The Forgotten Disease: Implications for the Future of Mental Health Care in Ghana and the U.S.

| October 19, 2012 | 1 Comment

By Bridget Gosis

As reported by the Ghanaian NGO Basic Needs, a man by the identity of M. has been suffering through his mental illness and wandering about Ghana’s countryside for nearly 20 years, eventually getting his leg stuck in a fallen tree trunk. M. has remained in that same position for four years, plagued by his disease and nearly forgotten by the rest of society.

Image credit: USAID.

M.’s condition points to the severe failures of the Ghanaian mental health system. In a country with 24 million people, roughly 650,000 suffer from a mental illness, the World Health Organization estimates. Even so, Ghanaian government allocates a mere one percent of its health care funds toward mental health, which provides for only 12 psychiatrists in the entire country. The few Ghanaian psychiatric facilities that exist are also only stationed in major cities, which although can serve the urban population, neglects the many mentally ill Ghanaians that live in more remote areas and are unable to access mental health services. This gross neglect of mental health care is not limited to Ghana. The Kaiser Commission on Medicaid and the Uninsured cites that 60 percent of mentally ill American adults remain untreated. The Center for American Progress also reports that roughly 58 million Americans suffer from mental illness, yet there are only 350,000 clinically trained mental health professionals nationwide.

Why is it that both a developing and a developed country suffer similar shortcomings in their mental health care system? The reason is both systemic and societal: the current model of mental health treatment is simply not serving the stigmatized mentally ill patients adequately in either country.  Where Ghana triumphs over the United States, however, is in its recent advances toward mental health reform.  A new mental health care bill was recently passed by Parliament on March 2, 2012. The bill aims to remove the barriers to mental health care by emphasizing that all patients have a right to treatment. Dr. Awkasi Osei, Chief Psychiatrist of the Ghana Health Service notes that the law will set up committees that review the conditions in mental health facilities, ensuring that treatment is of the highest quality and that patients’ rights are not abused.

This law also creates more opportunities for patients to be treated in their own communities, rather than being placed into psychiatric institutions. This will allow patients that do not live in major cities to receive quality care without the burden of traveling to sometimes impersonal institutions in the city.

If implemented effectively, this community health model has the potential to revolutionize mental health care in Ghana and other countries, replacing the inhospitable institution with immediate, personal care in the comfort of the patients’ own communities. And so, not only does this law emphasize the accessibility to effective mental health treatment, but it also focuses on the patients’ emotional well-being, ensuring that they receive care in a way that is easiest for them.

Interestingly, the United States health care system is not reliant on this community health model; instead, care is usually delivered in large hospitals, such as psychiatric institutions for mental health care.

A report by the WHO Regional Office for Europe’s Health Evidence Network states that a major drawback for such hospital-based care is cost-effectiveness. Due to the large number of patients that large institutions serve, they may not allocate their funds most efficiently. This is where the community-based model strengths lie: being stationed in local communities, these clinics are able to concentrate their resources on a small group of people, providing each of them with adequate mental health care. With reliable, continuous, and immediate mental health services, this community health model might prove superior to the often distantly located, inefficient hospitals.

In developing countries with limited resources, it is therefore more cost-efficient to adopt a community health model. This is not to say that the hospital-based model should completely be abandoned. In developed countries, it may be most beneficial to combine community and hospital-based care, with only the people that absolutely need long-term care ending up in the hospitals. This way, community mental health clinics will serve the majority of patients, and only the most severe cases will receive specialized treatment in hospitals, consequently allowing the hospital to focus its resources on only a few people. This balanced model will provide patients with care of the utmost quality on whatever level they need.

Overall, maybe it is time for a change. Maybe it is time to modify the typical American style of hospital-based care. Maybe it is time to embrace the community health model. After all, who is to say that the West is always right?

Although only time will tell which health care model is more effective, for now, we can celebrate Ghana’s accomplishment as an indication that mental illness is not something that can easily be overlooked.

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Category: Mental Health, Print, Spring 2012, Student Submissions

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