Managing abɔdam, the Mental Health Law (2012) and Ghana's 'democracy'

Next March, the Mental Health Act 2012 will be ten years old. It took a process of two decades to pass this Law to address mental health as a public health issue and also to protect the human rights of the mental ill in Ghana. MHA 2012 came some 40 years after the last major revision of mental health law in the 60s (Mental Health Decree NRCD 30) in 1972 which predictably was never implemented. Since 2012 when the Law was passed, one can safely say the vulnerable population for which it was crafted have benefited very little from it.

And yet Democracy supposes that all are equal before the law irrespective of ability or perception. It is in this light that we must commend the intention, at least. The content is sketchy, but the document offers Ghanaians a rare opportunity to recognize and reorganize the way democracy works in real life. By definition, mental health covers the gamut of ailments and disabilities that prevent a significant portion of our countrymen from benefiting from full-fledged citizen-hood.

In this sense, every family in the country has mental health issues in one form or the other: from poverty-induced depression to serious ailments arising out of medical anomalies. Therefore, as a common denominator among Ghanaians, mental health care must be a national priority not only because it deals with the majority of the people, but because it makes business sense. The truth of this matter is that effective mental health care delivery will go a long way to save lives and enhance individual potential, and at the same time create jobs and professions in the sector for mental health care providers, direct care professionals, social workers, and therapists, just to name a few.

Mental health management in a typical industrialized country is a robust industry that involves all aspect of society and reflects the premium placed on citizen-hood by the country. This is an all-embracing industry that encompasses the manufacture of pharmaceuticals, mental health research, adherence to fundamental human rights, job creation, professional specialization, health insurance, sound medical practice, an invigorated social services system, and personal opportunity. This translates into millions of jobs (especially for the unskilled, semi-educated unemployed), and billions of cedi annually. This is not unlike cocaine trafficking, only legal.

Unfortunately, in Ghana where we claim to love mankind more than other nations do, mental health management has always been considered a nuisance and is therefore relegated to the background. We still lock our patients in punitive medieval institutions under the watch of insanely understaffed teams of pseudo-professionals. Outdated or banned imported medication and practices keep our patients in zombielike trances all the time. The few lucky, daring ones who manage to escape captivity, wander aimlessly on unsafe streets offering comic relief to a society that does not seem to care very much. Shamefully, we ignore their plight, knowing full well that the right medication and therapy will rehabilitate most patients into becoming productive members of society.

Now, how do we achieve this goal? A mental health care Law must first and foremost define what mental health delivery entails as an integral aspect of this nation's development effort. It must be part of the nation's overall job creation strategy. It should be made part of the nation's primary health care delivery system generally and must therefore be tackled from the bottom up. This Law must bring mental health care into the 21st century where proper diagnosis and therapy reside. To that end, as a matter of urgency, "mental asylums" must be immediately abolished and patients must be brought to live in tax-payer funded assisted living residences in the community under professional management and guidance. This of course protects them from the anguish of imprisonment in terribly ran, understaffed care institutions that look more like torture chambers than asylums in the real sense of the word.

We also achieve the goal of respecting the rights of the mentally ill by investing in research into pathology, classification, medication, and treatment of disorders. As has been demanded on many, many occasions, we can achieve the goal by critically looking at the pertinent issues from a uniquely African perspective, investigating notions such as definitions of mental disorders, the epidemiology of mental illness, case management, community treatment, mental health research, and questions of policy. Making mental health a national priority will not only save lives and enhance performance but will also create jobs and professions in the fields of mental health care providers, social workers, and therapists.

We must then embark on a large scale enrollment of persons who have dropped outside the system due to lack of further education or job opportunities, train them in basic direct care practices, and deploy them in assisted living facilities to manage the lives of the mentally ill. Assisted living units are crucial since they take away a significant portion of the stigma and taboo of abɔdam and present patients as they are: ill persons under treatment in a home setting in the community.

In return for these suggestions, there are so many benefits to enjoy that it is almost criminal that we are not taking full advantage of such a godsend. Fundamentally, proper care of the mentally ill means a better quality of life for patients: this means your aunt or my sibling or someone else's son is becoming a more productive Ghanaian because they were given a hand to stand up and be counted. This means families that are burdened by the responsibility of taking care of their ill without the required training and skills can free themselves up and be as productive as they want to be.

This means employment for millions of unskilled Ghanaian youth who can now become direct care givers, and thousands of nurses who can specialize in the field of mental health, and senior nurses who can move on to become nurse practitioners, all the way to specialist psychiatrists, psychologists, neurologists, etc. etc. You catch my drift. The possibilities are endless. This means a thriving insurance sector that deals with the needs and premiums of such patients and their care givers. This means a housing boom to create homes for patients and the resulting boom in the delivery supply chain - food provision, support systems and the creation of a brand new industry revolving around the mentally ill.

This new industry starts as a repository of information and research, encourages pharmaceutical and medication production, local food production, improved educational institutions for both patients and care givers alike, and dare I say again health insurance.

If democracy really means we are all equal before the law irrespective of ability or perception, we should show that we mean that not just in words but indeed.