Transcript Rethinking human rights and mental health care in Ghana Ursula Read, Research Student Anthropology, University College London with Solomon Nyame, Research Assistant, Kintampo Health Research.

Rethinking human rights and
mental health care in Ghana
Ursula Read,
Research Student Anthropology, University College London
with Solomon Nyame,
Research Assistant, Kintampo Health Research Centre
Sources of treatment for mental illness
Kintampo districts:
• 1 District Hospital Kintampo (1 CPN)
• 2 private clinics – one staffed by former psychiatric nurse, now Medical
Assistant
• Rural clinics - community nurse/midwife (2 years training) - no mental
health specialist
• Traditional healers/herbalists
• Pastors/prayer camps
• Mallams
Brong Ahafo:
• CPN clinic Techiman (2 CPNs)
• Inpatient/outpatient Psychiatric Unit, Sunyani Regional Hospital
• Traditional healers/herbalists
• Pastors/prayer camps
National:
• Psychiatric hospitals – 2 in Accra, 1 in Cape Coast
‘In Ghana mental illness is associated
with all forms of spiritual beliefs or
absurd or ridiculous explanations’
(Mindfreedom Ghana 2009)
‘mental illness is a medical condition
requiring medical attention’
(CHRI 2008)
‘Campaigns on the importance of
seeing mental health as a psychological
problem needing clinical attention
rather than a spiritual one could help
increase awareness and knowledge of
appropriate sources for treatment’
(CHRI 2008)
‘psychiatric hospitals are the last portof-call’
• Limited efficacy of psychotropic medication, particularly on
functioning and motivation
• ‘First rank’ symptoms may be less troubling than loss of
function
• Dangerous and unpleasant side effects of psychotropic
medication
• ‘Non-adherence’ and ‘revolving door’
• Reliance on ‘evidence-based medicine’ - biomedical bias limited funding for non-medical interventions (‘big pharma’
influence)
• Human rights and involuntary treatment – chains/ropes
(‘barbaric’) or ‘control and restraint’ + injections (‘modern’)
• Causes of mental illness still uncertain
Setting the standard?
•Treatment = medication and
unmodified ECT
•Polypharmacy
•Quality of training
•Very limited psychosocial
interventions e.g. OT,
psychotherapy
•Overcrowding and poor hygiene
•Corruption
•Beatings
•Culture of neglect
•Lengthy admissions
•Abandonment by family
‘When I took it the first day, I slept deeply. And all my body became
very weak. So I said I won’t take it anymore.’
Interview with Comfort, 6th November 2008
‘When they gave her the medicine she became fine. But she became
fat. She was sleeping so much so she became very fat and I stopped
and we took her to a prayer camp.’
Interview with Gifty’s mother, 5th July 2006
‘when it started […] I took her to Techiman Hospital on the Sunyani
road. I took her there and they gave her some tablets. […] So when
she took it, she took it, but when she takes it her mouth does
[sucking noise] and her saliva comes out. She wakes up and it is like
she has drunk alcohol. […] Foam came out of her mouth.’
Interview with Mariam’s father, 24th July 2008
‘When we give him medicine he doesn’t take it. So my strength is
not enough that when we give him medicine I can force him to
take it.’
Interview with Yusuf’s mother, 8th July 2008
‘I wanted to know which way to get healing. In its first stage, as I
remember, I took him to somebody. Afterwards as it didn’t work, I took
him to Ankaful [psychiatric hospital]. There he escaped so I made them
take him back. So when we took him back, the doctor there said the way
the boy escaped from the compound I am worrying them. So if they admit
him and he escapes, he will put them into trouble. So there, he was not
accepted. So when I brought him back, I took him to the mental hospital,
Sunyani. There also they gave him some medicine. Even there, when I
came, he said he was not going to drink it. He cried and cried. He even
destroyed the medicine. So up to date. . . I took various paths but it didn’t
help me.’
Interview with Stephen’s father, 17th October 2008
‘When the illness first occurred and he was brought
from where he was, I took him to Ankaful [psychiatric
hospital] for his mind to be examined […] They didn’t
explain anything but prescribed some medicine for
him. They told us that when he finishes the drugs we
should go to Sunyani [regional hospital]. When he
took all the drugs we went back for more. Yet still the
illness was getting worse, so we went to the prayer
camp.’
Interview with Kwasi’s father, 18th June 2008
‘I took her also to the hospital. At that time, I brought her
here and they gave her medicine that will let her sleep, yet
when the medicine gets finished, it also returns. Sometimes
when they give her medicine it goes for about two months
then it returns.’
Interview with Akosua’s sister, 10th November 2008
‘The ones from Sunyani [psychiatric ward], I’ve taken them all
but I want the one that will heal me completely so that it
won’t come back again’
Interview with Akosua, 11th August 2008
‘First they say there is some town they call ‘Asylum’
that whoever has a serious one, if he is taken there
he becomes so well that if you see him you won’t
think it is him. So I know that doctors can treat that
illness very well. […] Unless God has ordained that he
will be well, he will be well. If He says he won’t be
well, even if you take him to a doctor [he won’t be
well].’
Focus group discussion with Muslim women, 9th June 2008
‘… if a family with a member in severe crisis is
primarily offered psychiatric drugs, when nondrug approaches can work, this too is a kind of
coercion. I respect an individual's right to take
prescribed psychiatric drugs. However, being
offered only one choice is not really a choice at
all. Creating more non-drug voluntary
alternatives has become a human rights
concern.’
David Oaks, Mindfreedom International
Acknowledgements
• The participants
• Dr. Victor Doku, Solomon Nyame (research assistant), Awudu
Issaka, Edward Adiibokah and the mental health research
team, KHRC
• Ms. Mary Lamptey, CPN Kintampo
• Kintampo Health Research Centre
• Prof. Roland Littlewood and Dr. Barrie Sharpe, Department of
Anthropology, UCL
• The Economic and Social Research Council for funding