High cost of drugs inhibits dynamism in mental care - Asare
Accra (Greater Accra) 21 November 2001 - Vice President Aliu Mahama has appealed to mental health professionals to spearhead the transformation of mental health service to make it affordable and accessible to those who need it.
Alhaji Mahama who stressed the importance of the contribution of all sectors of society in the improvement of mental health care, asked the professionals to develop programmes in partnership with families, local communities and district assemblies.
The Vice President was speaking at a ceremony in Accra at which he launched this year's WHO report which centres on mental health. There was also a forum for participants to discuss the lapses in mental health care in Ghana and their solutions.
The report titled, "Mental Health, New Understanding New Hope," provides detailed information about the state of mental health in member countries and advocates a revolution in mental health care including approaches to the practice that would significantly address the stigma usually associated with the illness.
Experts have identified inadequate professionals, stigmatisation of professionals and patients, poor remuneration of staff, run-down facilities in mental health institutions and expensive cost of modern efficient drugs as some the problems in mental health sector.
Alhaji Mahama said in many developing countries, because of their compelling primary health problems, gave minimum attention to mental health issues and gave the assurance that. "The government will not shirk its responsibilities in providing care to the underprivileged in society."
"Mental and behavioural disorders are estimated to account for 12 per cent of the global burden of diseases, yet the mental health budget of countries constitutes less than one per cent of their total health expenditures," he said.
"Ghana, in this respect, is doing better than many developing countries as we spend about five per cent of the total health budget on mental health."
The Vice President urged professionals to consider the rational use of drugs and apply innovative techniques in the management of mentally ill people and also ensure the continuity of treatment to prevent lapses.
According to reports, last year, 64,009 out patient cases were recorded at health institution, while 6,499 patients were admitted. It is, however, believed that the figure is higher as every person at one stage of his life would suffer a condition that requires treatment for mental illness.
Most people either ignore the condition or seek relief at religious camps, traditional healers and other unorthodox places. Reports say schizophrenia, manic depressive illness, substance abuse, depressive illness, schizophrenic affected disorders, undifferentiated disorders, acute organic psychosis, epilepsy, alcoholism and dementia, respectively, are the top 10 mental diseases in Ghana.
However, there are only 15 psychiatrists (with only seven below 60 years), 368 psychiatric nurses, five social workers and eight clinical psychologists.
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Accra (Greater Accra) - The World Health Organization (WHO) has urged governments to implement strategic programmes to improve the treatment of mental disorders, which currently affect about 450 million people globally.
Out of the number, 120 million suffer from depression while 50 million suffer from epilepsy. Twenty-four million people suffer from schizophrenia, while one million of the estimated 10 million people who attempt suicide succeed.
In its annual report titled, "Mental Health, New Understanding, New Hope," WHO said 40 per cent of countries had no mental health policies, while 30 per cent lacked programmes.
Every year, the Surgeon-General of WHO issues a report on the health of the people of the world, covering vital issues on health that should be addressed by every country.
The 2001 report launched by Vice President Aliu Mahama, in Accra on Tuesday, calls for a revolution in mental health care, including innovative approaches to the practice of mental health to improve the mental health of people and reduce the stigma usually associated with the ailment.
According to the report, "The mental health resources in countries present a dismal picture of severe shortage and neglect. Often, services are one-hundredth of what is needed."
Last year, mental health was estimated to account for 12 per cent of total disability. The report, however, notes that almost two-thirds of the people with a known mental disorder never seek health from a professional.
"Stigma, discrimination and neglect prevent people from seeking care, yet today, we have a better understanding of causes of illness and do know that more often than not effective treatment can be provided."
It stresses that mental illness should not be considered a personal failure, saying, "rare is the family which will be free from an encounter since one person in every four will be affected by a mental disorder at some point during their life time."
Presenting the highlights of the report, Dr Melville George, WHO representative in Ghana, urged governments to adopt treatments that focused on moving patients away from institutionalised care such as asylums and custodial care. Instead there should be community care, backed by availability of beds in general hospitals.
Dr George said mental health programmes should consider vulnerable groups and must be adequately funded, while policies should be developed in consonance with others on issues such as drugs and alcohol.
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Accra (Greater Accra) 21 November 2001 - Dr Joseph Bediako Asare, Chief Psychiatrist of the Ministry of Health, on Tuesday called for financial support to enable psychiatrists to treat mental health patients with modern drugs, which are expensive but efficacious with fewer side effects.
In an interview after a ceremony at which the Vice President launched WHO's annual report on mental health, Dr Asare said medical practitioners were still relying on "old" drugs for treatment, though more efficient drugs had been developed.
"These new drugs, like drugs for HIV/AIDS should be subsidised, otherwise, their importation must be encouraged for those who can afford ...."
The Chief Psychiatrist mentioned some of the new drugs as Olanzapine and Risperidone for the treatment of schizophrenia, and Fluoexethine and Prozac for the treatment of depressive illness.
It costs about 210,000 cedis per month to treat patients suffering from schizophrenia and about 300,000 per month for the treatment of depressive illness with the new drugs.
However, the treatment of schizophrenia, the most common mental disorder in Ghana, with old drugs such as amitrithyline costs about 6,000 cedis, while the treatment of depression with imipramire cost about the same. The treatment is free.
He called on the Ministry of Health to import such drugs into the country, which could either be selective for those who could afford or should be subsidised to enable patients to buy them.
"When we refer cases abroad and counterparts there learn about the drugs we prescribe, they think we are inefficient or out of touch, but the problem is funds," he said.
Giving an overview of mental health in the country, Dr Asare said health institutions received a total of 64,000 outpatients and 6,499 admissions last year.
He said these patients suffered various types of mental disorders including schizophrenia, accounting for 22.9 per cent, manic depressive illness (18.4 per cent), substance abuse (11.7 per cent), acute organic-psychosis (6.5 per cent), epilepsy (3.1 per cent), alcoholism (2.9 per cent) and dementia (1.8 per cent).
All of these conditions were treatable, he said, and urged patients to seek early treatment. Dr Asare talked about constraints to effective health care, saying the poor facilities at the psychiatric hospitals did not encourage recruitment of doctors for training and undermined the calibre and expertise of professionals working there.
"The ratio of patient to nurse at the two hospitals is 10:1 with a whole lot risks, including twisting of wrists and loss of teeth, yet these nurses do not even enjoy any risks allowance."
He called for a multi-disciplinary approach to mental health care, which should be community directed with the creation of awareness of the causes and symptoms and provision of requisite skills for people in the community to appreciate, manage and prevent mental illness.
Dr Isaac Ewusi-Mensah, a Psychiatrist who talked about Mental Health Law, said the 1990 Mental Health law was not comprehensive, making it easy for society to abuse the rights of people considered to be mentally ill.
He said every person had the right to reject hospitalisation and refuse treatment unless it was proved that they were a threat to society or could commit suicide if not hospitalised.
Dr Ewusi-Mensah said mental health institutions could be sued if a person felt his right was being violated, especially if he was not given the requisite medical treatment and food during his hospitalisation.
Dr Sammy Ohene, a psychiatrist, said mental illness could affect everybody and urged people who were mentally disturbed to seek treatment rather than coping with their conditions.
He said the commonest conditions often ignored were depression and anxiety and they should be treated. "When a person suffers from depression, he is likely to lose appetite, be withdrawn, cry at the least provocation, have bad dreams and does not sleep well," said Dr Ohene.
"Those who suffer anxiety have unreasonable or excessive fear, have a panic disorder, feel dizzy, sweat a lot and fear that they would pass out." Mrs Rosalind Oware-Nyarko, a psychiatric nurse, said nurses in mental health institutions were discriminated against, adding that the authorities must ensure that all nurses were treated fairly.
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