ATLANTIC INTERNATIONAL UNIVERSITY

MAD LIVES TOO MATTER: ASSESSING THE FACTORS THAT ACCOUNT FOR

POOR MENTAL HEALTH PROGRAMS IN THE WESTERN REGION OF GHANA

ERIC AKWASI ELLIASON

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DECLARATION

Candidates’ Declaration

I do hereby declare that apart from references to past and current literature duly cited in this thesis,

the entire research work presented in this thesis was done by me as students of the Atlantic

International University. It has neither in whole nor in part been submitted for a degree elsewhere.

Eric Akwasi Elliason Signature…………………… Date……………….

Supervisor’s Declaration

I hereby declare that, the preparation and presentation of this thesis was supervised in accordance

with the guidelines on supervision of thesis laid down by Atlantic International University.

Signature………………… Date ……………………………….

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 DEDICATION

I dedicate this work to………………..

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ACKNOWLEDGEMENTS

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TABLE OF CONTENTS

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 ABSTRACT

Mental health is as important as physical health to the overall well-being of individuals, societies
and countries. Yet only a small minority of the 450 million people suffering from a mental or
behavioral disorder are receiving treatment. The study was conducted to assess the factors that
account for poor mental health intervention programs in the western Region of Ghana. Study
adopted a survey study design using purposive and simple random techniques with a sample size
of 200 respondents. The data were gathered using structured questionnaire and interview guide.
Quantitative data analysis methods were used with the aid of SPSS version 23.0.

The study found some of the social factors the influence mental health programs as stigmatization
and discrimination, poverty insecurity and hopelessness, rapid social change and risks of violence,
influence on health behavior, trust and social capital, and peer influence. Some of the economic
factors included, low income, higher national levels of income inequality, country is under-
resourced and under-developed to finance mental health intervention programs. The study also
revealed the socio-cultural factors that influence mental health such as homelessness, poor
conditions, unequal distribution of amenities, ethnic disharmony, demolition of housing and
migration and displacement. Respondents believed that mental illness is caused by curses from the
gods and ancestors, culture can shape the mental health programs and alter the types of services
used, the attitude of some mental health practitioner deters them to seek for services, and it is often
possible to identify cultural values directly concerned with the essential features of mental health.
The study found that majority (69%) of the respondents affirmed that there were no mental health
intervention programs at time of the study. Finally the study found the institutional facing mental
health program: Notable among these challenges were, lack of financial support from government,
inadequate infrastructure and logistics, inadequate human resource, Stigmatization and
discrimination, and lack of support from family members.

The study recommends that Ghana Health Services through collaboration with Ministry of Health
should promote timely access to effective treatment of mental health conditions, including mild-
to-moderate mental illnesses, in both community mental health and primary care settings and
through co-location of health professionals to facilitate the referral to specialist mental health care,
while ensuring the involvement of people living with mental health conditions in decisions about
the appropriate care and treatment plan. In conclusion, to improve access to mental health care in
Ghana, the scaling up of mental health care services must be closely monitored, sensitive to
cultural and social context, accompanied by extensive research, and supported by adequate
funding.

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 CHAPTER ONE

NTRODUCTION
1.0 General Introduction

In recent times, the concept of Mental Health becomes more and more important and the World

Health Organization just recently released a report on adolescence mental health, the age group to

which students belong. According to the WHO, Mental Health is defined as "a state of well-being

in which the individual realizes his or her own abilities, can cope with the normal stresses of life,

can work productively and fruitfully, and is able to make a contribution to his or her community".

(World Health Organization, 2001).

The Mental Health Continuum-Short Form (Keyes, 2008) is a brief version of its long

counterpart, and it is based on the components of Mental Health that can be found in the

definition of the concept through the World Health Organization (2005), emotional, social,

and psychological wellbeing (Salama-Younes, 2011).

Back to the theoretical background of mental health, the definition of the WHO includes three

categories: well-being, effective functioning of an individual, and effective functioning for a

community. In accordance with these categories, Keyes says that mental health is a combination

of emotional, social and psychological wellbeing (2002), where emotional wellbeing is the

realization of well-being, social well-being the realization of effective functioning within a

community and psychological well-being the effective individual functioning.

Mental health is as important as physical health to the overall well-being of individuals, societies

and countries. Yet only a small minority of the 450 million people suffering from a mental or

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behavioural disorder are receiving treatment. Advances in neuroscience and behavioural medicine

have shown that, like many physical illnesses, mental and behavioural disorders are the result of a

complex interaction between biological, psychological and social factors. While there is still much

to be learned, we already have the knowledge and power to reduce the burden of mental and

behavioural disorders worldwide (Word Health Organisation 2001).

1.1 Contextual Data

Poor mental health is a leading cause of disability worldwide with considerable negative impacts,

particularly in low-income countries. Nevertheless, empirical evidence on its national prevalence

in low-income countries, particularly in Africa, is limited. Additionally, researchers and policy

makers are now calling for empirical investigations of the association between empowerment and

poor mental health among women.

Approximately one of every four people suffer from poor mental health, making it a leading cause

of disability around the globe (WHO, 2001). Poor mental health increases susceptibility to both

infectious and chronic diseases and accounts for more than 30% of years of life lost worldwide

(Prince, Patel, Saxena, Maj, Maselko, Philllips, & Rahman) .Additionally, the negative economic

impact of mental health issues is considerable (Siddiqi & Siddiqi 2007), particularly in low-income

countries where key risk factors including poverty, underemployment and unemployment, political

instability, and HIV/AIDS are most prevalent.

Nevertheless, empirical evidence on national prevalence of poor mental health in low-income

countries, particularly in Africa, is limited. Although several studies have been conducted in

African countries, most have used small, specialized populations including people living in rural

settings (Deyessa , Berhane, Alem, Hogberg, Kullgren, 2008; Tafari , Aboud & Larson , 1991),

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pregnant women (Abiodun , Adetoro, & Ogunbode , 1993], and hospitalized patients (Abiodun &

Ogunremi 1990; Nair & Pillay, 1997) and thus lack national generalizability.

Due in large part to the diversity of populations examined and methods used, prevalence estimates

of poor mental health have varied widely, ranging from 4% to 65% (Ovuga, Boardman, &

Wasserman, 2005). The Nigerian Survey of Mental Health and Well-Being (NSMHW) is the only

survey from the World Health Organization’s Mental Health Survey Initiative that was conducted

in a low-income African country (Gureje, Lasebikan, Kola, Makanjuola, 2006). These data,

however, are not nationally representative and were collected nearly a decade ago, limiting their

usefulness for estimating contemporary estimates of poor mental health.

The dearth of reliable and detailed information in research is the root cause of all failed intervention

programs. And mental health intervention programs in Ghana are no exception. Mental health

intervention research remains limited in both quantity and quality. Additionally, it is difficult to

estimate the true prevalence of mental disorder and plan effectively for mental health promotion

and treatment without more rigorous, large scale population based studies. Now considering this

gap and in the absence of reliable evidence as pointed by DOKU (2012), the gaps are filled with

“guesttimates” and anecdotal evidence.

As DOKU expands, early researchers and clinicians predicted an increase in mental health

disorders in Ghana as a result of the presumed stresses of industrialization and acculturation. “Yet

to date, the true prevalence of mental health disorder remains very uncertain”. Each year, several

mental health intervention programs are rolled out in Ghana. But on what data and credible

information do these programs rely on to execute their intervention? Well the answer is best left

for our imaginations. Unfortunately, of all reports on the mental healthcare in Ghana, this study

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never met one report where the story was positive. The study perused the following titles; “the

breakdown of Ghana’s mental healthcare, Amoakwa-Fordjour (2013), Ghana’s mental health

challenges: does the government show enough concern? Akapule (2015), time to deal with mental

health challenges, Yeboah (2013), Challenges facing Accra Psychiatric Hospital, Amarh (2016),

Accra Psychiatric Hospital may soon be shutdown, Akwasi Osei (2017), Mental Health: Ghana is

sitting on a time bomb, Akwasi Osei (2016), Mental health care undergoing silent revolution,

Akwasi Osei (2016), Dr. Akwasi Osei bemoans mental healthcare, Satsi (2017).

Although research that examines correlates of poor mental health within African countries are

limited in number, findings consistently indicate that lower socioeconomic status, less education,

and female gender are risk factors for poorer mental health (Nair, Pillay, 1997; Hamad, Fernald,

Karlan, & Zinman, 2008 ). Based on this evidence, researchers and policy makers are now calling

for empirical investigations of the association between empowerment and poor mental health

among women. Although this link has been suggested by a few small studies in Africa (Fernald,

Karlan, & Zinman, 2008; Abiodun, Adetoro & Ogunbode, 1992), a more thorough understanding

of this association may provide avenues for interventions.

Ghana is particularly relevant to this discourse as country leadership is poised to make substantial

improvements in mental health services since the recent passing of their Mental Health Bill, which

calls for better integration of mental health into the Ghanaian National Health Services (Mental

Health Act 846 of 2012). Consequently, current epidemiological data on mental health and its

correlates may be useful in understanding the scope of the problem in Ghana and for targeting

particular subgroups for effective interventions

According to the National Institute for Health and Care Excellence (NICE), common mental health

problems include depression, GAD, social anxiety disorder, panic disorder, OCD, and post-

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traumatic stress disorder (PTSD).The APMS (2014) does not include PTSD as a common mental

health problem.

Table 1: Prevalence of common mental health problems (adults 16+)

Mental Health Disorder 2007 (%) 2014 (%)

GAD 4.4 5.9
Depression 2.3 3.3
Phobias 1.4 2.4
OCT 1.1 1.3
Panic Disorder 1.1 0.6
CMD-NOS 9.0 7.8
(Stansfeld et al., 2016)

1.2 Statement of the Problem

Psychiatry in Ghana is neglected in health care and research. In 1972 Adomakoh proclaimed in

this journal ‘There is a dearth of detailed knowledge of psychiatric illness in this country’.

(Adomakoh, 1972). Nearly 40 years later the research record has expanded, but accurate data on

epidemiology, treatment and outcomes is still sorely needed. In the absence of reliable evidence

mental health intervention, the gaps are filled by data extrapolated from international research,

“guesstimates”, and anecdotal evidence

Mental health constitutes the most neglected sector in Ghana. In fact in no time has there ever been

an intentional neglect of a field as relevant as mental health. Yet ironically, every Ghanaian

appreciates the need for swift interventions to largely handle the mental health challenges

confronting the country. Our collective refusal to give the requisite attention and the needed merit

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to mental health in the country does not stem from lack of knowledge – the evidence on the level

of deterioration of our mental health institutions is even very visible to the blind.

The daily reportage of our defunct mental health institutions is enough to push policy makers to

rise above the nice talk into doing something innovative and progressive in the mental health

sector. Let it be said that we are very aware of the misfortunes in the sector. Therefore it may not

be wrong for one to conclude that we are so used to the mental health sector been neglected that

we are now very reluctant to do something about it. Perhaps many policy makers and implementers

feel that ‘mad lives don’t matter’. But it will be very unfortunate if this is the feeling because there

can be no health without mental health (Prince et al., 2007).

As a result, the problem of failed mental health interventions points in many directions –

intentional neglect, unattractive nature of the mental health sector, lack of motivation, inadequate

health workforce to implement mental health intervention programs, lack of government support,

the lack of credible data among others. As at 2015, there was only one psychiatry doctor for the

three regions in northern Ghana- that is Upper East, Upper West and Northern Region. Mean

whiles major health facilities for serious treatment of mental health related cases are centralized in

Ghana’s most popular two cities; Accra and Kumasi making it difficult for psychiatric patients to

access their services.

Very worrying is also that some regions in Ghana such as the Brong Ahafo and Volta Regions

each have one Psychiatrist. Central Region has three psychiatrists whilst Eastern and Western

Regions have no such experts. Whilst delivering a speech Dr. Akwasi Osei noted that the deficit

in the treatment of mental health ill persons in the Ghana was 98%. A recent study also showed

that Ghana had 41% psychological distress in various degrees – which means as many as 47 in

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every 100 admitted under negative stress which affected them mentally and that 19% of those with

negative stress had moderate to severe symptoms implying that their problem was serious enough

to be considered a mental illness.

Continuing to show how broken Ghana’s metal health care system have stretched so far, other

statistics suggest that Ghana has 12, 700 psychiatric nurses instead of 30,000 leaving a deficit of

17,300. Also the country has four clinical psychologists instead of a 100. The mental health ratio

in Ghana is 1:165. In effect, the field of mental health in Ghana is vast but the workers are few. At

a forum to mark the 2014 world mental health day in Bolgatanga it was revealed that mental health

patients could not get access to psychotropic medicine often administered and there are no

designated wards for patients suffering from mental health illness.

The Chief Executive Officer of Ghana’s Mental Health Authority (GHA), Dr. Akwasi Osei scored

the mental health situation in Ghana ‘two out of ten’. He summarized the mental health situation

in Ghana in three constraints; infrastructural challenges in terms of deficits, no money to run

mental health services and embark on effective rehabilitation services and the lack of government

support. The last time the government provided financial support for mental activities in the

country was in 2011. Amoakwa- Fordjour, Gina (2013) published a paper on Justice Ghana and

describes Ghana’s mental health system in a rather radical fashion

“the reality of mental health care in Ghana appears miserable, sorry, pitiful, paltry, imperfect,

pitiable, shame, mean, coarse, inferior, below bar, subnormal, under average, second-rate, reduced,

defective, deficient, lower, subordinate, minor, secondary, humble, pedestrian, beggarly, homely,

crumbling, forth-rate, tawdry, petty, threadbare, badly made, less than good, unwholesome,

lacking in quality, vile, disgusting, despicable, rustic, crude, outlandish, old-fashioned, odd, rock-

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bottom, garish, shaky, showy, inelegant, loud, unattractive, inartistic, affected, ramshackle,

pretentious, tumble-down, glaring, artificial, flaunting, newfangled, out-of-date, crummy, junky”

The Human Rights Watch (2014) released a damning report which documented the inhumane

treatment of Ghanaians suffering from mental illness. It is very sad that since the mental health

law has been passed things have been worse.

Specifically, some of the provisions in the new Act include:

1. Improving access to in-patient and out-patient mental care in the communities which people

live.

2. Regulation of mental health practitioners in both public and private sectors and traditional

healers too, everywhere in communities and hospitals.

3. Combating of discrimination and stigmatization against people with mental illness and

promoting their human rights among others.

Despite the above provisions, mental health issues in Ghana continue to become a challenge.

Although, the mental health bill has been passed, provisions made have not been implemented.

The Board formed to address issues concerning mental illness has not been able to do what is

expected of them apparently because the government has still not provided enough structures for

them to function. It is therefore not surprising to hear on air recently that some mental hospital

might close down due to inadequate food and financial constraints facing the hospitals.

There is an increase in the number of individuals affected by mental illness which has implications

for the nation as a whole (WHO, 2014). Meanwhile, there are not enough mental health facilities

to address the rising problems associated with mental illness, thus leading to stress on the little

facilitates available. Alternatively, community-based care is being proposed by Ghana’s Mental

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Health sector to reduce stress on mental health facilities. It therefore against this backdrop that the

study will was conducted to assess the factors accounting for poor mental health programs in

selected regions in Ghana.

1.3 Description of the Issue

In Ghana, as it is true of most African cultures, the causes of mental illness could have many

definitions or interpretations. Mindwsie (2), however, writes that most mental health professionals

believe that there are a variety of contributing factors to the onset of a mental illness. Research

shows that there are physical, social, environmental and psychological causes for mental illness

(Amoakwa-Fordjour 2013).

Social protection describes help and support designed to protect the vulnerable in society or at risk

of hardship such as those affected by illness, family circumstances or age. The plight of the street

mental health patient, challenges the said Ghanaian hospitality and middle-income accolades.

There are many ways of measuring the efficiency and timely intervention of mental healthcare

challenges and disorders. In the United Kingdom, it has been found that pressure on psychiatric

wards has become so great that doctors are sectioning mentally ill patients unnecessarily, because

it is often seen as the only way to gain access to a bed, Members of Parliament have found. For

example, the House of Commons Health Select Committee said it was shocked by “disturbing”

evidence that it was becoming increasingly difficult for mental health patients to gain access to

hospital on a voluntary basis, resulting cases of doctors declaring patients a risk to themselves and

others in order to speed admittance to a ward. As had been the traditional practice around the

world, in the UK, patients who are detained under the Mental Health Act can be held in hospital

against their will for up to 28 days before further assessments that can extend their detention

indefinitely.

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In the words of Dr Akwasi Osei, a recent study showed that Ghana had 41 per cent prevalence of

psychological distress in various degrees- meaning as many as 47 in a 100 admitted were under

negative stress which affected them mentally and that 19 per cent of those with negative stress had

moderate to severe symptoms meaning their problem was serious enough to be considered a mental

illness. Yet mental health care was largely limited to the urban area and even more specifically to

the middle and northern belts of the country with only three psychiatric hospitals and 12 practicing

psychiatrists for the 25 million people. The beggarly, homely, crumbling, petty and the threadbare

dilemma, it is said, required number of professionals for a low income country was 150. Dr Osei

states that Ghana has 12, 700 psychiatric nurses instead of 30,000 and four clinical psychologists

instead of a 100. “The field of mental health in Ghana is vast and the workers are few,” he said.

Whereas in the Kingdom of Great Britain the concerns, as reported by The Independent Newspaper

(1), had been that mentally ill patients are sectioned unnecessarily as ‘only way’ to a hospital bed,

the contrary is the case of the Republic of Ghana. As highlighted, the mental health patients in

Ghana, it seems to Justice Ghana, are deliberately allowed to roam and without any laid down

measures, to ease the immeasurable distress of families, relations, the responsible health

professionals and indeed the society at large. Legally, it is internationally accepted that in majority

of cases all compulsorily detained mental health patients, should be suffering from a mental

disorder or ailment which warrants detention in hospital or a mental home in the interests of their

own health or safety, or the safety of others.

In a study (Poor mental health in Ghana: who is at risk? (2009–2010), which sought to estimate

the national prevalence of poor mental health in Ghana, and to explore how it correlates on a

national level and aimed to examine associations between empowerment and poor mental health

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among women on the basis of epidemiological data on mental health and how it may be useful in

understanding the scope of the problem in Ghana- targeting particular subgroups for interventions.

For this reason the study seeks to unravel factors influencing mental health programs ranging from

socio-economic and socio-cultural.

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Summary of Problem Statement

Low Lack of
interest in support from
mental stakeholders Poor
Lack of health public
governmen perception
t support on mental
health Lack of
Inadequate
funding logistics

Inadequat
e mental
health socio-
workforce cultural
factors
Paucity of
accurate
mental socio-
health economic
data factors

Poor Mental
Health Programs

Source: Author’s Own Construct (2017)

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1.4 Objectives of the Study

1.4.1 General Objective

The principal objective of this study is to assess the factors that account for poor mental health

programs in the western Region of Ghana.

1.4.2 Specific Objectives

The specific objectives shall focus on the following;

1. To identify the socio-economic factors influencing mental health programs in the western

Region of Ghana.

2. To identify the socio-cultural factors influencing mental health programs in the western

Region of Ghana.

3. To find out available mental health intervention programs in the western Region of Ghana.

4. To identify the institutional challenges that impede successful implementation of mental

health intervention programs in the western Region of Ghana.

1.5 Research Questions

1. What are the socio-economic factors influencing mental health programs?

2. What the socio-cultural factors influencing mental health programs?

3. What are the available mental health intervention programs?

4. Are there institutional challenges that impede successful implementation of mental health

intervention programs?

1.6 Purpose of the Study

The mental health sector from afar is bewildered with seemingly insurmountable challenges - by

virtue of our financial nakedness as a country, it will not be possible to address all of the challenges

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at a go, there is therefore the need to prioritize which challenges to address first. The respective

factors pose different challenges on the sector. This study therefore seeks to identify the most

crucial factors that sham the greater challenges on the sector and advocate by measure of priority

which ones need urgent address. A question to ponder is that how come Ghana’s streets is overly

flooded with mentally unstable persons and people who need psychiatric attention whilst at the

same time the nation has witnessed the launching of mental health programs and with no effect?

What is happening? The study intends to make various recommendations on mental health to

ascertain how these have subsequently influenced the effectiveness or otherwise of the programs.

By and large, the study will interrogate specific and initiated mental health programs currently in

force to assess the estimated impact levels it has on persons who have suffered one of the myriad

causes associated with mental health. Subsequently, the researcher will determine where the main

focus of mental health intervention programs lie. As acknowledged from literature, most mental

health programs focus more on persons having already exhibited the full glimpses of mental health.

But mental health programs must and necessarily also target asymptomatic individuals who

haven’t fully manifested the uncurbed effects of mental health.

1.7 Scope of the study

To ensure an in-depth study of a critical analysis of the investigation, the researcher limited the

study to the Western Region of Ghana. Since the research cannot possibly cover everything

concerning industrial unrest, there study will be narrowed to the specific objectives, thus, socio-

economic factors influencing mental health programs, socio-cultural factors influencing mental

health programs, available mental health intervention programs , and challenges that impede

successful implementation of mental health intervention programs.

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1.8 Limitations of then study

The limitations of this study include factors such as; time constraints due to the fact that the

researcher had to spend much time at the study area in data collection and also the fact that the

research work is combined with assignments and studies. As a result of the time constraint, the

researcher may extend the study in different fields to obtain diverse views which may make the

study richer.

The financial factor also serves as a limitation to the study. This includes the cost of printing of

the questionnaire, printing of the actual work and binding cost. The use of large sample size may

contribute to the appropriateness of the results. However, the limited financial resources at the

researcher’s disposal may not permit the use of large sample size.

The inability of some respondents to complete the questionnaire after they have started, may serve

as a limitation to the study because it may affect the validity of final result. The researcher intends

to overcome these limitations by resorting to appropriate sample size, efficient sampling

techniques, and proper ethical consideration.

1.8 Organisation of the Study

The study is structured in six chapters. Chapter One deals with the background information of the

study, statement of the problem, objectives of the study, research questions, purpose of the study,

scope and limitations of the study, and organisation of the study. Chapter two (2) presents a review

of relevant literature. The major areas covered are the views, findings and suggestions made by

earlier researchers on related topics of the study. The third (3rd) chapter covers the methodology

used. It looks at the research design, sampling procedures, instruments, administration of

instruments and data collection procedure, data analysis, and ethical consideration. The fourth (4th)

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chapter gives the presentation and analysis of collected data. The fifth chapter focusses on the

discussion of results and last chapter six (6), presents the conclusion and recommendations.

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 CHAPTER TWO

LITERATURE REVIEW
2.0 Introduction

Opoku (2005), in his book A Short Guide to Research Writing in the Social Sciences and

Education, maintains that literature review involves extensive reading in areas which are directly

or indirectly related to the topic of study. Such extensive reading does not only provide supportive

information that is necessary to the study, but it is also the theoretical framework for the present

as well as future research work. Thus, this study must be systematically presented and evaluated

to give a clear idea of the topic studied.

The purpose of literature review is to establish the area of study, establish a theoretical framework

for the subject area of study and to identify studies, models and cases supporting the research topic.

The researchers looked deeper into what other scholars have produced pertaining poor mental

health programs and its related challenges. The study will further review literature based on the

specifics objectives of the study.

2.1 Concept of Mental Health

The World Health Organization (WHO) embraces a definition of health as “physical, mental, and

social well-being”. Of these elements, mental well-being historically has been misunderstood and

often forgotten. WHO has spent the last five years actively addressing the barriers that prevent

access to mental health care and campaigning for the full incorporation of mental health in

worldwide public health.

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Since its inception, WHO has included mental well-being in the definition of health. WHO

famously defines health as: … a state of complete physical, mental and social well-being and not

merely the absence of disease or infirmity (WHO, 2001b, p.1).

Three ideas central to the improvement of health follow from this definition: mental health is

an integral part of health, mental health is more than the absence of mental illness, and mental

health is intimately connected with physical health and behaviour.

Defining mental health is important, although not always necessary to achieving its improvement.

Differences in values across countries, cultures, classes and genders can appear too great to allow

a consensus on a definition (WHO, 2001c). However, just as age or wealth each have many

different expressions across the world and yet have a core common-sense universal meaning, so

too can mental health be understood without restricting its interpretation across cultures.

WHO has recently proposed that mental health is… a state of well-being in which the individual

realizes his or her own abilities, can cope with the normal stresses of life, can work productively

and fruitfully, and is able to make a contribution to his or her community (WHO, 2001d, p.1)

In this positive sense, mental health is the foundation for well-being and effective functioning for

an individual and for a community. It is more than the absence of mental illness, for the states and

capacities noted in the definition have value in themselves. Despite this, mental health is still

portrayed by some as a luxury. The misunderstandings on which this view is based are now clearer

than they were in the past, and WHO and other international organizations identify the

improvement of mental health as a priority concern for low and middle income countries as well

as for wealthier nations and people (WHO, 2001b).

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Neither mental nor physical health can exist alone. Mental, physical and social functioning are

interdependent. Furthermore, health and illness may co-exist. They are mutually exclusive only

if health is defined in a restrictive way as the absence of disease (Sartorius, 1990). Recognizing

health as a state of balance including the self, others and the environment helps communities and

individuals understand how to seek its improvement.

Along with enthusiasm for the new public health, over the past 20 years the interest in promoting

mental health has grown (Friedli, 2002; WHO, 2002). The fields of mental health and public health

have a long history of weak interactions, despite the possibilities for a stronger working

relationship (Goldberg & Tantam, 1990; Goldstein, 1989). This relates mainly to the stigma of

mental illness, and vagueness in the concepts of mental health and mental illness.

The interest has grown recently for two main reasons. First, mental health is increasingly seen as

fundamental to physical health and quality of life and thus needs to be addressed as an important

component of improving overall health and well-being. The concept of health enunciated by WHO

as encompassing physical, mental and social well-being is more and more seen as a practical issue

for policy and practice. In particular, there is growing evidence to suggest interplay between mental

and physical health and well-being and outcomes such as educational achievement, productivity

at work, development of positive personal relationships, reduction in crime rates and decreasing

harms associated with use of alcohol and drugs. It follows that promoting mental health through a

focus on key determinants should not only result in lower rates of some mental disorders and

improved physical health but also better educational performance, greater productivity of workers,

improved relationships within families and safer communities.

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1.2 The mental Health System in Ghana

In Ghana, there are three publicly acknowledged psychiatric hospitals, namely the Accra, Pantang

and Ankaful Psychiatric hospitals, with a host of private centres helping to manage mental

disorders. Regrettably, the country can boast very few specialists and professional nurses to

manage the heavy load of mental healthcare.

The mental health service in Ghana are available at most levels of care. However, the majority of

care is provided through specialized psychiatric hospitals, with relatively less government

provision and funding for general hospital and primary healthcare based services. The few

community based services being provided are private. In summary most treatment and care is being

provided by specialized hospital, close the capital, Accra, and servicing a small proportion of the

population in need.

The health system overall is decentralized from national, through to regional and district level.

Districts have a reasonable degree of autonomy in providing mental health services and relate both

horizontally to the district level health director and Budget Management Centre (BMC), and

vertically. For vertical reporting, the psychiatric hospital report to the chief psychiatrist while the

district community nurses report to the national coordinator of psychiatry who liaises with the

Chief Psychiatrist.

In October 2014, Human Rights Watch released a damning report which documented the

inhumane treatment of Ghanaians suffering from mental illnesses. In a country where an estimated

three million people live with mental disabilities, the report describes the overcrowding and

unsanitary conditions of three public psychiatric hospitals. The report also sheds light on so-called

spiritual healing centres presided by independent faith healers. Nearly all patients in the eight

centres inspected were chained to trees by their ankles and left to sleep, urinate, defecate and bathe

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on that same spot. Some of the patients had been chained for five months, and some of the patients

were less than 10 years old.

2.3 Socio-Economic Factors Influencing Mental Health Programs

2.3.1 Health Behavior

Mental health also influences physical health through its influence on health behaviour, which is

socially patterned and deeply embedded in people’s social, cultural and material circumstances

(NICE, 2007). The relative contribution of individual characteristics (affect, cognitive and social

skills), social context (peers, social networks, relationships) and material factors (income, access

to health products) is difficult to untangle and interventions to improve health behaviour through

improving mental health (in schools for example) often attempt to address all three areas.

2.3.2 Social Determinants of Mental Health and Public Health Implications

It is already well established that mental illness, across the spectrum of disorders, is both a direct

cause of mortality and morbidity and a significant risk factor for poorer economic, health and

social outcomes, although these adverse outcomes vary by type of disorder and socioeconomic

status (WHO 2005; 2006). However, it is now becoming clear that the presence or absence of

positive mental health or ‘wellbeing’ also influences outcomes across a wide range of domains.

These include healthier lifestyles, better physical health, improved recovery, fewer limitations in

daily living, higher educational attainment, greater productivity, employment and earnings, better

relationships, greater social cohesion and engagement and improved quality of life (WHO 2004b;

Barry & Jenkins 2007).

21
2.3.3 Mental Health and Inequalities

The relationship between a) health, b) material circumstances (indicators of wealth and income)

and c) inequalities (indicators of socioeconomic position) is the subject of debates that have very

significant implications for mental health. If relative deprivation is the major determinant of health,

then emotional and cognitive responses to inequality are of crucial importance.

Rogers and Pilgrim (2003) highlight three key issues in understanding the mental health impact of

socio-economic inequalities:

• social divisions - mental health problems both reflect deprivation and contribute to it.

• social drift - the social and ecological impact of adversity, including the impact of physical

health problems and the cycle of invisible barriers which prevent or inhibit people from

benefiting from opportunities

• social injuries – mental distress as an outcome of demoralisation and despair.

Poor mental health is thus both a cause and a consequence of the experience of social, economic

and environmental inequalities. Mental health problems are more common in areas of deprivation

and poor mental health is consistently associated with unemployment, less education, low income

or material standard of living, in addition to poor physical health and adverse life events. Lone

parents, those with physical illnesses and the unemployed make up 20% of the population, but

these three groups contribute 36% of all those with neurotic disorders, 39% of those with limiting

disorder and 51% of those with disabling mental disorders (Melzer et al., 2004).

A preliminary analysis suggests that higher national levels of income inequality are linked to a

higher prevalence of mental illness and, in contrast with studies of physical morbidity and

mortality, as countries get richer rates of mental illness increase (Pickett et al 2006). As comparable

22
data for more countries become available, it will be possible to estimate the independent,

ecological associations between mental health, inequality and income levels.

Richard Wilkinson’s work analyses relative deprivation as a catalyst for a range of feelings which

influence health through physiological responses to chronic stress, through the damaging impact

of low status on social relationships and through a range of behaviours seen as a direct or indirect

response to the social injuries associated with inequalities (Wilkinson, 2005). These ‘relational

features of deprivation’ have stimulated a greater focus on the psycho-social dimensions of

poverty, for example being ashamed to appear in public and not being able to participate in the life

of the community (Zavaleta, 2007). Recent analysis also suggests a significant relationship

between inequality and levels of violence, trust and social capital (Wilkinson & Pickett, 2007b).

The recently published European ‘Happy Planet’ index for EU countries found that inequalities of

income, education, health and social opportunity are the key factors that have a damaging impact

on wellbeing, with overall sense of wellbeing largely determined by income equality, trust within

the population and voluntary and political engagement (Thompson et al., 2007).

2.3.4 Stigma and Discrimination

There are still attitudes within most societies that view symptoms of psychopathology as

threatening and uncomfortable, and these attitudes frequently foster stigma and discrimination

towards people with mental health problems. Such reactions are common when people are brave

enough to admit they have a mental health problem, and they can often lead on to various forms

of exclusion or discrimination either within social circles or within the workplace ((Reavley &

Jorm, 2011).

23
What is mental health stigma?: Mental health stigma can be divided into two distinct types:

social stigma is characterized by prejudicial attitudes and discriminating behaviour directed

towards individuals with mental health problems as a result of the psychiatric label they have been

given. In contrast, perceived stigma or self-stigma is the internalizing by the mental health sufferer

of their perceptions of discrimination and perceived stigma can significantly affect feelings of

shame and lead to poorer treatment outcomes (Crisp, Gelder, Rix, Meltzer et al., 2000).

In relation to social stigma, studies have suggested that stigmatising attitudes towards people with

mental health problems are widespread and commonly held (Crisp, Gelder, Rix, Meltzer et al.,

2000). In a survey of over 1700 adults in the UK, Crisp et al., (2000) found that (1) the most

commonly held belief was that people with mental health problems were dangerous – especially

those with schizophrenia, alcoholism and drug dependence, (2) people believed that some mental

health problems such as eating disorders and substance abuse were self inflicted, and (3)

respondents believed that people with mental health problems were generally hard to talk to.

People tended to hold these negative beliefs regardless of their age, regardless of what knowledge

they had of mental health problems, and regardless of whether they knew someone who had a

mental health problem. More recent studies of attitudes to individuals with a diagnosis of

schizophrenia or major depression convey similar findings. In both cases, a significant proportion

of members of the public considered that people with mental health problems such as depression

or schizophrenia were unpredictable, dangerous and they would be less likely to employ someone

with a mental health problem (Reavley & Jorm, 2011).

24
2.3.5 Economic Burden

The sizeable and growing public health burden imposed by mental health problems across the

world has been well documented (Whiteford et al., 2001; WHO 2001a), as have low treatment

rates (Kohn et al., 2003). Mental health problems have considerable negative consequences for

quality of life, and in many countries, particularly low- and middle-income countries, they also

contribute to continued economic burden and sub-optimal productivity at the individual and

national levels, through their reinforcing relationships with poverty (Frank, 2001). Moreover, some

of the most serious mental health disorders have their onset in early adulthood when people might

be expected to be at their most economically active (Ustun, 1999).

Tackling this public health burden is a global challenge, for mental health systems in many

countries remain seriously under-resourced and under-developed (WHO 2001a). It has been

calculated that almost 90% of global health expenditure occurs in high-income countries which

have only 16% of the world population (Schieber & Maeda, 1997). This disparity in expenditure

is likely to be worse in the area of mental health because one-third of countries do not have a

specific mental health budget, while 36% of those countries that do, allocate less than 1% of their

public health budget to mental health (WHO, 2001b). There is a widespread view that mental

health problems in low-income countries could and should be tackled at the primary care level

(Institute of Medicine 2000), but on the basis of the current functioning of primary health care,

there is only limited evidence to support such an approach, and there are almost no economic data

(Chisholm et al., 2000; Srinivasa Murthy et al., 2005).

The global burden of mental ill-health is well beyond the treatment capacities of developed

and developing countries, and the social and economic costs associated with this growing burden

will not be reduced by the treatment of mental disorders alone (WHO, 2001c). Evidence also

25
indicates that mental ill-health is more common among people with relative social disadvantage

(Desjarlais et al., 1995).

Mental health and mental illness are determined by multiple and interacting social, psychological

and biological factors, just as are health and illness in general. The clearest evidence relates to the

risks of mental illness, which in the developed and developing world are associated with indicators

of poverty, including low levels of education. The association between poverty and mental

disorders appears to be universal, occurring in all societies irrespective of their levels of

development. Factors such as insecurity and hopelessness, rapid social change and the risks of

violence and physical ill-health may explain this greater vulnerability (Patel & Kleinman, 2003).

Economic levels also have important implications for family functioning and child mental health

(Costello et al., 2003; Rutter, 2003).

2.3 Socio-Cultural Factors Influencing Mental Health Programs

According to Florence (2004) cultural factors exert an influence on many aspects of mental health

care, from the initial seeking of professional help, through the procedures of diagnosis and

treatment, to aftercare and social reintegration, including the organisation of mental health

services. The first resource that individuals and their families utilise in the case of psychiatric

disorders is often the informal network of relatives and friends. If that fails, then the next stage on

the pathway to care depends on cultural factors, particularly beliefs about the causes and treatments

of mental disorders. In developing countries, traditional beliefs usually lead to consultation with a

healer before biomedical services are sought. The scarcity of such services also dictates this course

of action. Ethnic minority groups in a developed country also consult healers in their own

community first, at least until some degree of acculturation is achieved.

26
What becomes clear is that culture and social contexts, while not the only determinants, shape the

mental health of minorities and alter the types of mental health services they use. Cultural

misunderstandings between patient and clinician, clinician bias, and the fragmentation of mental

health services deter minorities from accessing and utilizing care and prevent them from receiving

appropriate care (Brown, Ojeda, Wyn, & Levan, & 2000).

The culture of the patient, also known as the consumer of mental health services, influences many

aspects of mental health, mental illness, and patterns of health care utilization. One important

cautionary note, however, is that general statements about cultural characteristics of a given group

may invite stereotyping of individuals based on their appearance or affiliation. Because there is

usually more diversity within a population than there is between populations (e.g., in terms of level

of acculturation, age, income, health status, and social class), information in the following sections

should not be treated as stereotypes to be broadly applied to any individual member of a racial,

ethnic, or cultural group (Brown, Ojeda, Wyn, & Levan, & 2000).

It has been claimed that psychiatric professionals faced with a person from an unfamiliar culture

are prone to make incorrect diagnoses, mistaking culturally acceptable ideas and behaviour as

indicative of psychopathology. While there is little evidence for these claims, they create an

atmosphere of suspicion in ethnic minority communities which inhibits contacting the services.

Racial prejudice has also been claimed as the cause of differential treatment experiences of

majority and minority ethnic patients. The engagement of patients in follow-up care after treatment

of an acute episode is often fraught with difficulties. Beliefs concerning cure as opposed to

maintenance are culturally influenced (Florence, 2004).

27
Furthermore, patients from ethnic minority groups who feel they have been discriminated against

during their acute care are less likely to comply with aftercare. Full reintegration into the

community depends crucially on the attitudes of the public towards psychiatric illness, and these

vary markedly between cultures. A contentious issue in a multicultural society is whether

dedicated services should be provided for patients from minority ethnic groups. There are strong

arguments for segregated services, including culturally sensitive staff and case of communication

with patients and relatives. However, there is the contrary argument that such services perpetuate

difference and foster discrimination (Florence, 2004).

The task of explaining the relevance of cultural values is complicated somewhat by the fact that in

most of the world’s and for that matter Ghana cultures mental health is a foreign concept. Even so,

it is often possible to identify cultural values directly concerned with the essential features of

mental health.

For example, cultural formulations of suffering as an essential feature of the human condition (e.g.

Buddhist) may complement or displace notions of mental illness; positive subjective experience

may refer to a sense of inner and interpersonal harmony (Wig, 1999) or be construed in religious

terms. The interplay and relative priority of personal achievement and independence in Euro-

American cultures may be contrasted with an emphasis on interdependence and family

commitment in Asia, Africa and elsewhere. In a diverse world, many factors outside the individual

produce stress or provide support that directly influence mental health intervention programs.

Cultural values, social organizations and socioeconomic conditions determine the nature and

availability of opportunities for productive and fulfilling activity.

Like any cultural comparison, ideas about mental health that emerge as products of the world’s

cultures are notable both for shared common features and for striking differences in their emphasis

28
and substance. The clinical formulation of health as the condition resulting from successful

treatment that cures illness often proves to be unsatisfactory, especially outside of clinical settings

where the health of populations rather than individual patients is at stake. Thus, the well-known

WHO definition of health aims to respect the interests of various cultures and avoids the kind of

specificity that would exclude the endorsement or participation of people from any particular

cultural group.

Earlier psychiatric concepts of mental health were mainly concerned with a working model for

clinical practice rather than broader population-based interests of mental health; they were also

less concerned with questions of culture. Among the few psychodynamically oriented clinical

scholars and teachers who explicitly addressed a need to define mental health in the context of

psychiatric assessment, Havens (1984) argued that human connectedness and self-protectiveness

should be regarded as key features. On the other hand, Freud’s relative inattention to the concept

of mental health remains a persistent feature of mainstream psychiatry. Although his famous quip

“to love and to work” seems benign and superficially appealing, Erikson’s (1963, p. 264–5)

elaboration of the remark – emphasizing genital sexuality, procreation and a capacity for recreation

– specifies a cultural ideal that would be unacceptable, if not offensive, in many cultures as a

working definition of mental health, and dated as well, even in Europe and America.

Writing from a feminist and mental health advocacy perspective in Pune, India, Bhargavi Davar

analysed a variety of definitions of mental health (including Erikson’s) formulated from the 1950s

through to the 1970s. She dismissed them as essentially bourgeois, concerned primarily with

promoting conformity and suppressing deviance (Davar, 1999). She argued that the unexamined

effort to generalize local cultural ideals as expectations defining “healthy” works to the

disadvantage of women and others who lack the entitlements and resources to achieve such ideals.

29
Others have argued that multicultural populations in America and Europe are also poorly served

because of too little attention being paid to social contexts and cultural values and by relative

inattention to subjective well-being compared with the predominant interest in the field of

psychopathology (Christopher, 1999).

Mental health for each person is affected by individual factors and experiences, social interaction,

societal structures and resources and cultural values. It is influenced by experiences in everyday

life, in families and schools, on streets and at work (Lahtinen et al., 1999). The mental health of

each person in turn affects life in each of these domains and hence the health of a community or

population. Some of the newest research across the disciplines of genetics, neuroscience, the social

sciences and mental health involves elaborations of ideas about the impact societies have on human

life over and above the sum of the impact of the individual members of the society.

Ethnographic studies show how people living in adverse environments and social settings such as

the slums of Mumbai are faced with problems such as migration and displacement, poor

conditions, unequal distribution of amenities, demolition of housing, homelessness and communal

and ethnic disharmony. These in turn shape local experience and affect the mental health of the

inhabitants and the community. Hopelessness, demoralization, addictions, distress, anger,

depression, hostility and violence can all be linked back to these experiences and problems (Parkar,

Fernandes & Weiss, 2003).

As already noted, mental health implies fitness rather than freedom from illness. In 2003, George

Vaillant in the USA commented that mental health is too important to be ignored and needs to

be defined. As Vaillant pointed out, this is a complex task. “Average mental health” is not the

same as “healthy”, for averaging always includes mixing in with the healthy the prevailing amount

30
of psychopathology. What is healthy sometimes depends on geography, culture and the historical

moment. Whether one is discussing state or trait also needs to be clear – is an athlete who is

temporarily disabled with a fractured ankle healthy or unhealthy? Similarly, is an asymptomatic

person with a history of bipolar affective disorder healthy or unhealthy?

There is also “the two-fold danger of contamination by values” (Vaillant, 2003, p. 1374) – a given

culture’s definition of mental health can be parochial, and, even if mental health is “good”, what

is it good for? The self or the society? For fitting in or for creativity? For happiness or for survival?

Even so, Vaillant advocates that common sense should prevail and that certain elements have a

universal importance to mental health; just as despite every culture having its own diet, the

importance of vitamins and the five basic food groups is universal.

There exist many misconceptions among the general public, politicians and even professionals

regarding the concept of mental health. This is due to the fact that mental health is in many ways

undervalued in our societies. The concept is often confused with severe mental disorders and

associated with societal stigma and negative attitudes.

In developed countries, the organisation of mental health care in a systematic manner is less than

three decades old. Most of the countries have only in the recent times initiated measures to develop

mental health programmes to cover the total populations. The challenges in developing countries

are the lack of mental health infrastructures and trained professionals, public ignorance and lack

of supportive policies, funding and legislation. There are a number of areas where cultural issues

play an important role in the organisation of mental health care. There are both positive and

negative aspects of culture that influence mental health care.

31
On the negative side, the existing beliefs about the supernatural causation lead to seeking initially

help from traditional healers or not considering the illness as requiring medical care. The

differential roles of men and women gets reflected in the differing ways ill men and women are

brought to care. The trend of the population to express their psychological distress in somatic terms

leads to people seeking help mainly from primary health care and being treated for physical

problems rather than the psychological problems. The strong belief of heredity as a cause of mental

disorders presents problems in marriage and breakdown of marriage among the ill persons (Ibid,

2004).

On the positive side, the high tolerance in the community to deviant behaviour in general and

mental illnesses in particular limits "exclusion" of the mentally ill from community life. Ill persons

continue to live in families and communities, especially in the rural areas. There is also less

resistance to setting up of community care facilities like half-way homes, day care centres and

hostels in the residential areas (Ibid, 2004).

2.4 Availability of Mental Health Intervention Programs

It is difficult to estimate the true prevalence of mental disorder and plan effectively for mental

health promotion and treatment without more rigorous, large-scale population-based studies.

However the published research on mental disorders such as psychosis, depression, substance

misuse and self-harm provides insights for future research on the cultural context of these disorders

in Ghana, including risk factors, with important implications for clinical intervention and mental

health promotion (Read, & Doku, 2012).

A major omission in the literature regards studies of the practice and efficacy of psychiatric

treatment in Ghana. Given the scarcity of psychosocial interventions, psychotropic medication is

the mainstay of treatment and has been the topic (Sanati, 2009; Adomakoh , 1972). One study

32
reports that adherence to medication is poor among many patients (Mensah & Yeboah, 2003)

suggesting the need for further research into the reasons for this, and methods by which to improve

both access and adherence.

It is for this reason that in 29 May 2017, Delegates at the World Health Assembly endorsed a

global action plan on the public health response to dementia 2017-2025 and committed to

developing ambitious national strategies and implementation plans. The global plan aims to

improve the lives of people with dementia, their families and the people who care for them, while

decreasing the impact of dementia on communities and countries of which Ghana is not an

exception. It provides a comprehensive blueprint for action, in areas such as: increasing awareness

of dementia and establishing dementia-friendly initiatives; reducing the risk of dementia;

diagnosis, treatment and care; research and innovation; and support for dementia carers (World

Health Organization, 2017).

Through a series of training workshops, broad consultations with key national stakeholders, and

ongoing critical analyses and reviews of the different drafts of the new law using WHO materials

and tools, Ghana has developed a comprehensive Mental Health Bill which protects the rights of

people with mental disorders and promotes mental health care in the community in accordance

with international human rights standards (WHO, 2013).

Mental health services in Ghana are available at most levels of care. However, the majority of care

is provided through specialized psychiatric hospitals (close to the capital and servicing only small

proportion of the population), with relatively less government provision and funding for general

hospital and primary health care based services. The few community based services being provided

are private (Ibid, 2017).

33
Great efforts are being made to change the model of service provision to one which emphasizes

care in the community. However, Ghana's 1972 mental health decree strongly emphasized

institutional care to the detriment of providing mental health care in primary health care settings,

contradictory to both national and international policy directives. Furthermore, procedures for

involuntary admission in the 1972 law did not sufficiently protect people against unnecessary

admission. Indeed, serious mistreatments of people with mental disorders; some have been

involuntarily locked away in institutions for decades have persisted under this legislation. (Ibid,

2017).

In 2011, there was a mental health policy in place dated 1996. Unfortunately, it did not cover the

integration of mental health into primary care nor the protection of human rights of the users, but

it did include the following components: organisation of services, developing community, mental

health services, human resources, involvement of patients and families, advocacy and promotion,

equity of access to mental health services across different groups, financing, quality improvement,

and monitoring system (Mark, Asare, Mogan, Adjase, & Akwasi, 2013).

Policy and plans: Well-defined mental health policies and plans help in the implementation and

maintenance of good governance and leadership. Thus, the existence of a clear mental health policy

and plan are important for improving the organisation and quality of mental health services.

The policy contained a list of essential medicines which had last been revised in 2004. The listed

medicines included: Antipsychotics, Anxiolytics, Antidepressants, Mood stabilizers, and

Antiepileptic drugs. The 2007-2011 Mental Health Strategy contained a budget, timeframe and

specific goals although by 2011, lack of funds had prevented many of the goals being reached. In

2011 there was no emergency / disaster preparedness plan for mental health (Mark et al., 2013)

34
Legislation is a key component of good governance and the upholding of human rights. In 2011

Ghana was on the path to developing a strong legislative position.

The Mental Health Act 846 2012. This new Act was drafted between 2004 and 2006 (and

continued to be modified until it was passed in 2012) with World Health Organisation (WHO)

experts and consultants from South Africa, Zimbabwe, Canada, USA and Switzerland. It received

presidential assent in May 2012, ready for the establishment of a Mental Health Board and

production of a Legislative Instrument. It became law on 1st December 2012 (Mark et al., 2013).

The new Mental Health Act focuses on improving the access to care for people with mental illness

or epilepsy including the poor and vulnerable, safeguarding human rights and promoting

participation in restoration and recovery. Although epilepsy is recognized in Ghana as elsewhere

to be a neurological disorder rather than a mental disorder, it is treated by psychiatrists in Ghana

for convenience on account of shared attributes of stigma and local belief systems. The law

provides for the integration and regulation of spiritual and traditional mental health practices in

Ghana. It supports decentralisation of mental health care and places emphasis on community rather

than institutional care (Ibid, 2013).

Non-governmental funding for mental health in Ghana: Ghana was receiving some funds and

services from international development partners. NGOs were purchasing some medicines when

hospitals ran out of government allocation. Mental health services were not generating significant

revenue, since most patients were too poor to pay fees and by government policy mental health

care was supposed to be free. As a result, internally generated funds were usually relatively small.

35
Mental health care was being purchased directly by some patients and their families via private

services and the traditional / faith-based practitioner systems. Some patients were buying their

own medicines when government supplies were short (Ibid, 2013).

Apart from the above the following programs are necessary:

Mental Health in the Media: Mental Health is changing the way that the media talks about

mental health. Mental health conditions affect one in five adults in the every year, and there should

be more emphasis on early intervention to ensure that they can enjoy the highest quality of life

possible. One of our main priorities is to encourage conversations about mental health and foster

an environment free from stigma and discrimination. This will proactively work to provide

comprehensive, accurate information about mental health by cultivating media relationships and

working to share mental health news via traditional and new media channels (Department of

Health, 2016).

Mental health first aid training for front line community workers: Funding is provided for

mental health first aid training for frontline community workers in the financial and legal sectors,

relationship counsellors, and healthcare workers. These sectors interact with people who may be

in financial, legal or relationship crisis where the risk of suicide is increased. The training has a

specific focus on suicide prevention to help better identify and respond to the needs of people at

risk of suicide or who have attempted suicide Department of Health, 2016).

Support for Day to Day Living in the Community: The "Support for Day to Day Living in the

Community (D2DL): a structured activity program" provides funding to improve the quality of

life for individuals with severe and persistent mental illness by offering structured and socially

based activities. The initiative recognises that meaningful activity and social connectedness are

36
important factors that can contribute to people's recovery. All Governments have made a

commitment that no programme clients will be disadvantaged in the transition Department of

Health, 2016).

Positive Behavior Interventions and Supports (PBIS): focuses on positive social culture and

behavioral support for all students. PBIS is not a specific curriculum, but an approach that

emphasizes the use of the most effective and most positive approach to address even severe

problem behaviors (Michael, et al., 2017). Evidence-based interventions programs are practices or

programs that have peer-reviewed, documented empirical evidence of effectiveness. Evidence-

based interventions use a continuum of integrated policies, strategies, activities, and services

whose effectiveness has been proven or informed by research and evaluation.

2.4.1 Status of Mental Health Intervention Programs in Ghana

Mental health programs are behind schedule in terms of comparing the rate of increase in mental

health cases on street canyons and the impact of the programs thereof. The implementation of

mental health programs in itself is a challenge and many mental health program implementers miss

a crucial point in their quest to address the mental health challenge. This informs that we ask a

suspicious question – do mental health program implementers really understand the concept of

mental health and the factors underpinning it? Probably not, but the answer may lie in decrepitude.

Programs in this regard are implemented not for the sake of the programs but for the sake of the

person’s implementing the programs. The assumptions still may be that their interest takes

precedence. But I am tempted by the literature reviewed so far to think although radical, that the

implementers of these mental health associated programs are mental health patients in themselves.

37
There are programs that only target to reduce the incidence of mental programs among healthy

people. Others also target full grown mental persons in their quest to take them off the street. The

unfortunate event here is that little is achieved for all these targets. For instance programs that

target to take mental persons off the street readily

2.6 Institutional Challenges facing mental health Intervention Programs

2.6.1 Cost and Financing

It is well known that low- and middle-income countries allocate lower proportions of their national

resources to health care, but the global disparity is much more marked when we look at expenditure

on mental health services and treatments. A recent estimate put the percentage of the total health

budget spent on mental health as 1.5% in low-income countries, 2.8% in middle-income countries

and 6.9% in high-income countries (WHO 2003d). Figures such as these do not tell the whole

picture, because some mental health treatment and support will be provided from generic health

budgets such as those allocated to primary care. It is highly unlikely, however, that the mental

health funding proportion from these generic sources will greatly alter the overall picture of very

low provision in low-income countries. In addition, there is very poor integration of mental health

services into general health care in most countries of which Ghana is not an exception.

Mental health budgets might therefore face unexpected threats even though the longer-term

consequences might include substantial growth in the incidence of, for example, post-traumatic

stress disorder.

The National Health Insurance Scheme (NHIS) passed in parliament in 2003 (MOH, 2004 p.26),

ensured universal healthcare services for all residents in Ghana (GHS, 2005, p.46). However, while

it says mental illness is exempt from the insurance Scheme, it implies that patients with mental

38
illness do not qualify to register with the Insurance Scheme. That means when a mentally ill patient

has a physical illness he will have to pay upfront for the cost of that physical illness (UNESCO,

2006). There are special regulations in the new NHIS for every poor people (“registered

indigents”) but for the time being people receiving mental healthcare, even very poor, cannot be

registered as indigent.

And in even the most generously resourced health system, there are numerous barriers to the

implementation of evidence-based mental health care (Lawrie et al., 2001; Wells et al. 2002),

among them financial resource constraints. Financing systems create both the resource base and

the economic incentives and disincentives that affect the implementation of accountable, high

quality, effective mental health care policies in all kinds of health system.

The total amount spent on mental health, as for any health care sector, is hard to calculate exactly.

Spending is being incurred via many routes including: direct government capital and revenue

spending on mental health, indirect government capital and revenue spending on services provided

via district level primary and secondary care and via teaching hospitals, privately funded mental

health care, internationally funded programmes, traditional and faith-based healer-provided mental

health care, and out-of-pocket expenses paid by patients and their families (Mark et al., 2013).

In 2014, the continued poor financing of the Service produced noticeably adversely effects on

health care services across districts and regions. The inability to address issues of inadequate

financing and the pattern of erratic fund flow over successive years is hampering service

delivery efforts as well as maintaining and running district, regional and national offices within

the metal Health service. The majority of funds disbursed in 2014 were earmarked for

implementing only particular programmes. This is reflected in the inability of the Service to

progressively achieve desired service delivery targets (Ghana health service Annual Report, 2014).

39
Inadequate Human Resources

Strengthening the mental health workforce is a global priority. The World Health Organization

(WHO) estimates that 1.18 million additional mental health workers are needed to close the mental

health treatment gap in low- and middle-income countries (Fulton, Scheffler, Auh Vujicic, &

Soucat, 2011). The WHO’s Mental Health Gap Action Program (mhGAP) and a number of

research priority-setting exercises, including the Lancet global mental health group and the Grand

Challenges in Global Mental Health Initiative, have identified mental health workforce expansion

as a key component for improving mental health worldwide (Mental Health Gap Global Action

Program, 2008).

2.6.2 Legal Framework, Policies and Programs

Ghana’s current law, the mental health Decree of 1972, is more than 30 years old, outdated and

serves to take the right of people with mental disorders. The focus of the law is on institutional

care and how to keep ‘sick” individuals off the street as well as how to their belongings and assets.

Patients under the law are not seen as having any human rights or capacity to make decisions.

Indeed, serious mistreatments of people with mental disorders have persisted under this legislation.

There is an official mental health policy which was never implemented due to a lack of

commitment on the par of policy makers and ownership by stakeholders. There is no mental health

plan for Ghana at the moment but a draft five-year program of work for health (2007-2011) of

which metal health is a component.

Mental health legislation needs to create a value base for positive mental health care by

establishing a balance between the rights to autonomy of people with mental health problems and

their protection on behalf of society. Legislation also needs to provide a framework for effective

practice, again balancing the clinical judgment of clinicians and the rights of patients and/or their

40
relatives and/or society. The protection of clinicians also needs to be safeguarded. Although these

balances will never be totally satisfactory to all interested parties, presently legislation in some

countries is dysfunctional, hindering service innovation. There are also some examples where

legislation is so innovative that it is out of touch with reality, and therefore ignored, creating a lack

of respect for mental health and disinterest in modern practice Matt, 2007).

2.6.3 Treatment Gap

A vast gap exists between the need for treatment and the services available. In a European Union

survey published in 2003, 90% of people who said they had mental health problems reported they

had received no care or treatment in the previous 12 months. Only 2.5% of them had seen a

psychiatrist or psychologist. Even in developed countries with well-organized health care systems,

between 44% and 70% of patients with mental health disorders do not receive treatment. For

example, in western Europe alone, evidence indicates that about 45% of people suffering from

depression get no treatment WHO European Ministerial Conference (2005).

2.6.4 Information Systems

The complexity of community care systems can result in the unintentional lack of care or

duplication of services. For psychiatrists to work effectively, they require information to plan, act

and evaluate. It is an obvious statement that systems and processes need to be introduced that assist

efficient clinical work, budget control, planning and inspection. However, in reality such systems

are highly complex and costly. Information functions all require inputs and analysis. There is too

often a tension between expectations of clinicians and managers for minimum input by themselves

but maximum information provided by the system. Designers do not always take into account time

requirements and clinical reality, and expectations of validity can be extremely optimistic.

Considering the importance of information for clinical practice, management and accountability,

41
involvement of clinicians in the design of systems and staff training is rarely adequate (Matt,

2007).

Although clinical, economic and services research over the last two or three decades has made

impressive contributions to the mental health evidence base, almost all of that evidence stems from

and relates to a small number of high-income countries and the kinds of services and treatments

they offer. Some of it, and particularly psychopharmacological research, should generally apply

with equal validity to people with mental health problems in low- and middle-income countries.

However, Soltani et al., (2004) caution that ‘diagnostic categories for common mental disorders,

usually developed in Western countries, may have limited validity’ (p. 65) in other parts of the

world, and Patel et al., (2003) warn that variance in culture and health systems may affect key

parameters such as rates of medication adherence. The brain chemistry action of medications may

not differ significantly across populations, but if situational factors influence whether patients take

their medications, or if religious or other beliefs influence a patient's willingness to accept a

chemical basis for their illness, then the potential for such action will vary. Moreover, a basic lack

of epidemiological data limits the ability of decision-makers to build a top-down framework to

allocate and distribute resources according to need.

2.6.5 Inadequate medical supplies

According Ghana News Agency (2016) Mental health nurses at the Accra Psychiatric Hospital

have embarked on what they call ‘Run from danger’ strike. The nurses claim the numerous

challenges faced by the health facility, including lack of hospital supplies and consumables, have

put their lives at risk because they could be harmed by the patients. A statement by the Psychiatric

Nurses Group (PNG) to the hospital’s management on behalf of the nurses stated, “Staff at Accra

42
Psychiatric Hospital (APH) face numerous challenges which bother on shortage of medication,

inadequate food for patients and lack of basic logistics to carry out our professional duties. “These

problems have become a major source of aggression towards staff (which in some instances to the

point of life-threatening scenarios) ………”. From the report, the health facility has been forced

to stop new admissions and closed its OPD due to the huge debts it owes suppliers as well as non-

availability of medical consumables to work with.

Again, the Regional coordinators of Mental Health Services in Ghana Dr Akwasi Osei have

lamented the severe and persistent shortage of essential psychiatric medicines and supplies for

mental health patients in the country in the whole of 2015. The shortage, reported, had in many

ways affected mental healthcare delivery of the already lackadaisically supported Mental Health

Services of the Ghana Health Service (GHS). To this end, patients and facilities had no option than

to resort to the open market where prices of such medications were very expensive. The situation

also forced most patients and their care givers to refuse review visits since they could not afford

their medications and in some cases not get it at all. The discussions at the review meeting indicated

that the shortage was mainly due to the lack of funds which was not forthcoming from the

government and some bureaucratic procurement processes (Ghana News Agency, 2016).

2.6.6 Insufficiency of resources

Poor recognition of the mental health burden is a particular problem in low-income countries, and

the difficulties in obtaining care are amplified if there is no publicly established pre-payment

scheme to support those needing long-term mental health care (Dixon et al., 2006). People with

mental health problems may be unwilling to seek or pay for treatment. Stigma, ignorance, cultural

considerations and low personal incomes are among the contributory factors.

43
Even in a well-resourced mental health system such as Australia's, only one-third of all people

with a mental disorder consult for treatment (Andrews et al., 2001). In the US, ‘30% to 50% of

adult primary care patients with depression do not have their condition recognised or treatment

initiated’ (Wells et al., 2002, p. 658). The shortfall could be much greater in other countries.

Surveys by the WHO World Mental Health Survey Consortium (2004) found that 36% to 50% of

people with serious mental illness in ‘developed countries’ and 70% to 85% in ‘less developed

countries’ had received no treatment in the previous 12 months (see also Kohn et al. 2003).

Finally, resource insufficiencies are magnified by poor stewardship: examples include overly

bureaucratic departments, failure to plan for the needs of the population, reactive responses to

public dissatisfaction, exclusive focus on legislation and regulation rather than health policy

development, and tolerance of corruption, such as condoning illicit fee collections by public

employees (WHO 2000). There is no reason to believe that mental health is immune from these

difficulties.

Mental health problems also result in a variety of other costs to the society (WHO, 2003). Yet

mental illness and mental health have been neglected topics for most governments and societies.

Recent data collected by WHO demonstrates the large gap that exists between the burden caused

by mental health problems and the resources available in countries to prevent and treat them

(WHO, 2001a). In contrast to the overall health gains of the world’s populations in recent decades,

the burden of mental illness has grown (Desjarlais et al., 1995; Eisenberg, 1998).

44
Resource distribution

Resource insufficiency is clearly the most pressing challenge for mental health care across much

of the world, but there are other difficulties. One is poor distribution, which might refer to

geographical distribution, the type of services provided, or the types of disorders for which services

are provided. It is often the case that mental health services are concentrated in urban areas, with

few services available in more rural areas. Although not a problem unique to low-income countries

(Rost et al., 1999), distance from the major conurbations is often correlated with access to

specialist treatment:

Problems concerning the allocation of resources and the selection and distribution of services are

even more evident in developing countries that face civil and political unrest. In these situations,

the need to prevent fragmentation of services, ensure that people with acute emotional distress are

able to access psychological first aid, and maintain basic treatment for people with pre-existing

mental disorders is paramount (WHO, 2003c).

2.6.7 Resource Inappropriateness

Inappropriate use of resources is linked to, but not exactly the same as, poor distribution. By

inappropriateness we mean the situation where the services available do not match the services

needed or preferred, quite possibly because those needs and preferences are poorly appreciated. A

good example is the dominant resource position of large psychiatric asylums in many mental health

systems across the world, often colonial relics, starved of funding and decaying since

independence. While undoubtedly seen at the time as the appropriate service responses to mental

health needs, offering asylum from a hostile world (Shorter 2006), these large, imposing, heavily

institutional and often geographically remote facilities still accommodate large numbers of

45
distressed people. But they often do so under conditions of very poor quality care and often human

rights abuses.

Conclusion

As argued above, although common to a great many health care systems across the world, these

challenges may be more obstructive in mental health contexts. Moreover, compared with high-

income countries, the effects of these compounding challenges may be amplified in low- and

middle-income countries because of a range of contextual factors. These latter include: multiple

demands on limited resources, ineffective infrastructures for raising revenue, underdeveloped

structures for delivering services, widespread unemployment, individual and national poverty, low

national productivity, corruption in public and private systems and unsupportive (or differently

directed) political priorities. The effect of each barrier on mental health care can thus be seen as

the product of cultural, political, historical as well as economic influences.

46
 CHAPTER THREE
RESEARCH METHODOLOGY

3.0 Introduction

The methodology indicates the way the research objectives are achieved. It introduces the study

area and also the design of study. The chapter further states clearly how data are collected to meet

research objectives, the instruments that are used to collect data, the sampling techniques, sampling

size, source of data employed, data analysis method as well as the ethical considerations associated

with this work.

3.1 Background of the Study Area

The Western Region of Ghana is situated in the south-western part of Ghana. It is bordered on the

east by Central Region, to the west by the Ivory Coast, to the north by Ashanti and Brong Ahafo

Regions and to the south by the Gulf of Guinea. The southern part of Ghana lies in the region at

Cape Three Points near Busua in the Ahanta West Region. The population of the region grew from

1,924,577 in 2000 to 2,376,021 in 2010. With a growth rate of 2.0% the population is estimated to

increase to 4.8 million by 2040. Fifty percent of the population are males and females. The age

structure of the region indicates that, the proportion of the population aged 0 - 14 (under 15 years)

is 39.9%, and those aged 15 - 64 and 65+ are 57.2% and 3.8% respectively.

The region occupies a total land area of 23,760 sq. km, which makes it the fourth largest among

the regions in terms of land size. It has a population density of 99.3 people per sq. km. The region

is 42.4% urban with an annual urban growth rate of 3.5%. The region experiences more inflows

from people to other parts of the country than people moving into the region, this therefore gave

47
the region a net migration value of 282,119 in 2010. With regards to the economy, the labour force

participation rate for population aged 15 - 64 is almost 71.4%.

The region recorded an Infant Mortality Rate (deaths of infants under age one) of fifty infant deaths

per 1,000 live births in 2011. Child Mortality Rate (deaths of children between age one and four)

was 17 deaths per 1,000 live births, this was the lowest among the regions and Under Five

Mortality (number of children who die by age five) was reported as 67 deaths per 1,000 live births.

Maternal Mortality Rate (relates the number of deaths due to pregnancy related causes to the

number of women of the child-bearing age group,15 - 49 years) in the region, was 435 per 100,000

live births in 2010, this was lower than the national value of 485 per 100,000 live births.

The Total Fertility Rate (TFR) of the region is slightly lower (4.2) as compared to the national

TFR of 4.0, showing that on the average women in the Western Region give birth to four children

as do all women in Ghana. In addition there are four births per every 100 adolescents in the region,

which is among the highest compared to the other regions. With regards to Contraceptive

Prevalence Rate (CPR), the use of modern contraceptives among currently married women

(Contraceptive Prevalence Rate) was 23.3% in 2014. In 2013, the HIV prevalence rate in the region

was 2.4%, has compared to the national HIV prevalence of 1.3%.

3.2 Study Design and Type

A range of methods were used to arrive at the research findings. This study adopted a survey study

design. A survey according to Tariq (2009) is a method of gathering information from a number

of individuals, known as a sample, in order to learn something about the larger population from

which the sample is drawn. This study uses the survey method because it involves a statistical

study of a sample population by asking questions on the socio-economic factors that influence

48
mental health programmes, socio-cultural practice that influence mental health, the available

mental health intervention programmes, and the institutional challenges facing mental health. The

study was based on questionnaire and interview guide. The survey design was employed because

it helps the researcher to solicit the needed information to arrive at a tangible conclusion on mental

health issues. This study type was descriptive in nature. The study was descriptive because it

describes the views of respondents on mental health. The study sought to describe events as they

were at the time of interview and questionnaire administration.

3.3 Study Population

Brink (2006) defines study population as “an entire group or persons or objects that are of interest

to the researcher”. Therefore the population of the study will constitute mental health officers,

medical directors, medical superintendents, family members of people with mental health

conditions. It is believed that these categories of respondents were in the right position to respond

to the research questions appropriate hence the main reason this population was chosen.

3.4 Study Variables

The research is made of two main variables namely dependent and independent. The dependent

variable in this study is poor mental health programs while the independent variables are socio-

economic factors, socio-cultural factors, availability of mental health programs, logistics and

supplies, human resource, finances, work force and politics.

3.5 Sampling Techniques and Sample Size

The study employed two sampling techniques thus; the probability and the non-probability

sampling techniques.

49
Non Probability Sampling Technique

Under the non-probability sampling technique, purposive sampling technique was used to select

key informants. The purposive sampling technique was used because the researchers have a

particular target in mind that could provide the needed information to satisfy the study objectives.

The purposive sampling technique was used to choose the only few health facilities in the regions.

Probability Sampling Technique

Under the probability sampling technique simple random sampling was used. Moving to the

selection of respondents for the study, the researcher used simple random sampling technique to

select one region out of the ten (10) regions in the Ghana through balloting. All the names of the

ten (10) regions districts were written on pieces of papers and shuffled. One paper was selected at

random which happened to be Western region. The simple random sampling technique was used

by the researcher for the study to ensure that all students have equal and independent opportunity

to participate.

Again, the same technique was used to select five (5) districts out of the twenty-two (22) in the

region; namely Wasa Amenfi West District, Sekondi-Takoradi, Ahanta West, Wassa West

(Tarkwa) and Ellembele District. A sample size of 200 respondents was used for the study

including key informants and families of people with mental health conditions in the selected

districts.

3.6 Data Collection Techniques

Both secondary and primary data collection methods are used during the research. Secondary data

sources are used to access information from books, journals, magazines, reports and the Internet.

Under the primary data collection method, both quantitative (survey structured questionnaire) and

50
qualitative methods (in-depth interviews and participant observation) are used through well-

structured questionnaire.

3.6.1 Questionnaire

The questionnaire was self-structured and administered. The questionnaire has some open-ended

questions as well as closed or multi-choice questions that required respondents to choose from

already listed possible answers. Confidentiality was also guaranteed as questionnaires were

returned anonymously. The questionnaires were written in English and were translated into the

language that the respondents especially families members of people suffering from mental illness

understand better.

3.6.2 Interview

A fully structured interview was used with the face to face approach. The fully structured interview

will be used to collected data from those respondents who could not read nor write, literate

respondents and other key informants, which helped in gaining vital information for the

achievement of the set objectives.

3.7 Data Processing and Analysis

The data collected was examined and analyzed objectively to capture and present an excellent

insight into the research topic. Quantitative data analysis method was used with the aid of

Statistical Package for Social Sciences (SPSS) version 23.0 in the analysis of the data. By the use

of this software, appropriate tables, frequencies and charts were generated which aided in easy

understanding of the research results. The software was chosen due to its easy, appropriate and

quality analysis method. Data was presented in tables, and charts for interpretation and analysis,

based on frequency distributions, percentages, and descriptive analysis on the variables under

study.

51
3.8 Ethical Consideration

To obtain ethnical consideration for the study as this requires a clear comprehension on the part of

the respondents as to the intended purpose of the assurance of anonymity and the fact that their

responses will be treated with the strictest confidentiality due to the nature of this topic. The

researcher obtained introductory letter from the department/Faculty of ………………..as evidence

for the data collection process. Informed consent was obtained from each respondent before the

commencement of each interview using the questionnaire.

Permission was sought from the facilities in which the questionnaire will be administered, stating

clearly the objectives of the study, what was involved and its significance, before proceeding.

Verbal consent was also obtained from the family members of persons with mental conditions on

the day of the interviews, after the nature of the survey has been explained to them, and all their

questions have been answered.

3.9 Limitations of Study

The study was limited to selected districts in the western region but could not collect data from the

entire population understudy due to lack of sufficient funds. The sampling procedure used for the

respondents might have excluded some respondents for the study. Time did not also permit the

researcher to include larger sample size to ensure more appropriate results since the larger the

sample size the more accurate the outcome of the study. However, with the use of systematic

sampling technique in selecting the respondents, the researcher believed that the error of sampling

bias was minimized and inference could made to the general population.

52
 CHAPTER FOUR

PRESENTATION AND INTERPRETATION OF DATA

4.0 Introduction

This section of the study details the results analyzed from the responses obtained from the

respondents. It is presented largely descriptively in the form of tables and charts and organized

according to the objectives of the study.

4.1 Demographic Characteristics of the Respondents

Table 2: Demographic Characteristics of Respondents

Variable Response Frequency (N) Percentage (%)

Gender Male 124 68.8
Female 56 31.2
Total 180 100.0
Marital status Married 52 28.7
Single 45 25.0
Divorced 77 42.7
Widowed 8 3.70
Total 180 100.0
Educational level Basic/Primary 104 57.7
Secondary/Technical 9 5.00
Tertiary 4 2.20
None 63 35.0
Total 180 100.0
Religion Christians 126 70.0
Moslems 45 25.0
Traditionalist 9 5.00
Other 0 0.00
Total 180 100.0
Occupation Self-employed 52 28.8
Employed by private sector 5 2.50
Government employee 6 3.40
Unemployed 117 65
Total 180 100.0
Source: Field Survey, 2017

53
Table 2 depicts the demographic characteristics of the respondents. Findings as the above table

indicated majority 68.8% of the respondents were males while (31%) of the respondents were

females. The marital status of the respondents revealed that higher number (42.7%) of the

respondents were divorced, (28.8%) of the respondents were married, whereas (25%) of the

respondents were single. With respect to respondents’ educational level, it is worrying to note that

more than half (57.5%) of the respondents attended basic/primary school, followed by (35%) of

the respondents who had no education at all. Again, religious affiliation of respondents indicated

that majority (70%) of the respondents were Christians, (25%) were Moslems, whiles the

remaining (2.5%) of were traditionalist. Finally, the occupation of the respondents revealed that

(65%) of the respondents were unemployed, followed by (28.7%) who were self-employed,

whereas only (3.7%) were government employees.

4.2 Socio-Economic Factors Influencing Mental Health Programs

Table 3: Social Factors Influence Mental Health Programs

Response Frequency (N) Percentage (%)

Stigma and Discrimination 90 50.0
Influence on health behavior 14 7.50
Poverty 34 18.8
Trust and social capital 5 2.5
Insecurity and hopelessness 18 10
Rapid social change and risks of violence 16 8.70
Peer influence 4 2.5
Total 180 100
Source: Field Survey, 2017

Table 3 above depicts some of the social factors the influence mental health programs. The results

obtained revealed that half (50%) of the respondents stated stigmatization and discrimination,

poverty was 18.8% while between 2-10% of the respondents affirmed insecurity and hopelessness,

54
rapid social change and risks of violence, influence on health behavior, trust and social capital,

and peer influence.

3%

33%

Yes
64% No
Don't know

Source: Field Survey, 2017

Figure 1: Mental Illness Is Self-Inflicted

Findings per above figure indicated that majority (64%) of the respondents affirmed that mental

illness is not self-inflicted; with the reason “that there are external issues within the society that

are likely to trigger mental illness”. On the other hand, for (33%) of those who responded yes,

explained that “mental illness is self-inflected because some people are engaged in unhealthy

behavior which leads them into such circumstances”

55
 5%

15%

Yes

No
80% Don't know

Source: Field Survey, 2017

Figure 2: People with Mental Illness Hard to Talk To

Data obtained from above figure indicated that vast majority (80%) of the respondents attested that

people with mental illness are hard to talk to. Probing further to know why they said so, the

following were their explanations:

Table 4: Opinion on the reason why people with mental illness are difficult to talk to

Reasons Frequency (N) Percentage (%)

Their physical and emotional appearance change. 57 31.6
Don’t know how to approach them. 34 12.2
Interpretation between two parties becomes difficult. 9 5.0
They can't communicate properly. 10 5.6
They think when they open up, society will discriminate against 22 18.9
them.
They do not think the way normal people think. 8 4.4

They seems not serious when you are talking to them on an 3 1.7
important issues.
They sometimes use words which does not make sense. 23 12.8
You don't know whether the person understands you or not. 14 7.8
Total 180 100.0
Source: Field Survey, 2017

56
The table above indicate some of the reason why respondents perceived people with mental illness

hard to talk to. It turned out that (31.6%) of the respondents said because of the changes in their

emotional and physical appearance, (19%) indicated that when they open up, society will

discriminate against them, (12.8%) of the respondents indicated they sometimes use words which

does not make sense, (12.2%) also said they do not know how to approach them, whiles between

(2-8%) of the respondents stated that, interpretation between two parties becomes difficult, can't

communicate properly, do not think the way normal people think, don't know whether the person

understands you or not and they seems not serious when you are talking to them on an important

issues
,

100 94
80
60
40
20 4
0
2
True False Don't know

Response
Source: Field Survey, 2017

Figure 3: People with Conditions Are Unpredictable and Dangerous

Findings from figure 3 revealed that preponderance of respondents affirmed that persons with

metal conditions are unpredictable and dangerous while the rest responded otherwise. It was

explained that such people are mostly noted to be wee smokers, drugs addicts and alcoholics.

57
 45

40

35
Percentage of Respondents

30

25

20

15

10

0
It is They are They can They can They can They can't They do They
sometime mostly harm you harm you hit you reason whatever normally
s difficult aggressiv anytime when with any well comes in behaves
to know e and aggressiv object their abnormall
their next irritable e available mind y
move
Percentage (%) 3.9 11.7 3.9 12.8 11.1 3.9 44.4 8.3

Source: Field Survey, 2017

Figure 4: Reasons why People with Mental Conditions are Unpredictable and Dangerous
When respondents were asked to explain why people with mental condition are unpredictable and

dangerous, it was revealed that (44.4%) of the respondents indicated they do whatever comes in

their mind, (12.8%) said they can harm you when aggressive, and (11.7 %) stated they are mostly

aggressive and irritable, (11%) claimed such people can easily hit you with available object,

58
(8.3%) said they normally behaves abnormally, whereas (4%) of the respondents stated that it is

sometimes difficult to know their next move and cannot reason well as expected.

5% 10%

Yes

No

Don’t know
85%

Source: Field Survey, 2017

Figure 5: People with Mental Illness are likely to be employed

When respondents were asked whether people with mental illness are to be employed, the study

found that majority (85%) of the respondents attested they are not likely to be employed, (10%)

stated they are likely to be employed.

Table 5: Why People with Mental Illness Likely not to be employed

Reasons Frequency (N) Percentage (%)

They are not likely to be employed because they lack the 35 19.4
mental capacity to perform.
Difficult to follow simple instructions. 23 12.8

Some employers considered these people as good for nothing 39 21.7

in most cases.

Such people are not of sound mind to cope 55 30.6

59
 They will not conform to the rules and regulations governing 8 4.40
the work.

Their condition does not favor them. 20 11.1

Total 180 100.0

Source: Field Survey, 2017

Findings as per above table represents reasons why people with mental condition are not likely to

get employment. The reasons and their respective percentages are as follows, such people are not

of sound mind to cope (30.6%), some employers considered these people as good for nothing in

most cases (21.7%), they are not likely to be employed because they may lack the mental capacity

to perform (19.4%), they are difficult to follow simple instructions (12.8%), their condition does

not favor them (11.1%), they will conform to the rules and regulations governing the work and

they will not conform to the rules and regulations governing the work (4.4%).

Table 6: Statements on Socio-Economic Issues Influencing Mental Health Programs

Statement Response
1 2 3 4 5 Total
Poor mental health programs are a consequence of
social, economic and environmental inequalities 0.00 3.70 15.0 37.5 43.8 100.0
Poor mental health programs is consistently
associated with unemployment. 2.50 3.70 41.3 35.0 17.5 100.0

Poor mental health is associated, less education,

low income or material standard of living.
0.00 0.00 12.5 62.5 25.0 100.0
Higher national levels of income inequality are
linked to a higher prevalence of mental illness and
low intervention programs 18.7 2.50 17.5 32.5 28.8 100.0
Mental health problems have considerable
negative consequences for quality of life in low-
and middle-income countries 6.30 8.70 26.3 25.0 33.7 100.0
The country is under-resourced and under-
developed to finance mental health intervention
programs. 10.0 13.8 23.7 27.5 25.0 100.0
Source: Field Data, 2017

60
KEY: 1=Strongly Disagree, 2= Disagree, 3= Fairly Agree, 4=Agree and 5= Strongly Agree
Scale 1+2=Disagree and 3+4+5=Agree

Table 5 illustrates the socio-economic factors that influence mental health programs. Finding as

per above table indicated that the high scores of 3+4+5 of 50% and above is an indication that

majority of the respondents agreed that, poor mental health programs are a consequence of social,

economic and environmental inequalities, mental health consistently associated with

unemployment, poor mental health is consistently associate with less education, low income or

material standard of living, poor mental health is consistently associated, less education, low

income or material standard of living, higher national levels of income inequality are linked to a

higher prevalence of mental illness and low intervention programs, mental health problems have

considerable negative consequences for quality of life in low- and middle-income countries, and

then country is under-resourced and under-developed to finance mental health intervention

programs.

4.3 Socio-Cultural Factors Influencing Mental Health Programs

Table 7: Explanation of mental illness by respondents

Reasons Frequency (N) Percentage (%)

A person whose brain is damaged. 12 6.7
An illness that affects the brain and change the person’s 27 15.0
behavior.
An illness that makes people loss contact with reality 3 1.7
Emotional instability of the individual. 30 16.7
It is a wide range of condition that affect the mode, thinking 8 4.4
and behavior.
It is an illness that contradictory to the normal person 26 14.4
People without sound mind. 57 31.7
When someone is behaving in certain conditions due to 17 9.4
smoking, drug abuse, drinking.
Total 180 100.0
Source: Field Data, 2017

61
The table above shows the explanation of mental illness by respondents. The study found that

(31.7%) of the respondents explained mental illness as people without sound mind, (16.7%)

emotional instability of the individual, (15%) an illness that affects the brain and change the

persons behavior (14.4%) it is an illness that is contradictory to the normal person, (9.4%) when

someone is behaving in certain conditions due to smoking, drug abuse, drinking, (6.7%) person

whose brain is damaged, (4.4%) it is a wide range of condition that affect the mode, thinking and

behavior, and (1.7%) an illness that makes people loss contact with reality.

30
30
Percentage of Respondnets

25
25
20

15
16.3
10
10
12.5
5
6.3
0
Poor Unequal Demolition of Homelessness Ethnic Migration
conditions distribution housing disharmony and
of amenities displacement
Response

Source: Field Data, 2017

Figure 6: Factors that influence Mental Health Conditions

Figure 6 indicated some of the social factors that influence mental health conditions. The study

found a higher proportion (30% ) of the respondents stated homelessness, this was immediately

followed by (25%) who said is due to poor conditions, (16.3% ) of the respondents stated unequal
62
distribution of amenities, (12.5%) ethnic disharmony, while the remaining (10%) and (6.3%)

affirmed demolition of housing and migration and displacement respectively.

25%
Yes
No
75%

Source: Field Data, 2017

Figure 7: Availability of Mental Health Facilities

When respondents were asked whether there were any mental health facilities in their community,

it turned out that majority (75%) of the respondents indicated there were not, whereas the

remaining (25%) said there were mental health facility in their respective communities.

Spiritualist 43.7
Response

Pastor 37.5

Mental health 6.3

practitioner

Herbalist 12.5

0 10 20 30 40 50
Percentage of Respondents

Source: Field Data, 2017

Figure 8: First line of contact when the condition began
63
Data gathered from above figure 6 indicated a higher proportion (43.7%) of the respondents

consulted the spiritualist, (37.5%) went to the pastor within their community, (12.5%) herbalist,

while just few consulted the mental health practitioner. Few of the respondents reported that they

would like to go to a psychiatrist when their family members are suffering from mental illness.

Table 8: Beliefs on the Causes and Treatments of Mental Disorders

Response Frequency (N) Percentage (%)
Causes
Broken heart and smoking 7 3.90
Cultural Bases 15 8.30
Divorce 13 7.2
Disappointments 8 4.40
Peer pressure and unhealthy behavior 9 5.00
Witchcraft and curses 20 11.1
The use of hard drugs 28 15.6
Too much thinking 3 1.70
Curses from gods and ancestors 16 8.9
Treatment
Divination 14 7.8
Mental illness is not completely treatable and takes a
very long time 34 18.9
Keeping fasting or a faith healer can cure them from
mental illnesses 6 3.3
Such people always need to seek for spiritual cleansing
7 3.9
Total 180 100.0

Source: Field Data, 2017

From table 7 participants were asked to state their beliefs on the causes and treatment on mental

disorders. On the causes of mental disorders (15.6%) of the respondents stated it is caused by the

use of hard drugs, (11.1%) peer pressure and unhealthy behavior, (8.9%) curses from gods and

ancestors, while the remaining perceived causes to be divorce, cultural bases, disappointments, too

much thinking, broken heart and smoking, witchcraft and curses. Again when it comes to the

beliefs on the treatment mental disorders, 19% of the respondents stated that mental illness is not

completely treatable and takes a very long time, (7.8%) of the respondents said it can be treated
64
through divination, whiles the remaining (3.9%) and (3.3%) of the respondents indicated such

people always need to seek for spiritual cleansing and keeping fasting to cure them from the

conditions.

Table 9: Issues on Socio-Cultural Factors Influencing Mental Health Programs

Statement Response Frequency (N) Percentage (%)

Mental illness are caused by curses from Agree 151 83.7
the gods and ancestors Disagree 29 16.3
Total 180 100.0
My Culture shape the mental health Agree 124 68.7
programs and alter the types of services Disagree 56 31.3
used. Total 180 100.0
The attitude of some mental health Agree 153 85.0
practitioner deters us to seek for services. Disagree 27 15.0
Total 180 100.0
Racial prejudice is the cause of differential Agree 155 86.3
treatment of illness. Disagree 25 13.7
Total 180 100.0
It is often possible to identify cultural Agree 135 75.0
values directly concerned with the essential Disagree 45 25.0
features of mental health. Total 180 100.0
Mental health is in many ways undervalued Agree 167 93.7
in our societies. Disagree 13 7.20
Total 180 100.0
Mental illness is associated with societal Agree 180 100.0
stigma and negative attitudes Disagree 0 0.00
Total 180 100.0
Mental health for a person is affected by Agree 158 87.5
social interaction, societal structures and Disagree 22 12.5
resources and cultural values. Total 180 100.0
Source: Field Data, 2017

Findings per above table 7 illustrates some of the socio-cultural issues surrounding mental health

programs. The study revealed that majority of the respondents between 70-100% all agreed that,

mental illness is caused by curses from the gods and ancestors, culture can shape the mental health

programs and alter the types of services used, attitude of some mental health practitioner deters

them to seek for services, racial prejudice is the cause of differential treatment of illness, it is often

65
possible to identify cultural values directly concerned with the essential features of mental health,

mental health is in many ways undervalued in their society, mental illness is associated with

societal stigma and negative attitudes, and mental health for a person is affected by social

interaction, societal structures and resources and cultural values.

4.4 Availability of Mental Health Intervention Programs

1%

30%

Yes
No
69%
Don’t know

Source: Field Data, 2017

Figure 9: The Availability of Mental Health Intervention Programs
From figure 9, majority (69%) of the respondents affirmed that there were no mental health

intervention program at time of the study, whiles (30%) of the respondents said there were

intervention programs.

66
 40

35
Percentage of Respondents

30

25

20 40

15

10 20
15
5 10 10
5
0
Mental health School mental D.F.I.D Rehabilitation Outreach and Education on
week health program program home visits mental health
celebration programs
Programs

Source: Field Data, 2017

Figure 10: Mental Health Programs
When respondents were asked to state the mental health intervention programs, (40%) of the

respondents embarked on outreach and home visits, (20%) undertook school mental health

programs, (15%) Department for International Development (D.F.I.D) program, whereas (10%)

and (5%) indicated mental health week celebration, education on mental health, and rehabilitation

program.

67
Table 10: Nature/Type of Program

Programs Frequency (N) Percentage (%)

National programs 2 10.0
Regional programs 1 5.0
District programs 3 15.0
Donors programs 2 10.0
Facility programs 12 60.0
Total 20 100
Source: Field Data, 2017
Table 9 illustrates the type of health intervention programs. The study found that majority (60%)

of the respondents affirmed their programs were from the facility level, (15%) of the respondents

indicated district programs, (10%) of the respondents indicated national and donors programs

simultaneously, whiles only (5%) of the respondent stated regional programs.

20%

Yes
No
80%

Source: Field Data, 2017

Figure 11: Whether the Programs Were Successfully Executed

68
Findings as per above figure11 indicated that majority (80%) of the respondents attested the above

stated programs from table 9 were not successfully executed while (20%) of the respondents

affirmed that these programs were successfully executed.

Table 11: Why These Programs were not successfully executed

Response Frequency (N) Percentage (%)

Inadequate psychotropic drugs 1 5.0

Lack of funds to organize the programs 9 45.0

Lack of psychiatric unit and nurses 5 25.0

Stigmatization 5 25.0

Total 20 100

Source: Field Data, 2017

From this table respondents were again asked to explain why these programs were not successfully

executed. It was found that (45%) there is lack of funds to organize the programs, (25%) attested

lack of psychiatric unit and nurses while (5%) of the respondents there was inadequate

psychotropic drugs.

4.5 Institutional Challenges Facing Mental Health Programs

Table 12: Challenges Affecting Mental Health Programs

Question Response Frequency (N) Percentage (%)

Are there challenges that affect mental Yes 20 100.0
health programs? No 0 0.00
Total 20 100.0
Challenges
Inadequate infrastructure and logistics 5 25.0
Lack of financial support from government 9 45.0
Lack of support from family members 1 5.00
Inadequate human resource 3 15.0
Stigmatization an discrimination 2 10.0
Total 20 100.0
Source: Field Data, 2017
69
Data gathered from table 11 portrays the institutional challenges that affect the mental health

programs. When respondents were asked to whether there were challenges affecting mental

programs, all (100%) of the respondents unanimously affirmed there are challenges affecting

mental health programs in their respective facilities. Among the challenges were, lack of financial

support from government (45%), inadequate infrastructure and logistics (25%), inadequate human

resource (15%), Stigmatization and discrimination (10%) and lack of support from family

members (5%).

70
 CHAPTER FIVE

DISCUSSION OF RESULTS

5.0 Introduction

This section deals with the various issues identified in the chapter four and are discussed

accordingly with the intended objectives set by the researcher. Also in this chapter literature will

be used to support the results obtained so as to add more weight to the discussion.

5.1 Demographic Data of Respondents

To better under the issues under discussion, the researcher find necessary to to gather demographic

data on the respondents to ascertain whether there exist a relationship between some mental

conditions and demographic variables.

Findings indicated majority 68.8% of the respondents were males while (31%) of the respondents

were females. It means there were more males than females suffering from mental conditions. The

possibility could be that more man are engaged in unhealthy behavior as compared to women;

even though there are other social and social and environmental issue that trigger mental

conditions. The marital status of the respondents revealed that higher number of respondents were

divorced, were married, whereas others were single.

When it comes to respondents’ educational level, it is worrying to note that more than half (57.5%)

of the respondents attended only basic/primary school, whiles the rest of the respondents who had

no education at all. The religious affiliation of respondents revealed that majority (70%) of the

respondents were Christians. It implies that the community is a Christian dominated one. Finally,

71
the occupation of the respondents’ revealed majority (65%) of the respondents were unemployed,

followed by 28.7% who were self-employed. It is deduced from the above that there higher

incidence of unemployment is these areas. This results is in line with survey conducted by Siddiqi

and Siddiqi (2007) who urged that the impact of mental health issues is considerable particularly

in low-income countries where key risk factors including poverty, underemployment and

unemployment

4.2 Socio-Economic Factors Influencing Mental Health Programs

The study found some of the social factors the influence mental health programs. The results

obtained revealed that half 50% of the respondents stated stigmatization and discrimination,

poverty insecurity and hopelessness, rapid social change and risks of violence, influence on health

behavior, trust and social capital, and peer influence. It deduced from the findings above that there

are social factors that affect mental health intervention programs. These social issues include

internal and external variables that has implications on mental health and its corresponding

intervention programs in Ghana. It for this reason that Patel and Kleinman (2003) contended that

the association between poverty and mental disorders appears to be universal, occurring in all

societies irrespective of their levels of development. The study further elucidated that factors such

as insecurity and hopelessness, rapid social change and the risks of violence and physical ill-health

may explain greater vulnerability.

Findings indicated that majority 64% of the respondents affirmed that mental illness is not self-

inflicted; with the reason “that there external issues within the society that are likely to trigger

mental illness”. On the other hand, for 33% of those who responded yes, explained that “mental

illness is self-inflected because some people are engaged in unhealthy behavior which leads them

72
into such circumstances” The study found that that vast majority 80% of the respondents attested

that people with mental illness are hard to talk to. Probing further to know why they said so, the

following were their explanations:

Participants commonly believed that people with mental illness are hard to talk to because, of the

changes in their emotional and physical appearance, when they open up, society will discriminate

against them, they sometimes use words which does not make sense, interpretation between two

parties becomes difficult, they can't communicate properly, they do not think the way normal

people think, they don't know whether the person understands you or not and they seems not

serious when you are talking to them on an important issues. It is therefore implies that people

have varied views on mental health issues in our society.

Participants explained that:

People with mental illness do whatever comes in their mind, they can harm you when aggressive,

mostly aggressive and irritable, such people can easily hit you with available object, normally

behaves abnormally, and sometimes difficult to know their next and cannot reason well as

expected. From the study it was revealed that preponderance of respondents affirmed that persons

with metal conditions are unpredictable. From the issues above it is deduced that people have

totally stigmatized mental health which can have an effect on any intervention program.

The study found that majority (85%) of the respondents attested people with mental illness are not

likely to be employed. When it comes to the reason why people with mental condition are not

likely to get employment. Respondents were of the view that: such people are not of sound mind

to cope, some employers considered these people as good for nothing in most cases, lack the mental

capacity to perform, difficult to follow simple instructions, their condition does not favor them,

73
and they will conform to the rules and regulations governing the work. This is in line with a survey

in the UK by Crisp et al., (2000) who found that (1) there is most commonly held belief that

people with mental health problems were dangerous – especially those with schizophrenia,

alcoholism and drug dependence, (2) people believed that some mental health problems such as

eating disorders and substance abuse were self-inflicted, and (3) respondents believed that people

with mental health problems were generally hard to talk to.

On the other hand Reavley and Jorm, (2011) opined that such reactions are common when people

are brave enough to admit they have a mental health problem, and they can often lead on to various

forms of exclusion or discrimination either within social circles or within the workplace. In both

cases, a significant proportion of members of the public considered that people with mental health

problems such as depression or schizophrenia were unpredictable, dangerous and they would be

less likely to employ someone with a mental health problem (Reavley & Jorm, 2011).

The study again concentrated on the socio-economic factors that that influence mental health

programs. The findings showed the high scores of 3+4+5 of 50% and above is an indication that

majority of the respondents agreed that, poor mental health programs are a consequence of social,

economic and environmental inequalities, mental health consistently associated with

unemployment, poor mental health is consistently associated, less education, low income or

material standard of living, poor mental health is consistently associated, less education, low

income or material standard of living, higher national levels of income inequality are linked to a

higher prevalence of mental illness and low intervention programs, mental health problems have

considerable negative consequences for quality of life in low- and middle-income countries, and

the country is under-resourced and under-developed to finance mental health intervention

programs. It is therefore deduced from the study that study that, respondents agreed on the socio-

74
economic factors that influence mental health programs. WHO (2001a) indicated in a survey that

mental health systems in many countries remain seriously under-resourced and under-developed.

For this reason WHO (2005) argued that it is well established mental illness, across the spectrum

of disorders, is both a direct cause of mortality and morbidity and a significant risk factor for poorer

economic, health and social outcomes, although these adverse outcomes vary by type of disorder

and socioeconomic status. In the same vain evidence also indicates that mental ill-health is more

common among people with relative social disadvantage (Desjarlais et al., 1995). This findings is

consistent with WHO (2001c) that stated the global burden of mental ill-health is well beyond

the treatment capacities of developed and developing countries, and the social and economic costs

associated with this growing burden will not be reduced by the treatment of mental disorders alone.

5.4 Socio-Cultural Factors Influencing Mental Health Programs

To understand the perspective on the explanation of mental illness by respondents. The study

found that respondents explained mental illness as people without sound mind, emotional

instability of the individual, an illness that affects the brain and change the persons behavior it is

an illness that contradictory to the normal person, when someone is behaving in certain conditions

due to smoking, drug abuse, drinking, person whose brain is damaged, it is a wide range of

condition that affect the mode, thinking and behavior, and an illness that makes people loss contact

with reality. There is a wide range of understanding of mental health and perception on the

explanation of mental which is based partly on the person’s background, cultural differences and

social orientation. The study also uncover some of the social factors that influence mental health

conditions. It turned out that a higher proportion of the respondents stated homelessness, poor

conditions, stated unequal distribution of amenities, ethnic disharmony, demolition of housing and

migration and displacement.

75
On the availability of mental health facilities in the study area, the study found that majority of the

respondents affirmed that there were no mental health facilities in their communities. This means

that there is lack of mental health units for easy accessibility by mental health patients. It implies

that the supply of community mental health facilities (eg office and clinic space) and resources (eg

medication supplies and transport) to support community mental health practice is very

insufficient. This therefore explains why most family members has no option than to consult

people who have no skills in delivering mental health services. This study in consistent with

Brown, Ojeda, Wyn, and Levan (2000) who argued that cultural misunderstandings between

patient and clinician, clinician bias, and the fragmentation of mental health services deter

minorities from accessing and utilizing care and prevent them from receiving appropriate care.

Data gathered from study indicated that respondents consulted the spiritualist, pastor, herbalist,

while just few consulted the mental health practitioner. Their option for consulting these people

could be attributed to the fact that there were few mental health facilities within their location and

also Ghanaians in general are spiritually minded when they are confronted with any eventuality.

By the time they the person is sent to the mental health officer/practitioner the condition might

have been worse. Few of the respondents reported that they would like to go to a psychiatrist when

they or their family members are suffering from mental illness.

When participants were asked to state their beliefs on the causes and treatment on mental disorders.

respondents said it is caused by the use of hard drugs, peer pressure and unhealthy behavior, curses

from gods and ancestors, while the remaining perceived causes to be divorce, cultural bases,

disappointments, too much thinking, broken heart and smoking, witchcraft and curses. Again when

it comes to the beliefs on the treatment mental disorders, respondents stated that mental illness is

76
not completely treatable and takes a very long time, it can be treated through divination, whiles

respondents indicated such people always need to seek for spiritual cleansing and keeping fasting

to cure them from the conditions. For this reason Florence (2004) opined that the engagement of

patients in follow-up care after treatment of an acute episode is often fraught with difficulties and

beliefs concerning cure as opposed to maintenance are culturally influenced.

Findings revealed the socio-cultural issues surrounding mental health programs. The study

revealed that majority of the respondents between 70-100% all agreed that, mental illness is

caused by curses from the gods and ancestors, their culture can shape the mental health programs

and alter the types of services used, the attitude of some mental health practitioner deters them to

seek for services, racial prejudice is the cause of differential treatment of illness, it is often possible

to identify cultural values directly concerned with the essential features of mental health, mental

health is in many ways undervalued in their society, mental illness is associated with societal

stigma and negative attitudes, and mental health for a person is affected by social interaction,

societal structures and resources and cultural values. This findings is in line with Brown, Ojeda,

Wyn, and Levan, (2000) who contended that culture of the patient, also known as the consumer

of mental health services, influences many aspects of mental health intervention programs, mental

illness, and patterns of health care utilization. Also a survey by Vaillant (2003) opined that there

exist many misconceptions among the general public, politicians and even professionals regarding

77
the concept of mental health. This is due to the fact that mental health is in many ways undervalued

in our societies.

5.4 Availability of Mental Health Intervention Programs

The study found that majority of respondents affirmed that there were no mental health

intervention programs at time of the study. When respondents were asked to state the mental health

intervention programs, the following programs were stated: outreach and home visits, school

mental programs, Department for International Development (D.F.I.D) program, mental health

week celebration, education on mental health and rehabilitation program. It is deduced from the

study that these programs stated by respondents were key activities that are undertaken by these

facilities aside the mental week celebration. Thus key mental health intervention are unavailable

neither to even look at its effectiveness. Mental health officers therefore termed these activities as

intervention but in reality there were no intervention program of these nature to help people with

mental conditions.

Soliciting respondent’s views on the nature of these supposed programs outlined by respondents,

majority of respondents indicated these were facility programs, while there rest were, district,

national, donors and regional programs. But unfortunately the study found that vast majority of

the respondents did indicated that these programs were not successfully executed partly due to

inadequate funds, lack of psychiatric unit and nurses, inadequate psychotropic drugs. This findings

is therefore in congruent with WHO (2013) which argued that mental health services in Ghana are

available at most levels of care. However, the majority of care is provided through specialized

psychiatric hospitals (close to the capital and servicing only small proportion of the population),

with relatively less government provision and funding for general hospital and primary health care

78
based services with few community based services being provided are private. For this reason

Sanati (2009) opined that the scarcity of psychosocial interventions, psychotropic medication is

the mainstay of treatment and has been the topic for further discussion.

4.5 Institutional Challenges Facing Mental Health Programs

This section looks at some the institutional challenges that affect the mental health programs.

When respondents were asked to whether there were challenges affecting mental programs, all

(100%) of the respondents unanimously affirmed there are challenges affecting mental health

programs in their respective facilities. It means that all the facilities providing mental health service

have challenges in one way or the other.

Among the challenges were, lack of financial support from government, inadequate infrastructure

and logistics, inadequate human resource-thus World Health Organization (WHO) estimates that

1.18 million additional mental health workers are needed to close the mental health treatment gap

in low- and middle-income countries (Fulton, Scheffler, Auh Vujicic, & Soucat, 2011).,

Stigmatization and discrimination, and lack of support from family members. It can be noted that

mental health challenges are documented worldwide: It is against this background that WHO

(2013) argued that low- and middle-income countries allocate lower proportions of their national

resources to health care, but the global disparity is much more marked when we look at expenditure

on mental health services and treatments. This is consistent with Ghana Health Service report

(2005, p.46) which noted that the National Health Insurance Scheme (NHIS) which was passed

in parliament in 2003 ensured universal healthcare services for all residents in Ghana. However,

while it says mental illness is exempt from the insurance Scheme, it implies that patients with

79
mental illness do not qualify to register with the Insurance Scheme. In fact these challenges are

not quite different from report by Ghana News Agency (2016) where nurses from Accra

Psychiatric Hospital claim the numerous challenges faced by the health facility as, including lack

of hospital supplies and consumables, have put their lives at risk because they could be harmed by

the patients. Recent data collected by WHO demonstrates the large gap that exists between the

burden caused by mental health problems and the resources available in countries to prevent and

treat them.

80
 CHAPTER SIX

CONCLUSION AND RECOMMENDATIONS

6.0 Introduction

The chapter will concentrate on the conclusion and recommendations of the study. These will

based on the specific objectives outlined for the study. This includes the key findings of the study.

6.1 Conclusion

Socio-Economic Factors Influencing Mental Health Programs

The study found some of the social factors the influence mental health programs. The results

obtained revealed that half 50% of the respondents stated stigmatization and discrimination,

poverty insecurity and hopelessness, rapid social change and risks of violence, influence on health

behavior, trust and social capital, and peer influence.

The study found that majority 85% of the respondents affirmed people with mental condition are

not likely to be employed. Regarding the reason why people with mental condition are not likely

to get employment. Respondents were of the view that: such people are not of sound mind to cope,

some employers considered these people as good for nothing in most cases, lack of mental

capacity to perform, difficulty in following simple instructions, condition does not favor them,

difficult conform to the rules and regulations governing the work .

The study revealed the socio-economic factors that that influence mental health programs. The

study found high scores of 3+4+5 of 50% and above as an indication that majority of the

respondents agreed that, poor mental health programs are a consequence of social, economic and

environmental inequalities, unemployment, less education, low income or material standard of

81
living, higher national levels of income inequality are linked to a higher prevalence of mental

illness and low intervention programs, mental health problems have considerable negative

consequences for quality of life in low- and middle-income countries, and the country is under-

resourced and under-developed to finance mental health intervention programs. It is therefore

deduced from the study that study that, respondents agreed on the socio-economic factors that

influence mental health programs.

Socio-cultural Factors Influencing Mental Health Programs

The study also uncover some of the social factors that influence mental health conditions. It turned

out that a higher proportion of the respondents stated homelessness, poor conditions, stated

unequal distribution of amenities, ethnic disharmony, demolition of housing and migration and

displacement. However respondents consulted the spiritualist, pastor within their community,

herbalist, while just few consulted the mental health practitioner when the condition started. Their

option for consulting these people could be attributed to the fact that there were few mental health

facilities within their location and also Ghanaians in general are spiritually minded when they are

confronted with any eventuality.

Findings revealed the socio-cultural issues surrounding mental health programs. The study

revealed that majority of the respondents between 70-100% all agreed that, mental illness is

caused by curses from the gods and ancestors, their culture can shape the mental health programs

and alter the types of services used, the attitude of some mental health practitioner deters them to

seek for services, racial prejudice is the cause of differential treatment of illness, it is often possible

to identify cultural values directly concerned with the essential features of mental health, mental

health is in many ways undervalued in their society, mental illness is associated with societal

82
stigma and negative attitudes, and mental health for a person is affected by social interaction,

societal structures and resources and cultural values.

Availability of mental health intervention programs

The study found that majority (69%) of the respondents affirmed that there were no mental health

intervention programs at time of the study, When respondents were asked to state the mental health

intervention programs, respondents embarked on outreach and home visits, school mental health

programs, Department for International Development, (D.F.I.D) program, mental health week

celebration, education on mental health, and rehabilitation program. But it should therefore be

noted that these were key activities not actual intervention programs.

Soliciting respondent’s views on the nature of these supposed programs outlined by respondents,

majority of respondents indicated facility programs, while rest were, district, national, donors and

regional programs. But unfortunately the study found that vast majority of the respondents did

indicated that these programs were not successfully executed partly due to inadequate funds, lack

of psychiatric unit and nurses, inadequate psychotropic drugs as some of the bottlenecks.

Institutional Challenges Facing Mental Health Programs

This section looks at some the institutional challenges that affect the mental health programs. All

(100%) of the respondents unanimously affirmed there are challenges affecting mental health

programs in their respective facilities. Notable among these challenges were, lack of financial

support from government, inadequate infrastructure and logistics, inadequate human resource,

Stigmatization and discrimination, and lack of support from family members.

83
Final Remarks

Mental health challenges can affect anyone regardless of race, gender, education, religion, age,

intelligence or income. They are not the result of personal weakness, lack of character, poor

upbringing, or lack of faith. It is imperative to recognize people with mental conditions as human

beings for they also deserve a descent life. Thus the principle of the Human Dignity must be

observed as far as health delivery is concern.

In conclusion, to improve access to mental health care in Ghana, the scaling up of mental health

care services must be closely monitored, sensitive to cultural and social context, accompanied by

extensive research, and supported by adequate funding.

6.2 Recommendations

Base on the findings the study recommends that:

1. There is the need to scale up strategies for improvement, the nation should implement

culturally sensitive strategies through education for optimal mental health care delivery.

For instance, family members have historically played a central role in providing care for

relatives with severe mental illness. Due to the extensive involvement of family members

in mental health care, assertive community treatment is recommended as an essential

component of improving mental health care.

2. Ghana Mental Health Authority should develop a strategy for addressing the stigma,

discrimination and misconceptions faced by many people living with mental health

conditions, with a focus on strong leadership, improved competencies of managers and

84
 worker representatives to deal with mental health issues, peer worker training, and active

promotion of workplace psychological health and safety.

3. Ghana Health Services through collaboration with Ministry of Health should promote

timely access to effective treatment of mental health conditions, including mild-to-

moderate mental illnesses, in both community mental health and primary care settings and

through co-location of health professionals to facilitate the referral to specialist mental

health care, while ensuring the involvement of people living with mental health conditions

in decisions about the appropriate care and treatment plan.

4. Government as a matter of urgency should register all people with mental health conditions

under the National Health Insurance Scheme (NHIS) so that they can health access they

essential drugs needed for the management of mental conditions as universal access is

concern.

5. Government should make appropriate budget to finance and expand the humans and

infrastructural gaps affecting mental health delivery in Ghana.

85
BIBLIOGRAPHY

86
APPENDICES

87