The Global Burden of Mental Disorder
According to the WHO 2005 report, 31.7% of all years lived with disability is attributed to Mental,Neurological and Substance (MNS) use disorders. MNS disorders in many countries are among the ten leading causes of disease burdens in Lower- and Middle-Income Countries (LAMICs). The WHO in 2017 declared major depressive illness as a leading cause of disability worldwide, while schizophrenia and alcohol misuse was also identified as key causes of disability.
Theneed for Greater Focus on Mental Health
Despite the obvious importance of mental health, it continues to occupy the back seat when it comes to the allocation of resources. This is due to the burden of infectious and non-communicable diseases which are given priority over mental health.
There are fundamental reasons why mental health needs to be a greater priority in development. First is that copious reference can be made to studies which show that of people with disability, people with psychosocial disability are the poorest and the most unemployed. The rates of unemployment among people with mental illness who have stabilised in their conditions remain unacceptably high in many countries including Ghana.
Good mental health has implications for personal, community and even national development. If one in four people in their lifetime have a mental health problem and if that is not dealt with properly, quickly and effectively, then it is likely to even affect their family’s income catastrophically.Meanwhile, pathetically, budget or funding allocations for mental health remain scandalous and it is broadly encapsulated by stigma and ignorance.
Why Greater Mental Health Investment Is Necessary
In the first place, many make the argument that It makes economic sense to invest more in mental health. This is so because when cost-effective community level treatment is available, there is substantial improvement in workforce productivity. It is estimated that the global impact of mental disorders will amount to loss of economic output of US$16 billion!
Secondly, an improved mental health budget has the potential to articulate what physical and human resources are required to deliver a mental health service that is effective, efficient, accessible and of acceptable quality. Budgetary allocations to mental health will honour the various perspectives in the field, while inspiring a united vision of a person’s right to dignity and right to care and facilitate effective development of policies,strategic plans and programmes. An increased mental health budget will bring forward those marginalised by psychosocial disability and those who have worked beside them to share their own unique experiences and insights on the intersection between mental health and poverty, health and peace.
Financing Mental Health
Ghana’s mental health is funded primarily by the Government of Ghana and is supplemented to a small extent by internally generated funds and donations.
It is estimated that of the nearly 30 million people living in Ghana, about 3 million suffer from mental illness.Meanwhile, a major challenge of mental health remains funding. Even though it is difficult to calculate the total amount spent on mental health, it is generally accepted that mental health is the least prioritised. The lack of priority has consistently led to insufficient funding. In 2012, total health expenditure as a percentage of gross domestic product was 5.2 percent—the agreed target is 15 percent. In 2010, 1.3 percent of this figure was spent on mental health, very low when compared to the (global) estimate of 13 percent of total burden of disease attributable to mental, neurological, and substance use disorders.
The Issue of Access: Some System Factors Impacting Access to Mental Health Services
It is to be admitted that progressive change in mental health services cannot happen in a vacuum and is dependent on the existing health infrastructure, particularly if there is a commitment to investing in sustainable change through integration in mainstream structures. Similarly, comprehensive mental health services must provide access to biological, psychological, and social interventions (or facilitate access to such services for those who need them).
- Access to biological treatments: The point that needs to be made is that having professionals in the right place with the right skills to prescribe appropriate medications is, without doubt, important, but cannot be done without a reliable supply of medications. This is particularly the case for severe mental disorders such as schizophrenia, bipolar affective disorder, moderate and severe depression, and epilepsy. Unfortunately, shortages of psychotropic medicines are commonplace, and this serves as serious drawback to effective treatment. Access to treatment is a right that cannot be denied.
- Access to psychological treatments: In general, there has been a tendency for mental health services to mainly focus on biological treatments. There are a number of reasons for this: training is biologically focused, and there are few trained psychologists; patients expect and value medication; availability of appropriate, practical talking therapies has been limited even in international guidelines. Besides, it is logistically more complex and expensive to provide talking treatments.
Sadly, clinical psychologists are nearly absent from Ghana. Clinical psychologists in Ghana number around 100, but fewer than 20 work in the public sector and are accessible mostly to people living in the two biggest cities of Accra and Kumasi.
- Access to social interventions:In general, there is inadequate intersectoral collaboration in providing the broad care that many people with mental health challenges need. Apart from the few community-based rehabilitation (CBR) programmes, health, education, social welfare, and livelihood services do not engage well together. However, the existence and activities of organisations such as MindFreedom Ghana which continue to engage inter alia in mental health advocacy and awareness creation made up of multiple stakeholders is a positive development that has certainly helped to break down some of the traditional vertical silos in which different sectors work. The coming of the Mental Health Law has also ensured some collaborative work across agencies.
In the aftermath of the coronavirus pandemic, many creative solutions have been offered to increase access to mental health services, including integrating behavioural health services into primary or community-based care, and augmenting the workforce.
It is within the context of the foregoing- including the need for collaboration for effective advocacy towards mental health and other disability issues- that we recognise and appreciate the funding support MindFreedom Ghana has received from the Open Society Initiative for West Africa (OSIWA) to implement a two-year project (2020-2022).
The project, which is titled: “Institutional Strengthening and Awareness Raising to Fight COVID-19 And Its Impact on People with Lived ExperiencesinGhana”, when completed will support to strengthen the capacity of MindFreedom Ghana for advocacy and awareness creation, which are aimed at addressing the scourge of stigma and discrimination (associated with the disease) that patients as well as relatives of the pandemic suffer. Further, the project will help build awareness among the general public as a way to support the fightagainst the coronavirus pandemic in the country.
Dan Taylor is the Executive Secretary of MindFreedom Ghana
By Dan Taylor