in2mentalhealth

This is the fourth interview in the Global Mental Health Inside Stories series. In this series I want to collect and spread information/ideas from people active in mental health from all over the world and specially from low resource settings or fragile countries.
I hope this series contributes to more insight in the challenges and wishes from people active in these settings and adds to a more bottom up movement in global mental health.
James Sanahene answered the 10 interview questions as follows:

Work location and some background information:
I’m a Mechanical Engineer, specialized in Facilities Design and Human Engineering.
At the time, people with severe mental problems were commonly regarded as loonies, whose families, sensitive to the public stigma, kept them out of sight. Severely ill people were chained, beaten, starved and some committed to asylums to live as tormented prisoners in cells with barred windows. Their treatment was little better than that of jail inmates, but unlike prisoners, held little prospect of parole.
I became dismayed by the callous popular opinion and the condition of the psychiatric hospitals that I searched for a way to educate and sensitize the Ghanaian public. This inspired me and together with other mental health professionals I developed the For All Africa Foundation (FAAF).

Brief country profile:
Ghana which means ‘Warrior King’, officially the Republic of Ghana, is a sovereign state and unitary presidential constitutional republic. Ghana is located on the Gulf of Guinea, only a few degrees north of the Equator, therefore giving it a warm climate. Ghana spans an area of 238,535 km2 (92,099 sq mi), and has an Atlantic coastline that stretches 560 kilometers (348 mi) on the Gulf of Guinea and Atlantic Ocean to its south in West Africa.
The northern half of Ghana contains deserts, savannas and wildlife and the southern half of Ghana dominates in terms of population, industrial mineral, petroleum and natural gas, agricultural resources, rich forests, and features a string of springs, waterfalls, streams, rivers, caves, lakes, mountains, wildlife parks and nature reserves. The coast of Ghana is a labyrinth of castles, forts, ports and harbors.
Ghana was created as a parliamentary democracy at independence in 1957, followed by alternating military and civilian governments. In January 1993, military government gave way to the Fourth Republic after presidential and parliamentary elections in late 1992. The 1992 constitution divides powers among a president, parliament, cabinet, council of state, and an independent judiciary.
Ghana is a Middle Income Economy by the World Bank and has a reported population of about 24 million people. According to the 2010 census, 71.2% practice Christianity and 17.6%, Islam. Christian–Muslim relations in Ghana are peaceful, tolerant and bilateral. Ghana has a universal health care system, National Health Insurance Scheme (NHIS), and life expectancy at birth is 66 years with males at 64 years and females at 67 years, and infant mortality is at 39 per 1000 live births. The total fertility rate is about 3.57 children per woman.
The adult literacy rate in Ghana was 71.5% in 2010, with males at 78.3% and females at 65.3%. The youth female and male ages 15–24 years literacy rate in Ghana was 81% in 2010, with males at 82%, and females at 80%.

Overview of work activities:
For All Africa Foundation (FAAF) is a mental health charity of professionals, sufferers, families of sufferers, related organizations and concerned members of the public.
FAAF works to influence individuals, organizations and communities to improve and sustain their mental health and reach their full potential. The vision of FAAF is to continue to ensure that everyone experiencing a mental health problem gets both support and respect. The core mission of FAAF is to campaign to increase knowledge and skills about mental disorders and how they can be prevented and treated.
FAAF believes that mental health advocacy is one of the pillars to combat stigma and prejudice against people with mental disorders and improving services. The primary purpose of FAAF’s advocacy movement is to: critique actions of the Government of Ghana and prod policy makers to improve services for and treatment of people with mental disorders; and debunk myths about people with mental disorders and spread basic information about mental disorders and how to maintain good mental health.
FAAF is active in supporting persons with mental illness to reduce their risk of drifting into poverty. This is done by advocating for increases in employment support programs and raising income support to reflect the actual cost of living.
FAAF’s Healthy Mind Healthy Bodies Project (HMHB) views health as encompasses the dimensions of social, physical, intellectual, mental and emotional well being. The purposes of HMHB Project are to enhance educational outcomes and to facilitate action for health by building health knowledge and skills in the cognitive, social and behavioral domains.
The HMHB is currently underway in four schools and communities across the Ga East District in Accra. The foundation is currently searching for people to fund the HMHB project.
The desire of the foundation is to draw more connection with people worldwide so as to anchor our advocacy request in a language understood by many and to present a well-thought-out request that shows commitment to improving the health and social functioning of people with mental illnesses.

The main challenges personally in work/study/life:
The depth of my job as an Executive Director in fund raising activities has been much greater than I expected. The frequency of change in such things as client demand, regulatory environment, staffing, Board Member composition, and fundier requirements has also been greater than expected.
Workload and responsibility is also far greater than expected. Sometimes surprised by issues related to, work-life imbalance, recruitment difficulty and, service responsiveness problems. Funder requirements (particularly government) for detailed applications and outcome reports are more complex than also expected.

The main challenges for the organization(s)/colleagues/clients:
Difficulty in finding sufficient, appropriate and continuous funding for our programs. FAAF is widening its resource mobilization skills and not waiting for international donors to approach the foundation.
It was difficult to achieve good governance during the developmental stages of FAAF. With committed Board Members and Working Staff, there is better understanding of good governance which is fundamental to FAAF’s accountability and transparency.
There was very poor communication within FAAF. With access to a reliable email and internet connection now, FAAF receives literature on development issues and is connected to issues of global, regional and national importance.

The main challenges for the country regarding mental health care:
Due to a plethora of challenges facing Ghana, mental health in is largely marginalized.

Ghana has only 11 psychiatrists, four of them at the higher, board certified consultant level, and 6 retired psychiatrists, four of whom continue to work at private psychiatric hospitals. There is one retired occupational therapist. Clinical psychologists are regrettably not even recognized by Ghana’s Ministry of Health, and any clinical psychologists working at a Psychiatric Hospital have to be listed under another title on the payroll.

Brain drain is a phrase all too common to the mental health care system in Ghana. Many Ghanaian mental health professionals go overseas seeking better pay and better conditions.

The psychiatric hospitals have a problem with patients overstaying their welcome because there is not enough manpower to frequently evaluate each patient’s progress. In some cases, the families forget to inquire about their relatives or refuse to pick them up due to the hospital’s distance from their village, or the families can no longer be reached (sometimes due to a purposefully bogus address given during admission).

Moreover, the associated stigma results in a great deal of patients being abandoned by their families upon admittance into the psychiatric hospital. A heartbreaking pattern common to the children’s ward at the Accra Psychiatric Hospital, is parents giving spurious phone numbers and addresses to the hospital so that they can no longer be contacted in reference to their child.

For many years and still to this day, countless Ghanaians believe that supernatural, evil forces or spirits, bewitchment, or planted ‘juju’ cause mental illness. This combination of ignorance yields the mentally ill vulnerable to suffering human rights abuse.

What should be changed in mental health care on a local or national level:
There is a need to develop an addiction outpatients clinic hot line in our psychiatric hospitals, equip laboratory’s, records, and pharmacy departments with a software, utilize a computerized data system, create a web page, expand a Drug Rehabilitation Centre, build more staff accommodation units, ensure accessibility to needed medications at the pharmacy, increase security, focus on prevention, recovery, and relapse-reducing programs and activities, and enhance staff morale by providing better incentives, training, equipment, and uniforms.

It is imperative to create an evaluation ward which would help to avoid long-stay patients and streamline the diagnosis and welfare process. In this ward the patients would be observed for a maximum of 72 hours by a specialized screening team in order to make sure the patients’ diagnoses are correct and that they require admittance into the hospital.

Government should release more funds and resources for mental health care, train more mental health personnel including psychotherapists and counselors, give incentive (salary, insurance, benefits) for people to work in mental health care, provide newer generation medicine, overhaul and decentralize the hospital-based system and make mental health care more community based, create an anti-stigma and education campaign, and protect the human rights of the mentally ill.

Right now there are no checks for human rights abuses of the mentally ill, and the Mental Health Law should be enforced to make it illegal to put the mentally ill in chains. The Mental Health Board when established should work closely with prayer camps to oversee and enforce the upholding of all human rights.

What is the right direction for the global mental health movements:
A health issues gain priority when, Political leaders publicly and privately express support for the issue, Policies are enacted to proactively prevent problems and to ameliorate existing problems and resources appropriate to the disease burden) are allocated to the issue.
The Global Mental Health Movement is making significant strides in establishing itself as a force to be reckoned with and it can do so in a sustained fashion when it continues to forge strategic partnerships with other agencies that have the same goal.

What can ICT, mhealth and e-learning contribute to mental health care:
Despite long-standing and widespread acknowledgment of need, relevant ICT programs and services continue to be a supplementary item on government’s agenda. In Ghana, planning and implementing ICT programs and services to promote mental health often occurs in an unsystematic and ad hoc fashion. This is as a result of limited resources and the huge sums of money involved.
With a view to enhancing understanding and resolving these problems, online mental health education should rise on government agenda and demonstrates its social and economic impact. Academic institutions, government agencies, donors, nonprofit sectors, can all offer special online courses and training at affordable fees to impact more knowledge and skills to mental health workers

Other links and contact information:
For All Africa Foundation website
Mail address: info@forallafricafoundation.com
Address: Post Office Box Ct 6013, Cantonments, Accra, Ghana
FAAF on Facebook

With many thanks to James Sanahene!
Roos Korste, psychologist, international trainer and blogger