment plan. Residential rehab is focused towards staying away from the predictor that triggered the particular conditions, such as from all drugs and alcohol.
Length of Stay at Private Residential Rehab
Patients are usually admitted into treatment at a private clinic or hospital from four weeks to 6 months, depending on the severity of the addiction. Depending on the severity of the addiction, the best results are achieved when people stay in treatment for at least 12 weeks. Detox can take place before admission or on arrival alongside other therapies.
Treatment at Rehab Centers
The length of stay of a mentally ill patient at a rehabilitation center may vary depending on the type of illness and the willingness of the patient to comply with therapeutic processes and procedures. Some form of addiction however, such as alcohol and drug treatment is structured and follows a carefully planned timetable. Patients sleep and eat at the center, and all medical care and therapy sessions are conducted onsite. Treatment is provided by a team of medical staff which includes consultant psychiatrists, doctors, nurses, trained therapists and experts in fitness and holistic therapies.
Psychotherapy usually includes individual therapy, group therapy, cognitive behavioral therapy (CBT), educational lectures, family counselling and other therapies.
Complementary therapies, or holistic therapies, may be provided alongside psychotherapy and these can include hyperbaric oxygen therapy, equine therapy, drumming therapy, art therapy and mindfulness meditation
Halfway houses – also known as sober living homes- are group residences which provide recovering patients especially addicts a free environment which may provide more stability and support to individuals than if they were to return home.
Patients who recently finished inpatient treatment might particularly find the structure of halfway homes much helpful towards ensuring long-term recovery. Again, halfway homes may allow one to work or attend school and therefore equally attractive to those enrolled in outpatient treatment programs.
The most important advantage of halfway homes undoubtedly is that it provides a social support network to recovering patients. Patients are encouraged to support and encourage each other towards full recovery. Halfway houses provide an added layer of stability which insulates recovering addicts from relapse.
- Traditional & faith Based Healers
There have been studies to show that Traditional & faith Based Healers play very important roles in addressing mental health care needs in Ghana by offering what is religiously or culturally acceptable to the mentally ill. The MHA, has therefore seen the need to collaborate with such practitioners who in most cases are the first point of call to the mentally ill at the onset of a crisis.
In traditional African belief systems, mental health problems are perceived as due to ancestors or by bewitchment and traditional healers and religious advisors are viewed as having expertise in these areas. Furthermore, these sources of care are often more accessible than the orthodox forms of mental health care.
The collaboration therefore involves the training of traditional and faith based healers to first have a fair understanding of cases patients present, act on those that require no medication, but have the capacity to improve with some show of care and refer those they are unable to handle to medical practitioners who will be attached to such places.
The practice of traditional healing has tremendously evolved with time in Ghana, especially in this era of globalisation and what some have generally termed the associated “enlightenment” that comes with it.
The traditional practice of traditional healing which was dominated by fetish priests and priestesses has now been seen as a backward and outmoded form of practice. The practice was so dominated by the fetish practitioners that ordinary herb collectors had to associate themselves with these fetishes to receive the kind of patronage they would want to see. With the advent of modernity and the huge wave of Christianity, Islamism, and other forms of religions, traditional forms of worship have taken a backstage.
Patrons of traditional religion have now fused their practice with one form of these modern religions or the other. Today, most faith based healers exhibit the spirituality which is the ability to divine within the supernatural context to find the cause of illness and misfortune, as well as the collection of herbs to produce herbal medicines.
Together with you we will build a strong mental health care and create a society with total health, for truly, there is no health without mental health.