Int
ern
at
i
onal
Journ
al of
P
u
bli
c Hea
lt
h S
c
ie
nce (IJPH
S)
Vo
l.
6
,
No.
4
,
D
ece
m
ber
201
7
, pp.
299
~
313
IS
S
N:
22
52
-
8806
,
DOI: 10
.11
591/
ij
phs
.
v6
i
4
.
8
474
299
Journ
al h
om
e
page
:
https:
//
ww
w.i
aesco
re
.c
om
/j
our
nals/
ind
ex.
php/IJP
H
S
Ment
al Health
S
ervi
ce in Ghan
a: A Re
view of th
e Case
Sa
muel
A
d
u
-
Gyamfi
Depa
rtment
o
f
H
istor
y
and
Polit
i
ca
l
Studie
s,
Kw
a
m
e
Nkrum
ah
Univer
sit
y
of
Sci
en
ce
and Technolo
g
y
,
Ghan
a
Art
ic
le
In
f
o
ABSTR
A
CT
Art
ic
le
history:
Re
cei
ved
Sep
21
, 201
7
Re
vised
N
ov
16
, 2
01
7
Accepte
d
Dec
2
, 2
01
7
Menta
l
he
al
th
care
in
Ghana
has
bee
n
fra
ught
wi
t
h
seve
ral
ch
al
l
en
ges
le
adi
ng
to
stagna
nt
gro
wth
in
m
ent
al
h
ea
l
th
service
de
li
ver
y
and
in
som
e
ca
ses
a
seve
re
d
epr
e
ci
a
t
ion
in
the
nat
ur
e
of
ca
r
e.
The
Governm
ent
of
Ghana
pa
y
s
li
ttle
or
no
at
t
ention
to
m
ent
a
l
he
al
th
ca
re
in
th
e
count
r
y
,
a
situati
on
tha
t
h
as
le
d
to
poor
servic
e
del
iv
er
y
in
th
e
thre
e
m
aj
or
psy
ch
iatric
hospit
a
ls
in
Ghana
.
The
implement
a
ti
on
of
the
Gha
na
Menta
l
Ac
t
of
2012
has
al
so
bee
n
fa
ce
d
with
m
aj
or
ch
al
l
enge
s
with
no
s
igni
ficant
progr
e
ss
bei
ng
m
ade
.
Thi
s
stu
d
y
the
ref
or
e
sought
to
rev
ie
w
and
document
the
de
vel
opm
ent
of
m
ent
a
l
health
ca
re
servi
ce
s
i
n
Ghana
.
Spec
ifi
c
al
l
y
,
th
e
st
ud
y
exa
m
ine
d
th
e
v
ari
ous
le
gislations
on
m
ent
al
health
th
at
have
be
en
en
ac
t
ed
in
Ghana
since
1900,
inve
stigated
the
implementa
t
ion
of
the
cur
r
ent
M
ent
a
l
Hea
lt
h
Act
of
Ghana
,
found
out
whe
t
her
th
e
Ghana
ian
gover
nm
ent
h
as
priori
t
ised
m
ent
a
l
he
al
th
servic
e
in
the
count
r
y
an
d
assess
ed
the
chal
le
nges
and
pro
ble
m
s
that
conf
ronte
d
m
en
t
al
he
al
th
servi
ce
in
Ghana
sin
ce
1900.
Th
e
stud
y
conc
lud
es
tha
t
,
since
1888
eff
orts
have
been
m
ade
b
y
v
ari
o
us
gover
nm
ent
s
to
le
gisl
ate
the
provision
of
m
ent
al
serv
ice
in
Ghana
.
How
e
ver
,
the
se
le
gisl
at
ions
hav
e
not
a
lwa
y
s
prot
e
ct
ed
the ri
gh
ts and i
nt
ere
st
of
th
e
m
ent
all
y
i
ll.
Ke
yw
or
d:
Gh
a
na
Me
ntal
healt
h
l
aw
Me
ntal
healt
h
Po
li
cy
Psychia
try
Copyright
©
201
7
Instit
ut
e
o
f Ad
vanc
ed
Engi
n
ee
r
ing
and
S
cienc
e
.
Al
l
rights re
serv
ed
.
Corres
pond
in
g
Aut
h
or
:
Sam
uel A
du
-
G
yam
fi
,
Dep
a
rtm
ent o
f Hist
or
y a
nd P
ol
it
ic
al
Stud
ie
s,
Kw
am
e N
kr
um
ah
U
niv
e
rsity
o
f
Science
and Tec
hnol
og
y
,
Ku
m
asi
,
As
ha
nti Re
gion
,
Gh
ana
Em
a
il
:
m
cgyam
fi@yaho
o.
c
om
,
sadu
-
gyam
f
i.cass@
knus
t.e
du.gh
1.
INTROD
U
CTION
Me
ntal
healt
h
serv
ic
e
ha
s
be
com
e
an
issue
wo
rt
h
inve
sti
gating
because
of
the
num
ber
of
people
aff
ect
ed
by
m
ental
dis
order
s
.
S
ociet
al
pr
e
ssu
re
s
a
nd
va
rio
us
iss
ues
of
li
fe
hav
e
be
com
e
the
so
ur
ce
of
depressi
on
ca
usi
ng
m
any
pe
op
le
t
o
ha
ve
m
ental
pr
oble
m
s.
The
globa
l
incidence
of
m
ental
diso
r
de
rs
wa
s
est
i
m
at
ed
to
be
ab
ou
t
12
perce
nt
of
t
he
glo
bal
bur
de
n
of
disease
i
n
the
ye
ar
2000
[
1]
.
T
he
World
Healt
h
Orga
nisati
on
e
stim
at
es
that
glo
bally
,
one
out
eve
ry
f
our
per
s
ons
s
uffer
from
a
diagno
sable
m
ental
diso
r
der
the
course
of
their
li
fetim
e.
In
G
han
a
howe
ver,
there
is
no
com
pr
ehe
ns
i
ve
data
on
the
incidence
of
m
enta
l
disorde
rs.
I
nfo
rm
ation
a
bout
the
prevale
nce
of
m
ental
diso
r
ders
in
G
hana
is
of
te
n
base
d
on
e
stim
at
es
from
the
W
H
O
or
th
rou
gh
anec
dot
al
info
rm
at
ion
.
Ba
sed
on
the
est
i
m
at
e
fr
om
t
he
WH
O
,
at
least
13
pe
rcen
t
of
the
adu
lt
popula
ti
on
in
G
ha
na
are
li
kely
to
su
ff
e
r
from
m
ental
diso
rd
e
rs,
with
ab
ou
t
3
per
ce
nt
su
f
fe
ri
ng
f
r
om
sever
e
m
ental
i
ll
nesses
[
2].
Me
ntal
healt
h
care
in
Gh
a
na
has
been
fr
a
ug
ht
with
se
ver
al
chall
enges
le
adin
g
to
sta
gn
a
nt
gro
wth
i
n
m
ental
healt
h
serv
ic
e
delive
r
y
and
in
so
m
e
cases
a
seve
r
e
de
pr
eci
at
io
n
in
the
nat
ur
e
of
care.
Me
nta
ll
y
il
l
people
are
so
m
e
of
the
m
os
t
vu
lne
rab
le
pe
op
le
in
so
ci
et
y.
They
are
oft
en
su
bject
to
discrim
inati
on
,
so
ci
al
isolat
ion
a
nd
e
xclusi
on,
hum
a
n
rig
hts
vi
olati
on
s
,
an
d
a
n
an
ci
ent
dem
eaning
sti
gm
a
wh
ic
h
le
ads
to
rem
ov
al
of
so
ci
al
s
upport,
sel
f
-
re
proach,
or
the
decayi
ng
or
stra
ini
ng
of
im
po
rtant
relat
ion
s
hip
s
[
3].
Co
ns
e
quen
ces
of
poor
m
ental
healt
h
al
so
i
nclud
e
bei
ng
pre
dispose
d
to
a
var
ie
ty
of
ph
y
sic
al
il
lnesses,
ha
ving
qu
al
it
y
of
li
f
e
reduce
d,
ha
ving
fe
wer
o
pp
or
t
un
it
ie
s
f
or
inc
om
e,
and
ha
ving
lowe
r
in
div
i
dual
pro
du
ct
ivit
y,
wh
i
c
h
aff
ect
s
total
national
ou
t
pu
t
.
Poor
m
ental
healt
h
can
al
s
o
account
f
or
vi
olence,
dru
g
tr
aff
ic
ki
ng,
chil
d
ab
us
e
,
pae
do
ph
il
ia
,
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
6
, No
.
4
,
Decem
ber
20
1
7
:
299
–
313
300
su
ic
ide,
crim
e,
an
d
oth
e
r
s
oc
ia
l
vices
[
4].
Eve
n
th
ough
m
ental
healt
h
is
bec
om
ing
a
serio
us
i
nter
na
ti
on
al
healt
h
co
nce
rn,
m
any
c
ou
ntri
es,
sp
eci
fical
ly
the
Less
De
ve
lop
e
d
Co
un
t
ries
(LD
C
),
str
uggle
to
a
ddres
s
the
inade
qu
at
e
am
ount
of
re
sourc
es
being
c
hann
el
le
d
into
the
pr
ovisi
on
of
m
e
ntal
healt
h
ser
vice.
G
han
a
does
not
hav
e
a
de
qu
at
e
le
gislat
ion
s
to
protect
the
rig
hts
of
pe
ople
with
m
ental
di
so
r
de
rs.
T
her
e
is
app
a
ren
tl
y
li
tt
le
or
no im
ple
m
enta
ti
on
of the e
xis
ti
ng
m
ental
h
e
al
th poli
ci
es.
The
Worl
d
Ps
yc
hiatri
c
Associ
at
ion
(
WPA)
had
ind
ic
at
e
d
that
the
dev
el
opm
ent
of
m
ent
al
healt
h
in
LDCs
li
ke
Ghana
a
re
im
peded
by
sca
rcit
y
of
res
ources
,
l
a
ck
of
a
war
e
ne
ss
of
t
he
prev
al
ence
r
at
e
of
m
ental
il
lness
and
t
he
so
ci
al
sti
gm
a
associat
ed
with
seeki
ng
m
edical
ca
re
from
the
ps
yc
hiatri
c
ho
sp
it
al
.
Siginifica
ntly
,
the
kind
of
tre
atm
ents
avail
able
for
m
ental
l
y
ill
patie
nts
in
Gh
a
na
is
ver
y
poor.
The
m
ain
f
o
r
m
of
ca
re for
m
ental
h
eal
th p
at
i
ents is throug
h i
ns
ti
tuti
on
al
c
onfinem
ent w
it
h
it
s att
end
a
nt m
ist
reat
m
ents
and
t
he
cur
ta
il
ing
of
the
ri
gh
ts
of
pa
ti
ents.
This
is
a
rem
nan
t
fro
m
the
colo
nial
past
of
the
c
ount
ry
[5
]
.
T
he
W
H
O
est
i
m
at
es
that
ov
e
r
t
wo
m
il
lio
n
G
ha
naians
are
s
uffer
i
ng
f
r
om
m
od
erate
to
se
ver
e
m
enta
l
il
lness
out
of
wh
ic
h
le
ss
than
two
pe
rcen
t
recei
ve
treat
m
ent
fr
om
public
hos
pital
s
du
e
t
o
ina
dequate
facil
it
ie
s
t
o
adm
it
m
entally
ill
patie
nts.
Me
nt
al
healt
h
ser
vice
is
under
resour
ce
d
in
Gh
a
na
.
In
2012
,
t
he
Mi
nistry
of
He
al
th
repor
ts
th
a
t
on
ly
3.4
pe
rcen
t
of
the
total
healt
h
budg
et
wa
s
de
dicat
ed
to
the
i
m
pr
ov
em
ent
of
m
ental
healt
h
serv
ic
es
[6
]
.
The
unde
rd
e
velo
pm
ent
of
m
ental
healt
h
se
r
vice
is
even
m
or
e
s
erio
us
wh
e
n
one
c
on
si
ders
th
e
doct
or
-
patie
nt
rati
o
.
Currentl
y,
ther
e
is
on
e
psy
chiat
rist
per
1.5
m
i
ll
ion
people
in
G
han
a
with
only
thre
e
m
ajo
r
ps
yc
hi
at
ric
ho
s
pital
s
ser
vi
ng
the
w
ho
le
c
ountry.
The
se
m
ental
healt
h
f
aci
li
ti
es
are
locat
ed
in
t
he
s
ou
ther
n
par
t
of
G
han
a
.
This
m
akes
m
ental
healt
h
se
rv
ic
es
inac
ce
s
sible
to
a
vast
nu
m
ber
of
th
e
Gh
a
naian
po
pu
la
ti
on.
T
his
poor
m
ental
healt
h
serv
ic
e
ha
s
cause
d
m
any
fam
ilies
to
rely
on
tra
diti
on
al
m
et
ho
ds
to
se
ek
healt
h
care
for
their
m
ental
ly
ill r
el
at
ives which
s
om
eti
m
es co
m
plica
te
the initi
al
il
lness.
Irresp
ect
ive
of
these
glari
ng
pro
blem
s
facing
the
m
ental
healt
h
care
sect
or,
po
li
ti
ci
ans
and
poli
cy
m
aker
s
ha
ve
expresse
d
ve
ry
li
ttle
con
cer
n
to
so
lve
the
m
a
ny
prob
le
m
s
facing
m
ental
he
al
th
patie
nts.
Po
li
cy
m
aker
s
f
oc
us
m
or
e
on
oth
e
r
form
s
of
ai
l
m
e
nts
to
the
ne
glect
of
m
ental
healt
h
issues.
T
he
un
derde
velop
m
ent
of
m
ental
health
se
rv
ic
es
has
histor
ic
al
a
nte
ceden
ts
.
I
n
t
he
ye
ar
1888,
t
he
then
G
over
no
r
of
t
he
Go
l
d
Coast,
Sir
Gr
if
fith
E
dwar
ds
prom
ulga
te
d
the
Lu
natic
Asylum
Or
di
nan
ce
wh
ic
h
encou
rag
e
d
the
detenti
on
of
m
ental
he
al
th
patie
nts
in
pr
iso
n
in
the
capit
al
ci
ty
of
Acc
ra.
I
n
the
ye
ar
1906,
the
colo
nial
adm
inist
rati
on
bu
il
t
a
Lu
natic
Asylu
m
to
hous
e
the
inc
reasin
g
insane/
vagra
nt
pe
ople
.
T
he
Accr
a
ps
yc
hiatri
c
H
ospit
al
was
com
plete
d
in
1951
a
fter
the
s
uccess
fu
l
c
onve
rsion
o
f
the
ol
d
pr
is
on
int
o
a
ho
s
pital
.
T
his
f
aci
li
ty
was
the
on
ly
ps
yc
hiatri
c
fac
il
ity
in
the
West
Africa
n
S
ub
-
Re
gion
i
n
th
e
1950s
.
Gh
a
na
’s
Me
ntal
He
al
th
Dec
ree,
w
hic
h
insist
ed
on
the
com
pu
lsory
de
te
ntion
of
m
ental
ly
s
ic
k
patie
nts
did
no
t
c
ha
ng
e
m
uch
ove
r
tim
e.
Me
ntall
y
sic
k
people
in
G
ha
na
are
sti
ll
treat
ed
as
if
t
he
y
do
not
ha
ve
a
ny
rig
hts
at
al
l.
Although,
G
ha
na
ha
s
seen
consi
der
a
ble
c
hanges
i
n
the
pro
vision
of
m
ental
healt
h
se
rv
ic
es
si
nce
18
88,
the
re
are
s
ti
ll
lots
of
wor
k
that
need
to
be
do
ne
to
i
m
pr
ov
e
t
he
natu
re
of
he
al
th
care
serv
ic
es
avail
able
to
m
ental
ly
il
l
per
sons
in
Gh
a
na
.
It
is
base
d
on this
r
easo
n
that t
his
stud
y
has
bee
n cond
ucted
t
o
r
eview a
nd
m
ak
e a stat
e
m
ent o
n
po
or
m
ental
h
eal
th
serv
ic
es
in G
ha
na
si
nce
1900
.
Ag
ai
n,
m
ental
healt
h
ser
vic
e
in
G
h
ana
ha
s
not
been
a
pr
i
or
it
y
f
or
bo
th
go
vernm
ent
an
d
healt
h
researc
hers.
T
her
e
seem
to
be
a
subtl
e
i
m
pr
ession
t
hat
m
e
ntal
il
lness
m
u
st
no
t
be
disc
usse
d
in
public
ci
rcles
m
aking
it
s
t
re
atm
ent
as
a
re
le
van
t
s
ocial
a
nd
resea
rc
h
prob
le
m
a
dif
ficult
y.
W
it
hi
n
f
a
m
ilies,
pe
op
l
e
wit
h
m
ental
diso
rders
are
of
te
n
neg
le
ct
e
d
and
abandone
d
on
the
street
s.
Diff
e
re
nt
gove
rn
m
ent
in
Ghana
at
diff
e
re
nt
tim
es
payed
li
tt
le
or
no
at
te
ntio
n
to
m
ental
healt
h
care
in
the
co
un
try
,
a
sit
uation
that
has
le
d
to
poor
serv
ic
e
deliver
y
in
t
he
three
m
ajo
r
ps
yc
hiat
ric
hosp
it
al
s
in
Gh
a
na.
The
i
m
ple
m
entat
ion
of
th
e
G
hana
Me
ntal
Healt
h Act o
f 201
2 has als
o been
f
ace
d wit
h
m
ajo
r
ch
al
le
ng
e
s w
it
h no sign
i
ficant
pro
gress b
ei
ng m
ade.
Also
,
irre
sp
ect
ive
of
the
obvi
ou
s
c
halle
nge
s
within
the
m
ental
heal
th
care
syst
em
,
t
o
em
ph
asi
ze,
researc
hers
ha
ve
not
paid
at
te
ntion
to
the
poor
m
ental
healt
h
serv
ic
es
in
Gh
a
na.
Histori
ans
in
par
ti
c
ular
an
d
oth
e
r
s
ocial
sc
ie
ntist
s
have
not
s
how
n
inter
est
in
in
vestig
at
ing
int
o
t
he
antece
de
nts
of
this
poor
ser
vices
delivery
withi
n
the
m
ental
healt
h
syst
em
in
G
ha
na.
In
t
he
ye
ar
1972,
A
do
m
akoh,
i
nv
e
sti
gating
in
to
the
prof
il
e
of
m
ent
al
ho
s
pital
patien
ts
rem
ark
ed
that,
there
wa
s
scanty
know
le
dg
e
of
ps
yc
hia
tric
il
lness
in
Gh
a
na
[7
]
.
A
ca
reful
search
of
m
ental
healt
h
ca
re
s
tud
ie
s
i
n
G
ha
na
show
s
that
ve
ry
fe
w
re
sear
cher
s
ha
ve
i
nterest
in
the
fiel
d
an
d
c
onduct
ed
stu
dies
in
that
re
gard.
Yet
li
tt
le
or
none
of
these
r
esearche
s
was
cond
ucted
by
s
ocial
histor
ia
ns
.
Si
gnific
antly
,
the
pro
per
un
der
st
and
i
ng
of
m
edical
histor
y
of
a
patie
nt
and
a
par
ti
cular
s
ociet
y
is
about
half
-
way
to
getti
ng
the
healt
h
pro
ble
m
so
lved.
Yet,
histo
rians
an
d
m
edical
histor
ia
ns
f
or
that
m
at
te
r
hav
e
a
ba
ndone
d
resea
rc
h
into
m
ental
healt
h
care
ser
vices
i
n
G
ha
na
le
adi
ng
to
a g
e
ner
al
la
ck
of u
nder
sta
nd
i
ng
into
the
facto
r
s
that
ha
ve
c
ontrib
uted
t
o
th
e
poor
ser
vice
s
delive
ry
in
that
sect
or.
T
he
re
is
the
nee
d
f
or
accurate
data
on the
ep
i
dem
iolog
y
of m
ental
disorde
rs
i
n G
han
a
.
The
ab
sence
of
reli
able
data
and
researc
h
in
ps
yc
hiatri
c
stu
dies
has
le
d
to
us
e
of
ane
cd
ot
al
eviden
c
e
for
po
li
cy
deci
sion
s
in
Gh
a
na
.
Me
ntal
healt
h
only
becam
e
a
n
iss
ue
in
G
ha
na
in
1945,
in
the
the
n
Go
l
d
Coast
wh
e
n
the
c
olonial
m
ast
ers
com
m
issi
on
ed
a
stud
y
int
o
m
ental
il
lness.
T
he
f
oc
us
of
th
is
stud
y
was
only
to
enu
m
erate
the
nu
m
ber
of
We
st
Africa
ns
li
vi
ng
with
a
ny
f
orm
of
neurosi
s
an
d
ps
yc
hosis
.
A
s
a
res
ult,
it
wa
s
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N:
22
52
-
8806
Mental
He
alth
Service i
n G
ha
na:
A
Revi
ew
of
the Ca
se
(S
amuel
Ad
u
-
Gy
amfi
)
301
par
t
of
a
broa
der
West
Africa
n
stu
dy
no
t
j
ust
lim
it
ed
to
Gh
a
na.
H
owe
ver,
it
was
this
stud
y
th
at
drew
the
at
te
ntion
of
he
al
th
ex
per
ts
t
o
the
se
rio
usnes
s
of
m
ental
il
l
ness
i
n
Gh
a
na
w
hen
over
f
our
hund
red
cas
es
of
m
ental
disorde
rs
wer
e
ide
nt
ifie
d
with
th
e
help
of
ce
ns
us
e
nu
m
erator
s
an
d
vill
age
c
hiefs
[
8].
A
fter
ind
e
pende
nce,
li
ttle
stud
ie
s
ha
ve
been
c
onduct
ed
i
nto
the
incidenc
e
of
m
ental
il
lness
in
Gh
a
na
by
s
om
e
few
ps
yc
hiatri
sts
[
9],
wh
ic
h
a
re
occasio
nally
assist
ed
by
f
or
e
ign
resea
rch
e
r
s
[
10
]
.
It
is
f
or
this
reas
on
t
hat
this
histor
ic
al
stu
dy
has
been
co
nducte
d
to
inv
e
sti
gate
the
reaso
ns
for
the
po
or
sta
te
of
m
e
ntal
healt
h
ser
vices
in
Gh
a
na
from
19
00
to
20
12
w
her
e
i
ncr
ease
d
public
awa
reness
drew
t
he
at
te
ntion
of
poli
ti
ci
ans
to
the
ne
ed
to
dev
el
op
a
new
m
ental
healt
h
le
gislat
ion
to
a
ddress
the
new
chall
eng
es
fac
ing
pe
ople
with
m
ental
diso
rd
ers
i
n
Gh
a
na.
The
st
ud
y
the
refo
re
gleans
sec
onda
ry
inf
or
m
at
ion
from
the
literat
ur
e
a
nd
c
onte
m
po
rar
y
res
pons
es
t
o
highli
gh
t t
he
is
su
es i
n
c
on
te
m
porar
y t
im
es to b
et
te
r
t
he
lot
of s
ociet
y and G
han
a
in pa
rtic
ul
ar.
2.
METHO
D
O
F THE ST
UDY
This
stu
dy
is
a
qu
al
it
at
ive
r
esearch
.
O
rm
s
ton
,
Sp
e
nce
r,
Ba
rn
a
rd
a
nd
S
nap
e
[
11
]
ci
ti
ng
Fli
ck
[12]
exp
la
ine
d
qua
li
ta
ti
ve
research
to
be
the
natur
al
ist
ic
,
interp
reti
ve
a
ppr
oach,
co
nc
ern
e
d
with
e
xp
l
or
i
ng
ph
e
nom
ena
fro
m
the
interi
or
and
ta
king
t
he
per
s
pecti
ves
a
nd
the
ac
co
unts
of
researc
h
pa
rtic
ip
ants
as
s
ta
rting
po
i
nts.
Q
ualit
at
ive
researc
h
de
sign
in
vo
l
ves
the
us
e
of
qu
al
it
at
ive
instru
m
ents
li
ke
interv
ie
w
schedule
am
on
g
oth
e
rs
to
gat
he
r
data
on
a
pa
r
ti
cular
phe
no
m
enon
unde
r
in
ve
sti
gation
has
been
f
ound
use
fu
l
i
n
this
res
earch
.
Qu
al
it
at
ive
dat
a
has
bee
n
ob
t
ai
ned
from
bo
t
h
pr
im
ary
and
seco
nd
a
ry
sou
r
ces.
Q
ualit
at
ive
data
c
on
ce
rn
i
ng
the
per
ce
ptio
ns
an
d
at
ti
tud
es
of
Gh
a
naian
s
towa
rd
ps
yc
hiatri
c
patie
nts
wer
e
retrieve
d
f
ro
m
the
respo
nd
e
nt
s;
te
n
in
nu
m
ber
,
thr
ee
doct
ors
w
ho
a
re
sta
ke
holders
,
tw
o
ot
he
r
st
a
ke
ho
l
der
s
from
relat
ed
i
ns
ti
tuti
on
s
a
nd
thre
e
ps
yc
hiatry
nur
ses
who
a
re
al
so
co
ns
ide
red
as
sta
ke
hold
ers
f
ro
m
the
Ko
m
fo
A
noky
e
Teachin
g
H
os
pita
l
(KAT
H)
,
K
um
asi
.
The
res
pons
es
from
t
he
se
ver
al
ly
anonym
iz
ed
resp
on
den
ts
wer
e
ta
pe
rec
orde
d
wit
h
per
m
issi
on
fr
om
the
con
cerne
d
res
pondent
s,
oth
e
rs
wer
e
reco
r
de
d
in
a
fiel
d
no
te
bo
ok,
an
d
this
en
su
re
d
consi
ste
ncy.
A
gain,
co
rpus
of
inf
or
m
at
ion
w
as
retrieve
d
fro
m
existi
ng
li
te
ratur
e:
books,
arti
cl
es
and
rel
evan
t
internet
source
s.Th
e
qual
it
at
ive
data
ob
ta
in
ed
from
info
r
m
ants
from
Ku
m
asi
and
KATH
i
n
par
ti
cul
ar
were
analy
sed
t
hem
at
ic
al
ly
by
com
par
ing
the
diff
e
ren
t
res
ponse
s
in
orde
r
t
o
i
den
ti
fy
c
omm
on
tre
nd
s
,
sim
i
la
riti
es
and
c
ontrast
s
thr
ough
the
ap
plica
ti
on
of
et
hnogra
phy.
Ethno
gr
a
phic
an
al
ysi
s
inv
olv
es
identify
ing
ca
te
gorie
s
relat
ed
to
a
culture’
s
ec
onomy
,
dem
og
raphi
cs,
hu
m
an
li
fe,
par
ti
cularly
f
a
m
ily,
edu
cat
ion,
an
d
healt
h
care
issues,
a
nd
th
e
env
i
ronm
ent
[13].
S
pecific
norm
at
ive
and
sub
j
ect
ive
st
at
e
m
ents
and
view
po
i
nts
f
rom
the
per
s
pecti
ve o
f resp
onde
nts
w
ere
pr
ese
nte
d t
hro
ugh direct
quotati
ons am
ong othe
rs.
3.
DISCU
SSI
ON
This
sect
io
n
di
scusses
t
wo
t
hem
es;
rev
ie
w
of
t
he
m
ental
healt
h
issu
es
thu
s
fa
r,
a
nd
re
sp
onses
f
ro
m
intervie
wees c
on
ce
r
ning the
s
ta
te
o
f p
oor
m
ental
h
eal
th
in Gha
na.
3.1.
Histo
ri
c
al
ov
e
rview
Stat
uto
ry
backi
ng
for
insti
tut
ion
al
isa
ti
on
of
m
ental
healt
h
patie
nts
sta
rte
d
with
e
nactm
ent
of
the
Asylum
Or
dina
nce
in
1888
by
the
then
Gov
ernor
of
the
G
old
C
oast,
Sir
Gr
if
fith
E
dw
a
r
ds
as
a
m
ov
e
to
cu
r
b
the
sit
uation
wh
e
re
m
ental
l
y
il
l
patie
nts
wer
e
see
n
r
oa
m
ing
in
town
s
and
vill
ages
causin
g
dam
age
to
pro
per
ti
es
an
d
so
m
et
i
m
es
inflic
ti
ng
ha
rm
on
pe
op
le
[14].
T
he
e
nactm
ent
of
this
act
le
d
to
the
crim
inali
s
at
ion
of
in
sanity
w
he
re
pe
ople
who
we
re
pe
rceiv
ed
to
be
m
enta
ll
y
i
ll
wer
e
pu
t
in
pr
is
on
in
th
e
capit
al
of
the
Gol
d
Coast.
T
his
spe
ci
al
pr
iso
n
a
rrang
em
ent
was
unde
r
ha
rs
h
co
nd
it
io
ns
a
nd
t
he
‘priso
ne
rs’
,
who
wer
e
m
ental
ly
i
ll
wer
e
pu
t
unde
r
stric
t
restrict
ion
s
[15].
By
the
ye
ar
19
00,
the
sp
eci
al
pr
i
so
n
for
ho
us
in
g
ps
yc
hiatri
c
pa
ti
ents
was
f
ull an
d
ne
w
cases
of
m
ental
il
l
ness
co
ul
d
not be a
dm
itted.
T
his n
eces
sit
at
ed
the con
structio
n
of a
n ac
tual
ps
yc
hiatri
c
hos
pital
in
the
capit
al
.
Ther
e
f
ore
in
the
ye
ar
1906
the
first
psy
chiat
ric
ho
s
pi
ta
l
was
bu
il
t
in
the
West
of
A
fr
ic
a
by
the
Brit
ish
E
m
pire.
This
facil
it
y
was
kn
own
as
the
“The
Lu
natic
As
yl
u
m
”
[1
6].
From
the
incepti
on
of
l
unat
ic
asy
lum
i
n
19
06
ti
ll
1950,
the
facil
it
y
ran
with
out
a
substanti
ve
psy
chiat
rist.
It
w
as
not
un
ti
l
1951
that
a
native
of
the
Gam
bia,
Dr
.
E.F.
B
Fo
ste
r
was
poste
d
by
the
colon
ia
l
adm
inist
rati
on
fr
om
Lo
nd
on to
h
ea
d
the
psy
chiat
r
ic
h
ospit
al
in A
ccra [1
7].
The
w
ork
of
D
r.
Fo
ste
r
helpe
d
to
tra
ns
f
orm
the
deli
ver
y
of
m
ental
healt
hc
are
dr
ast
ic
al
ly
in
G
ha
na.
It
was
durin
g
the
era
of
Dr.
F
ost
er
that
t
he
as
yl
u
m
was
tra
nsfo
rm
ed
into
a
H
ospit
al
with
a
re
side
nt
m
e
dica
l
do
ct
or
base
d
on
global
tren
ds
at
the
ti
m
e.
It
was
durin
g
hi
s
te
nure
t
hat
m
any
ps
yc
hiatri
c
doct
ors
a
nd
nurse
s
wer
e
gi
ve
n
trai
nin
g
to
becom
e
pr
of
e
ssio
na
ls.
These
doc
tors
la
te
r
beca
m
e
trai
ner
s
the
m
sel
ves.
Throug
h
hi
s
init
ia
ti
ve,
m
an
y
ps
yc
hiatri
c
doct
ors
wer
e
se
nt
ab
road
t
o
pursu
e
f
ur
t
her
stu
dies
in
ps
yc
hiatry
m
edici
ne.
Durin
g
the
tim
e
of
Dr.
Fo
ste
r,
t
her
e
was
th
e
trai
ni
ng
of
Q
ualifi
ed
Re
gistered
Me
ntal
N
ur
se
s
(
Q
.R.M.N
)
in
19
52
by
Mrs.
Hi
gg
i
nso
n,
a
Brit
ish
na
ti
on
al
[
18
]
.
I
n
the
ye
ar
1963,
the
Gh
a
na
Me
dical
Sc
hool
sta
rte
d
wi
th
the
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
6
, No
.
4
,
Decem
ber
20
1
7
:
299
–
313
302
inclusio
n
of
an
undergr
a
duat
e
cou
r
se
in
Psychia
try
.
The
fi
rst
trai
ned
m
e
ntal
healt
h
nur
se
in
Gh
a
na
w
as
Mr.
L.L. Ta
m
akloe
w
ho joine
d
t
he
trainin
g
sc
ho
ol in 1
965
[
19
]
.
In
1983,
D
r.
B
.
Asa
re
was
a
ppoi
nted
by
the
then
hea
d
of
st
at
e,
H.
E
.
J.
J.
Ra
wling
s
to
be
the
hea
d
of
Gh
a
na
Psyc
hiatri
c
Ho
s
pital
.
The
ap
pointm
e
nt
of
Dr.
Asa
r
e
coupled
with
the
interest
from
the
Head
of
Stat
e
in
1983,
res
ul
te
d
in
the
set
ti
ng
up
of
a
com
m
ittee
to
a
dv
ise
the
Gov
ern
m
ent
on
im
pr
ov
in
g
Psy
chiat
ric
Ser
vices
in
the
country
an
d
especial
ly
in
the
Accr
a
Psyc
hiatri
c
Ho
s
pital
.
This
was
f
ollowe
d
by
the
creat
ion
of
the
m
ental
healt
h
unit
within
the
Mi
nistry
of
Healt
h.
This
c
ulm
inate
d
int
o
the
new
era
of
psy
chiat
ric
c
are
in
Gh
a
na.
T
his
ne
w
e
ra
was
c
ha
racteri
sed
by
the
ope
nin
g
of
m
or
e
m
ental
healt
h
care
facil
it
ie
s
in
G
han
a
as
well
as
trai
ning
ce
nt
res
f
or
Qu
al
ifi
ed
Re
gistere
d
Me
ntal
Nurses
in
the
1900s.
Publi
c
awar
e
ne
ss
of
m
ental
healt
h
issues
was
inte
ns
ifie
d
durin
g
this
era
le
adin
g
to
the
re
duct
ion
of
th
e
m
ental
ly
ill
in
insti
tuti
on
al
ca
re
from
a
popula
ti
on
of
2000 t
o 100
0 pa
ti
ents b
y t
he
yea
r 200
0
[
20]
.
3.2.
Le
gislat
i
on
s
f
or
me
ntal he
al
th
in
Gh
ana
This secti
on
st
ud
ie
s the
histo
r
ic
al
o
verview
of
legisl
at
io
ns
on
m
ental
h
eal
th in
G
han
a
ov
er th
e p
e
rio
d
unde
r
re
view.
These
le
gislat
ion
s
i
nclu
de
sta
tute
la
ws
an
d
gove
r
nm
ent
decr
ees
co
nce
rn
i
ng
healt
hca
re
de
li
ver
y
to m
ental
h
eal
th
patie
nts.
3.2.1.
Luna
tic
asylu
m a
c
t
(18
88)
This
Acts
enc
oura
ged
the
c
onfinem
ent
of
m
ental
l
y
i
ll
p
at
ie
nts
to
instituti
on
al
care.
These
pe
ople
wer
e
see
n
m
ore
of
outc
ast
s
that
so
ci
et
y
ne
eded
t
o
ri
d
it
sel
f
of.
T
his
w
as
the
fir
st
Ac
t
enacte
d
in
t
he
Go
l
d
Coast
in
relat
ion
to
m
ental
healt
h
in
G
ha
na.
T
he
e
nact
m
ent
of
t
his
a
ct
m
ark
ed
t
he
be
ginnin
g
of
form
a
l
gove
rn
m
ent
m
ental
healt
h
se
rv
ic
e
delive
ry
in
G
ha
na
[21].
The
L
un
at
ic
Asyl
um
Act
of
1888
treat
ed
m
enta
l
il
lness
as
if
it
was
a
crim
e,
c
reati
ng
a
spe
ci
al
ise
d
pr
is
on
f
or
patie
nts
instea
d
of
seekin
g
to
cur
e
them
of
th
e
disease.
D
ur
in
g
the
pe
rio
d
of
ope
rati
on
al
iz
at
ion
of
t
his
A
ct
,
an
i
nd
i
vidu
al
lost
his
or
he
r
f
reedom
upon
the
su
s
pi
ci
on
of
m
ental
il
lness.
T
his
le
d
to
a
sit
uation
w
her
e
f
a
m
ilies
wer
e
r
el
uctant
to
repor
t
cases
of
fa
m
ily
m
e
m
ber
s
su
f
fe
rin
g
from
m
en
ta
l
illness
to
th
e
ho
s
pital
for
f
ear
of
incarce
r
at
ion
.
T
his
la
w
was
operati
on
al
in
Gh
a
na f
or
ei
ghty
-
four (
84)
ye
ars un
ti
l 1
972
wh
e
n
t
he NRC
p
asse
d
t
he
Me
ntal Heal
th
A
ct
.
3.2.2.
The
men
ta
l
he
alth decre
e
of
1972
(NRCD
30)
The
1972
la
w
was
con
si
dered
a
m
ajo
r
im
pr
ov
em
ent
ov
er
the
L
un
at
ic
Asylu
m
Act
of
1888.
Howe
ver,
so
m
e
el
e
m
ents
of
the
1888
O
r
dina
nce
we
re
m
a
i
ntained
.
Ju
st
li
ke
the
1888
o
r
din
a
nce,
the
M
ental
Healt
h
Decr
ee
of
1972
em
ph
asi
zed
i
ns
ti
tu
ti
on
al
care
t
o
t
he
detrim
ent
of
pro
vi
ding
m
ental
care
in
pri
m
ary
healt
h
care
set
ti
ng
s
[
22]
.
This
prov
isi
on
in
t
he
Act
was
a
c
on
t
rad
ic
ti
on
to
the
m
any
inter
natio
nal
treat
ie
s
that
Gh
a
na
ha
d
sig
ned
un
t
o.
The
NRCD
Dec
ree
30
ga
ve
way
f
or
the
ab
us
e
of
people’s
f
reedom
and
li
ber
ti
es
[5
]
.
Fo
r
in
sta
nce,
t
he
proce
dure
f
or
in
vo
l
un
ta
ry
adm
issi
on
in
the
1972
Act
did
not
suffici
ently
pr
otect
pe
op
l
e
against
unnece
ssary
adm
issi
on
.
Seri
ou
s
m
istr
eat
m
ents
of
pe
op
le
with
m
ental
dis
order
s
took
place
unde
r
this
le
gislat
ion
wit
h
s
om
e
peo
ple
bein
g
loc
ke
d
a
way
in
insti
tuti
on
s
f
or
deca
de
s
[2
3
]
.
T
his
la
w
wa
s
oper
at
io
nal
f
or
forty
(40)
ye
ar
s
an
d
sig
nifica
ntly
took
awa
y
the
rig
hts
of
people
with
m
ental
diso
r
de
rs
by
see
king
t
o
ke
ep
sic
k
pe
op
le
off
the
street
as
well
as
pr
otect
their
bel
onging
s
and
asset
s.
U
nd
e
r
this
la
w,
m
ental
healt
h
patie
nts
wer
e
not
co
ns
i
der
e
d
sa
ne
e
nough
to
en
joy
ba
sic
hu
m
an
rig
hts
[
2
4
]
.
The
Me
ntal
Healt
h
Decr
ee
NRCD
30
wa
s
nev
e
r fu
ll
y i
m
plem
ented.
3.2.3.
The
men
t
al
he
alth ac
t of 2
01
2
In
2012,
a
re
vised
Me
ntal
He
al
th
Law
was
passe
d:
the
Me
ntal
Healt
h
Ac
t
846
(
2012
).
T
his
ne
w
Act
was
dr
a
fted
be
tween
2004
a
nd
20
06
with
World
Healt
h
Orga
nisati
on
(
WHO)
ex
per
ts
and
c
ons
ultan
ts
fro
m
South
Africa
,
Zi
m
bab
we
,
Ca
nad
a
,
U
SA
a
nd
S
witz
erlan
d.
It
receive
d
pr
esi
den
ti
al
asse
nt
in
Ma
y
2012,
r
eady
for
the
est
ablis
hm
ent
of
a
Me
ntal
Healt
h
Bo
ard
an
d
pro
duc
ti
on
of
a
Le
gis
la
ti
ve
Instrum
ent.
It
bec
am
e
l
aw
on
1s
t D
ecem
ber
2
01
2.
The
ne
w
La
w
becam
e
necessary
as
it
was
reco
gnise
d
that
the
19
72
le
gislat
ion
,
eve
n
i
f
now
f
ully
i
m
ple
m
ented,
was
outdate
d
a
s
it
no
l
onger
fell
within
bes
t
pr
act
ic
es
i
n
m
ental
healt
h
care.
The
ne
w
Me
ntal
Healt
h
Act
focuses
on
im
prov
i
ng
t
he
acc
ess
to
care
for
pe
ople
with
m
ental
il
lnes
s,
inclu
ding
e
pilepsy
captu
rin
g
the
chall
en
ges
f
aci
ng
t
he
po
or
an
d
vu
l
ner
a
ble,
sa
feguar
di
ng
hu
m
an
ri
gh
ts
a
nd
pr
om
ot
ing
par
ti
ci
patio
n
in
resto
rati
on
and
rec
overy
of
the
m
ental
l
y
i
ll
.
Altho
ug
h
epile
ps
y
is
recogn
iz
e
d
in
G
ha
na
an
d
el
sewh
e
re
to
be
a
neuro
l
og
ic
al
diso
r
der
rather
tha
n
a
m
ental
dis
order
,
it
is
treat
ed
by
psy
chiat
rists
in
Gh
a
na
for
co
nv
e
nien
ce
based
on
s
har
e
d
at
tribu
te
s
of
sti
gm
a
an
d
local
belie
f
syst
e
m
s.
The
l
aw
pro
vid
es
f
or
t
he
integrati
on
a
nd
re
gula
ti
on
of
sp
irit
ual
a
nd
tra
diti
on
al
m
ental
health
pr
act
ic
es
in
G
han
a
.
It
s
upports
dec
ent
rali
sat
ion
of m
ental
h
eal
th care
a
nd
places em
ph
asi
s
on co
m
m
un
it
y rather
tha
n
i
ns
ti
tuti
on
al
care
[2
5
].
The
pas
sage
of
the
Me
ntal
Healt
h
Act
2012
by
par
li
am
ent
i
n
Ma
rch
2012
m
ark
ed
a
m
ajo
r
m
il
est
on
e
in
ad
dr
essi
ng
m
ental
healt
h
as
a
public
hea
lt
h
issue
an
d
al
so
in
the
prot
ect
ion
of
the
hum
an
righ
ts
of
people
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N:
22
52
-
8806
Mental
He
alth
Service i
n G
ha
na:
A
Revi
ew
of
the Ca
se
(S
amuel
Ad
u
-
Gy
amfi
)
303
with
m
ental
di
so
r
de
rs
in
G
ha
na
[
2
3
]
.
T
he
la
st
m
ajo
r
re
visi
on
of
m
ental
healt
h
la
w
was
unde
rtake
n
in
the
la
te
1960s,
c
ulm
in
at
ing
in
the
e
na
ctm
ent
of
th
e
Me
ntal
Healt
h
Decr
ee,
NR
CD
30,
in
1972
[2
6
]
.
U
nfo
rtun
at
el
y
,
ov
e
r
the
forty
ye
ars
of
it
s
ex
ist
ence,
the
M
ental
Healt
h
D
ecree
(
NRCD
30),
was
not
im
ple
m
ented.
Ra
ther
,
since
the
early
1990s
seve
ral
un
s
uccess
fu
l
at
tem
pts
wer
e
m
ade
to
enact
a
new
m
ental
healt
h
la
w.
B
efor
e
2004,
T
he
La
w
Re
form
Com
m
iss
ion
(LR
C)
was
in
vo
l
ve
d
in
re
visio
ns
of
the
1972
Decr
ee
.
It
is
su
r
pr
isi
ng
howe
ver
that
t
hese
earli
er
re
visio
ns
inclu
di
ng
t
he
Me
ntal
Healt
h
Law
,
1990,
w
ere
not
enacte
d,
no
t
even
durin
g peri
ods
of co
ns
ti
tuti
on
al
r
ule
[2
7
].
The
proces
s
th
at
le
d
to
the
pa
ssage
of
t
he
Me
n
ta
l
Healt
h
Act
by
Pa
rlia
m
ent
in
Ma
rc
h
2012
w
a
s
init
ia
te
d
in
2003.
F
ro
m
2004,
fina
ncial
and
t
echn
ic
al
s
uppo
rt
was
gi
ve
n
by
the
Me
ntal
Healt
h
De
pa
rtm
ent
of
the
W
orl
d
Hea
lt
h
Or
ga
nizat
ion
(
WHO
).
T
he
pr
oc
ess
of
f
or
m
ulati
ng
an
d
rev
isi
ng
the
le
gislat
ion
involve
d
a
series
of
co
nsu
lt
at
ion
s
with
a
wide
va
riet
y
of
inte
rn
at
io
nal
and
local
sta
ke
ho
l
der
s
.
A
ne
w
Me
ntal
Heal
th
Act
846 was
pass
e
d
in
20
12.
3.3.
The
im
plem
en
tation o
f the c
urrent
men
ta
l
hea
l
th
act
of
Ghana
Accor
ding to
the
Mi
nistry of
Healt
h,
ei
ght pe
r
cent of all
ad
m
issi
on
s to
ge
ner
al
hos
pital
/ cli
nic b
ase
d
ps
yc
hiatri
c
in
pa
ti
ent
un
it
s
an
d
2%
of
al
l
ad
m
issi
on
s
to
m
e
ntal
hosp
it
al
s
wer
e
le
gally
sancti
on
e
d
i
nvol
un
ta
ry
adm
issi
on
s.
T
he
rem
ai
nin
g
patie
nts
are
ei
ther
vo
l
un
ta
ry
or
a
dm
it
te
d
a
gainst
thei
r
wi
ll
without
the
us
e
of
le
gislat
ion
but
with
prox
y
c
on
s
ent
by
thei
r
relat
ives,
an
d
that
is
sti
ll
consi
der
e
d
t
o
be
‘
volu
ntary’.
Ten
t
o
twenty
p
e
rce
nt of in
-
patie
nts
are r
e
strai
ne
d (
m
echan
ic
al
and/o
r non
-
m
echan
ic
al
) or
secl
uded
[
28
]
.
Gr
eat
er
Accr
a
Re
gion
had
7.2
3
tim
es
m
or
e
b
eds,
4.2
8
tim
es
m
or
e
ps
yc
hiatri
sts
and
4.4
4
tim
es
m
or
e
nurses
th
an
t
he
rest
of
t
he
c
ountry
des
pite
on
ly
sixtee
n
per
c
ent
of
the
24.2
m
illi
on
popula
ti
on
of
G
ha
na
l
iving
in that Re
gion.
Most m
ental
h
eal
th service
s a
re in o
r near
larg
e
cit
ie
s [
29
].
Gr
eat
er
Ac
cra
has
the
m
os
t
sta
ff
an
d
treat
s
the
m
os
t
ou
tpati
ents
pe
r
100,0
00
of
thei
r
popula
ti
on
wh
e
reas
As
ha
nt
i
has
the
fe
we
st
an
d
treat
s
th
e
fe
west
patie
nt
s
(p
e
r
100,0
00
).
U
pp
e
r
Ea
st
a
nd
U
pper
W
e
st
are
no
t
well
s
uppl
ie
d
with
sta
f
f
bu
t
both
t
reats
a
hi
gh
pr
oport
ion
of
their
popula
ti
ons,
part
ic
ularly
Uppe
r
Eas
t
su
ggest
in
g
high
ef
fici
ency
a
nd
pro
duct
ivit
y
in
these
regi
on
s
[
28
]
.
T
he
re
are
c
urre
ntly
about
1,8
87
sta
f
f
work
i
ng
in
m
e
ntal
healt
h
ser
vices.
Sixty
tw
o
pe
r
cent
(1,177)
of
the
1,887
are
s
pecifica
ll
y
trai
ned
in
m
ental
healt
h
a
nd 71
0 (38%
)
are
staf
f
workin
g
i
n
m
e
ntal healt
h b
ut
no
t
sp
eci
fical
ly
traine
d
in
m
ental
h
eal
th [2
3
].
Althou
gh
the
re
is
no
national
or
ga
nizat
io
nal
body
for
m
en
ta
l
healt
h,
the
respo
ns
ibil
it
y
fo
r
nati
on
al
orga
nizat
ion
of
m
ental
healt
h
serv
ic
es
is
vest
ed
in
the
Chief
Psychia
trist
as
the
national
he
ad
w
ho
al
s
o
s
erv
e
s
to
dir
ect
ly
advi
se
the
Mi
niste
r
f
or
Healt
h
on
m
ental
healt
h.
The
re
is
a
f
oc
al
per
s
on
f
or
m
ental
healt
h
locat
ed
in
the
I
ns
ti
tuti
on
al
Ca
re
Divi
sion
of
the
G
ha
na
Healt
h
S
er
vice,
to
co
ordi
n
at
e
m
ental
healt
h
care
i
n
the
G
hana
Healt
h
Ser
vice
insti
tuti
on
s.
The
Chief
Psy
chiat
rist
al
so
coor
din
at
es
pl
ann
i
ng
a
nd
organ
iz
at
io
n
of
m
ental
healt
h
act
ivit
ie
s
at
the
natio
nal
le
vel.
At
the
reg
io
nal
and
district
le
vels,
the
Re
gional
and
Distric
t
Coordi
nato
r
s
of Com
m
un
it
y Psy
chiat
ric N
ursin
g
se
rv
e
as t
he
c
oor
din
at
or
s.
3.4.
Problems
conf
ronti
ng
men
tal
hea
lt
h c
are
i
n Ghan
a
Seve
ral
chall
eng
e
s
sti
ll
con
fron
t
m
ental
healt
h
care
in
G
ha
na.
T
hese
cha
ll
eng
es
are
gro
up
e
d
unde
r
orga
nisati
on
al
,
finan
ci
al
,
le
ga
l
and
jud
ic
ia
r
y
as
well
as
the
ro
le
of
the
Com
m
issi
on
fo
r
H
um
an
Ri
gh
ts
an
d
Ad
m
inist
rati
ve
Ju
sti
ce
(CHR
AJ). T
hese c
ha
ll
eng
es a
re
dis
cusse
d
in
the
f
ollow
i
ng secti
ons.
3.4.1.
Healt
h
s
ys
te
m
o
r
ganiz
at
ion
al
cha
ll
enge
The
Me
ntal
H
eal
th
Ser
vices
hav
e
by
a
nd
la
rg
e
rem
ai
ned
a
tt
ached
to
thei
r
hist
or
ic
al
ori
gin
s
within
the
cu
rati
ve
he
al
th
fr
am
ework
[
3
0
]
.
T
he
e
xtensi
on
of
ps
yc
hiatri
c
facil
it
ie
s
to
unit
s
within
Re
gion
al
and
Distric
t
H
os
pit
al
s
is
co
ns
ist
ent
with
the
c
urat
ive
par
a
digm
.
Co
m
m
un
ity
ps
yc
hiatry
i
s
viewe
d
with
in
this
fr
am
ew
ork
as
‘outreac
h’
ser
vices
from
ps
ych
ia
tric
facil
it
i
es.
The
ap
plica
ti
on
of
public
healt
h
pr
inci
pl
es
to
m
ental
h
eal
th s
erv
ic
es
has
not
b
ee
n
trie
d.
The
Me
ntal
H
eal
th
U
nit
(M
HU)
is
orga
ni
zat
ion
al
ly
plac
ed
within
the
In
sti
tuti
onal
C
are
Divisio
n
(I
CD
)
of
the
Gh
a
na
Healt
h
Ser
vice.
T
he
offices
a
re
loca
te
d
in
t
he
Acc
ra
Psyc
hiatri
c
Ho
s
pital
.
F
rom
this
locat
ion
the
M
HU
gov
e
rns
th
e
three
sta
te
psy
chiat
ric
ho
s
pi
ta
ls
and
ope
rates
a
national
c
omm
un
it
y
ps
ych
ia
tric
nursing
se
rv
ic
e
[14].
Ov
e
rsi
gh
t
for
the
re
gional
ps
yc
hiatr
ic
un
it
s
is
prov
i
ded
by
thei
r
res
pecti
ve
re
gional
healt
h
a
dm
inis
trat
ion
s.
Com
m
un
it
y
ps
yc
hiatri
c
nurses
a
r
e
paid
a
nd
s
uper
vised
by
th
ei
r
res
pecti
ve
district
healt
h
adm
inist
rati
on
s.
The
re
is
no
op
e
rati
onal
li
nk
betwe
en
the
Directo
rate
of
Publi
c
Healt
h
in
the
Gh
a
na
Healt
h
Se
rv
ic
e
(
G
HS) a
nd the
Mental
H
eal
th
Unit
[
3
1
]
. T
he
re is no o
rg
a
ni
zat
ion
al
or str
uc
tural r
e
presen
ta
ti
on
of the M
HU w
i
thin the
Mi
nist
ry of
Healt
h hierarc
hy.
The
l
ow
m
or
al
e
and
dissati
s
facti
on
of
m
ental
healt
h
pr
of
essi
onal
s
an
d
thei
r
per
cei
ved
n
e
gative
treatm
ent
within
the
G
ha
na
Healt
h
Ser
vic
e
ov
e
r
the
ye
ars
m
igh
t
have
been
a
m
otivati
ng
facto
r
in
the
form
ulati
on
of
the
or
igi
nal
ver
si
on
of
the
Me
ntal
Health
Act
of
2012
wh
ic
h
pro
po
s
ed
a
Me
ntal
Healt
h
Ser
vice
separ
a
te
fr
om
the
Ghana
Healt
h
Se
r
vice.
This
obs
erv
at
io
n
m
igh
t
hav
e
in
f
or
m
e
d
a
view
report
ed
to
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
6
, No
.
4
,
Decem
ber
20
1
7
:
299
–
313
304
hav
e
been
e
xpr
essed
by
a
pro
m
inent
ps
yc
hia
trist
that
m
ental
healt
h
prof
es
sion
al
s
we
re
‘
m
isfit
s’
in
the
Gh
a
na
Healt
h
Se
rv
ic
e
(GHS
)
[
3
2
]
.
Howe
ver
t
he
i
dea
of
a
Me
nt
al
Healt
h
Se
rvi
ce
separ
at
e
from
the
Gh
a
na
Healt
h
Ser
vice was
no
t adopted
.
3.4.2.
Le
ga
l
and
j
ud
ic
ial challe
n
ge
The
a
vaila
bili
ty
of
a
le
gal
f
orum
wh
ere
pe
ople
can
go
to
s
eek
e
nforce
m
e
nt
or
redress
f
or
the
breac
h
of
thei
r
rig
ht
s,
trai
ne
d
hea
lt
h
prof
es
sio
na
ls
and
a
dm
i
nistrato
rs,
a
dvocates
to
assi
st
people
in
their
represe
ntati
on
s
,
are
necessa
ry
co
nd
it
io
ns
for
the
im
ple
m
entat
ion
of
t
he
m
e
ntal
healt
h
act
.
These
facil
it
ie
s
will
need
t
o
be
put
in
place
in
Ghana
as
s
oon
as
po
s
sible.
Indee
d
the
c
ongesti
on
of
t
he
sta
te
ps
yc
hiatri
c
hos
pital
s
and
c
onse
qu
e
nt
v
iolat
ion
of
the
hum
an
rig
ht
s
of
patie
nts
c
an
be
at
tribu
te
d
in
par
t
to
the
fail
ur
e
of
su
cc
essive
healt
h
a
dm
inistr
at
ors to
im
ple
m
ent the Ment
al
H
eal
th T
rib
unal
P
ro
ce
dures
.
A
fe
w
prom
inent
hum
an
rig
hts
la
wyers
a
nd
NGOs,
nota
bly
the
H
um
an
Ri
gh
ts
A
dvocacy
Ce
ntre,
a
re
the
visible
ad
vocat
es
for
the
rig
hts
of
per
s
ons
with
m
ental
il
lness
wh
ose
hu
m
an
rig
hts
hav
e
been
br
e
ached.
HelpLa
w
Gh
a
na
is
an
oth
e
r
NGO/C
ha
rity
est
ablished
with
the
s
ole
pur
po
s
e
to
pr
ov
i
de
fr
ee
se
rv
ic
es
to
the
poor
a
nd
le
ss
pr
i
vileged
in
Gh
a
na.
H
owe
ver,
the
exte
nt
of
thei
r
in
volvem
ent
with
pa
ti
ents
in
ps
yc
hiatri
c
facil
it
ie
s r
e
m
ain
s
uncertai
n [
3
3
].
The
la
w
fac
ulti
es
of
the
U
ni
ver
sit
y
of
G
ha
na
an
d
Kw
a
m
e
Nk
r
um
ah
Un
i
ver
sit
y
of
Scie
nce
a
nd
Tech
no
l
og
y,
do
no
t
offe
r
el
e
ct
ive
co
urses
of
stu
dy
in
he
al
th
la
w
he
nce
la
wyers
trai
ne
d
i
n
Gh
a
na
qual
ify
without
ex
pos
ur
e
t
o
healt
h
l
aw
trai
ni
ng,
le
t
al
on
e
m
ental
healt
h
la
w.
W
it
hout
la
wye
rs
w
ho
are
tra
ined
i
n
healt
h
la
w
to
help
inte
rpret,
advocate
an
d
enfor
ce
t
he
m
ental
healt
h
act
,
to
protect
patie
nts’
ri
ghts
and
im
ple
m
entat
io
n
of
the
Act,
the
risk
of
no
n
-
fu
lfil
m
ent
or
breac
h
of
patie
nt
s’
righ
ts
will
be
aco
ntinuos
reali
ty
.
The
Act
sti
pul
at
es
that
the
Me
ntal
Healt
h
Re
view
Tri
bunal
s
(MHR
Ts)
are
presi
de
d
over b
y
se
nio
r
la
wy
ers.
In
the
earli
er
draf
ts
of
the
Act,
i
t
was
e
nv
isa
ge
d
that
the
Me
nt
al
Healt
h
Au
t
hority
would
be
responsi
ble
f
or
the
regulat
ion
of
t
he
MHRTs
.
It
has
bee
n
s
uggested
that
as
the
MHRTs
are
quasi
-
j
udic
ia
ry
in
natu
re,
their
regulat
ion
s
hould
be
f
r
om
the
Ju
dicia
l
Servi
ces
and
not
by
the
Me
ntal
Healt
h
A
uthor
i
ty
.
This
arr
an
gem
ent
if
pu
t i
n place
would g
uar
a
ntee a
h
ig
he
r
le
vel
of
ind
e
pe
nd
e
nce
and im
par
ti
al
i
t
y of t
he
M
HR
Ts.
In
the
Me
nta
l
Healt
h
Decr
ee,
NRC
D
30
1972,
no
pro
vision
was
m
ade
fo
r
re
cei
vin
g
a
nd
inv
est
igati
ng
c
om
plaints
fr
om
detai
ned
pa
ti
ents.
It
m
ight
be
reas
on
a
bl
y
assum
ed
that
the
app
eal
s
process
would
ta
ke
c
om
pla
ints
into
account
or
t
ha
t
the
hos
pital
s
m
igh
t
ha
ve
a
rob
us
t
gr
ie
va
nce
a
nd
com
plaints
proce
dure.
T
he
Me
ntal
Healt
h
Act, w
hic
h
cl
e
arly
places
m
or
e
em
ph
asi
s
on
the
patie
nt
,
is m
or
e
exp
li
ci
t
in
t
his
reg
a
rd
an
d
m
a
kes
pro
vision
for
c
om
plaints
from
detai
ned
pa
ti
ents
to
be
heard
a
nd
inv
est
igate
d.
A
hi
gh
tur
nover
of
co
m
pla
ints
sh
oul
d
the
refor
e
be
antic
ipate
d
a
nd
pr
e
par
e
d
f
or.
A
re
view
of
e
na
ctm
ents
relev
ant
to
the
m
ental
healt
hcar
e
nee
ds
to
be
unde
rtak
e
n
to
br
i
ng
the
m
in
l
ine
with
the
m
ental
he
al
th
Act.
This
m
igh
t
resu
lt
in
c
onse
qu
e
ntial
am
en
dm
ents.
Fo
r
ex
a
m
ple
the
dec
r
i
m
inali
zation
of
su
ic
id
e
re
qu
i
r
es
an
am
end
m
ent
the
Cri
m
inal cod
e
,
1960, Act
29.
3.5.
The
am
bigu
ous role
of
th
e
commissi
on
for hum
an
ri
ght
s a
n
d
ad
mi
nis
trative
ju
s
tice
(CHR
AJ)
It
is
co
m
m
on
know
le
dg
e
t
hat
the
Com
m
issi
on
for
H
um
an
Ri
gh
ts
and
Ad
m
inist
rati
ve
Ju
sti
ce
(CHRA
J)
recei
ves
a
nd
in
vesti
gates
c
om
plaints
from
and
on
beh
al
f
of
patie
nts
who
s
uffe
r
from
m
ental
ill
ness,
par
ti
cula
rly
tho
se
on
adm
is
s
ion
to
va
rio
us
ps
yc
hiatri
c
hosp
it
al
s.
I
n
this
reg
ar
d,
it
is
no
t
unreas
onable
to
assum
e
that
in
resp
ect
of
re
cei
vin
g
a
nd
in
vestigat
in
g
co
m
pla
ints,
CH
RAJ
is
the
de
facto
Me
ntal
Healt
h
Re
view
T
rib
un
al
.
In
rece
nt
tim
es
,
CHRAJ
ha
s
unde
rtake
n
an
advocacy
r
ole
in
resp
ect
of
P
ersons
wit
h
Di
sabili
ty
and
the
cal
ls
for
th
e
i
m
ple
m
entat
i
on
of
the
le
gis
la
ti
ve
instru
m
ent
f
or
the
Pers
on
s
with
Disab
il
ity
Act,
2006
(A
ct
715).
A
st
ron
g
li
nk
bet
ween
cl
ause
72
of
th
e
Me
ntal
Healt
h
Act,
w
hich
r
equ
i
res
the
Mi
nister
res
pons
i
ble
for
So
ci
al
W
el
fa
re
to
m
ake
pr
ovisi
on
for
the
psy
cho
s
ocial
rehabil
it
at
ion
an
d
after
-
ca
re
ser
vi
ces
of
m
ental
healt
h
patie
nts,
i
nclu
ding
s
up
e
r
vision,
re
ha
bili
ta
tio
n
an
d
vocat
ion
al
tr
ai
ning,
and
cl
ause
15
of
the
Pers
on
s
with
Disabili
ty
Act;
it
req
uire
s
th
at
,
a
s
far
as
pract
ic
able,
pe
r
so
ns
with
disa
bili
ty
sh
al
l
be
reh
a
bili
ta
te
d
in
their
com
m
un
it
ie
s
t
o
f
os
te
r
thei
r
integrati
on,
w
ou
l
d
ens
ure
that
pe
op
le
w
it
h
m
ental
ill
ness
who
be
com
e
ps
yc
hos
ocial
ly
disable
d
as
a
r
esult
of
their
m
ental
dis
order
will
ben
e
fit
f
rom
the
pro
visio
ns
of
t
his
e
nactm
ent
.
Eq
ually
,
the
R
igh
ts
of
Pe
rs
ons
with
disa
bili
ty
(clauses
1
-
15
of
the
G
ha
na
Disabili
ty
Act
2006)
m
i
gh
t
be
app
li
cable
to
a
pr
op
or
ti
on
of
the
m
ental
ly
ill
wh
o
s
uffer
psy
cho
s
ocial
disabili
ti
es
du
rin
g
the
cou
rse
of
il
lness.
It
is
n
ot
certai
n
that
the
CHRAJ
pro
gram
m
e
on
the H
um
an
Ri
gh
ts
inclu
de
s
the
Ri
gh
ts
of Per
s
on
s w
it
h
Me
ntal
Illness.
3.6.
Financi
al
pr
obl
ems
Me
ntal
Healt
h
fina
ncin
g
s
ho
uld
be
re
-
e
xa
m
ined
syst
em
a
ti
cal
ly
from
br
oad
va
riet
y
of
view
points
.
Me
ntal
healt
h
had
a
rin
g
-
fence
d
b
ud
get
of
1.4%
of
total
gove
rn
m
ental
healt
h
e
xpen
di
ture.
It
is
not
f
easi
ble
for
the
he
al
th
sect
or
al
one
to
bear
the
bur
de
n
of
m
ental
healt
hcar
e
costs
.
This
ex
pectat
ion
is
al
so
unr
eal
ist
ic
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
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S
N:
22
52
-
8806
Mental
He
alth
Service i
n G
ha
na:
A
Revi
ew
of
the Ca
se
(S
amuel
Ad
u
-
Gy
amfi
)
305
giv
e
n
the
c
onstrai
nts
on
the
he
al
th
budget
.
C
aref
ul
m
app
ing
of
po
te
nt
ia
l
sources
of
f
unding
is
the
fir
st
ste
p
in
ens
ur
in
g
that
m
ental
healt
h
care
is
no
t
un
de
rfunde
d
[
2
5
].
The
Me
ntal
H
eal
th
Act
seek
s
to
introd
uce
sever
al
new
c
om
po
ne
nt
s
to
m
ental
healt
hcar
e
delive
ry
wh
ic
h
woul
d
require
a
n
au
gm
entat
ion
of
the
sect
or’s
fin
ancia
l
base if
it
is to
be
worka
ble. T
o t
his end,
the
A
ct
p
r
opos
e
s the
establi
sh
m
ent o
f
a
Mental
He
al
th Auth
or
it
y
with
a
gove
rn
i
ng
bo
ard
a
nd
seve
ra
l
dep
a
rtm
ents
t
o
pe
rfor
m
ro
le
s
that
are
pa
ral
le
l
to
the
Gh
a
na
Healt
h
Se
rv
i
ce.
It
al
so
pro
poses
the
set
ti
ng
up
of
v
isi
ti
ng
c
omm
ittee
s
in
al
l
t
en
re
gions
to
c
onduct
per
i
od
i
c
insp
ect
io
n
of
m
ental
healt
h
facil
it
ie
s.
If
al
l
these
adm
inist
rati
v
e
bodies
are
t
o
be
a
dequate
ly
cat
ered
for,
the
m
eagr
e
f
isc
al
arr
a
ng
em
ent
that
cur
re
ntly
exists
m
ay
no
t
be
able
to
su
sta
i
n
the
ne
w
re
gi
m
e,
and
m
ay
i
ncr
ease
t
he
res
ource
go
i
ng
to
t
he
t
op
m
anag
em
e
nt
rat
her
tha
n
the
act
ual
f
rontli
ne
patie
nt
care.
T
his
will
bur
den
the
a
lready
ov
e
rstretc
hed na
ti
on
al
bu
dget
to wo
rk agai
nst
the s
pirit o
f
t
he Act
.
Exten
ding
the
m
and
at
e
of
s
om
e
existi
ng
insti
tut
ion
s
an
d
stren
gth
e
ning
their
capaci
ty
to
deal
with
m
ental
healt
h
r
el
at
ed
m
a
tt
ers
cou
l
d
cu
rtai
l
the
fina
ncial
bur
den,
w
hich
m
igh
t
resu
lt
f
r
om
the
creati
on
of
these
new
i
ns
ti
tuti
ons.
For
insta
nce,
the
ro
le
that
th
e
propose
d
visit
ing
com
m
i
tt
ee
s
are
to
pe
r
for
m
can
in
the
in
te
ri
m
be
pe
r
form
ed
by
CHRA
J
co
nv
e
niently
pe
r
form
ed
in
the
short
to
m
edium
te
r
m
,
by
the
Com
m
issio
n
on
Hu
m
an
Ri
gh
ts
and
Ad
m
inist
rati
ve
Ju
sti
ce
(
CHRAJ
).
Sigi
nificantl
y,
heal
th
ser
vices
can
no
t
be
r
un
with
this
le
vel
of
f
un
ding
if
ram
pan
t
m
isc
arr
i
ages of
justi
ce
an
d
cost
s
du
e
t
o
com
pen
sat
io
n
f
or
s
uc
h
m
isc
arr
ia
ges
are
to
be
a
vo
i
ded.
Com
m
un
it
y
–
based
care
for
people
with
m
ental
diso
r
de
rs
dece
ptivel
y
app
ear
s
to
be
chea
p
bu
t
evide
ntly
no
t.
Also
,
e
xpansi
on
of
the
lo
gisti
cal
i
m
pr
ov
em
ents
that
m
igh
t
be
re
q
ui
red
to
bu
il
d
t
he
capa
ci
ty
of
CHRAJ
t
o
under
ta
ke
it
s
ne
w
m
and
at
e
m
i
gh
t
al
s
o
im
pr
ove
the
capaci
t
y
of
C
HRA
J
t
o
perform
it
s
existi
ng
m
and
at
e
[
3
4].
Im
po
rtantl
y,
C
HRAJ
will
pr
ov
i
de
i
nfor
m
ed,
i
nd
e
pe
ndent
an
d
obj
ect
ive
oversi
gh
t
w
hi
ch
a
n
ov
e
rsight
body
m
a
y l
ack,
at
le
ast
, in
t
he
fi
rst
two
a
reas.
3.6.1.
So
ci
al
services
cha
ll
en
ge
The
prese
nt
sit
uation
c
oncer
ni
ng
the
workf
orce
an
d
co
nd
it
i
on
s
of
se
rv
ic
e
of
gen
e
ral
so
ci
al
serv
ic
es
in
Gh
a
na
do
not
ho
l
d
out
m
uch
hope
reg
a
rdi
ng
the
abili
ty
of
the
s
ocial
serv
ic
es
to
pr
ov
i
de
ade
qu
at
e
nu
m
ber
s
of
s
ocial
w
ork
ers
well
-
s
kill
ed
in
m
ental
healt
h
to
sup
port
the
im
ple
m
entat
ion
of
the
M
ental
Healt
h
A
ct
[
35
].
Unde
r
the
Act
,
ps
yc
hiatri
c
r
ehab
il
it
at
ion
is
not
co
ns
ide
re
d
as
a
cl
inica
l
issue
for
ps
y
chiat
ric
ser
vic
es,
but
rather
t
he
dut
y
of
t
he
Mi
ni
ste
r
respo
ns
ible
for
S
ocial
W
el
far
e
.
Th
e
com
m
un
it
y
-
base
d
re
hab
il
it
at
io
n
pro
gr
am
m
e
in
Gh
a
na
is
m
ai
nl
y
restrict
ed
t
o
t
he
needs of
t
he
physi
cal
ly
disabled
with
ou
t ackno
wled
gem
ent
of
the
pr
ov
isi
on
f
or
com
m
un
it
y
reh
a
bili
ta
ti
on
ne
eds
of
pe
ople
with
m
ental
disabili
ty
.
Although
t
he
def
i
niti
on
of
disabili
ty
as
def
ine
d
in
the
Pers
on
s
with
Disabili
ty
Act
include
s
pe
ople
with
m
ental
diso
r
de
rs,
m
ental
disabili
ty
is
not
add
re
ssed
within
the d
isa
bili
ty
fr
am
ewo
rk
i
n
G
ha
na.
T
herefo
re,
the
re
is a
need
t
o
ad
dr
e
ss
this
app
a
re
nt
an
om
al
y
and
integ
ra
te
m
ental
health
i
nto
t
he
c
omm
un
it
y
-
based
r
ehab
il
it
at
ion
w
it
hin
s
ocial
ser
vices
in
Gh
a
na.
A
t
a
higher
organ
is
at
ion
al
le
vel,
cro
ss o
r
re
ci
pro
cal
rep
rese
ntati
on
b
et
wee
n
the
Nati
on
al
Co
unci
l
of
Pers
on
s
with
Disabili
ty
(N
CPD)
a
nd
th
e
B
oard
of
the
pro
po
s
ed
Me
ntal
Healt
h
A
uthori
ty
m
igh
t
be
m
utu
al
ly
ben
e
fici
al
in
adv
a
ncin
g
s
ocial
care
prov
isi
on
an
d
com
m
un
it
y
reh
abili
ta
ti
on
need
s
for
people
with
m
ental
disabili
ty
.
3.6.2.
Po
or
men
t
al h
ealth
service
s
ince
1900
The
K
om
fo
A
nokye
Teachi
ng
H
os
pital
is
the
m
a
in
governm
ent
ho
sp
it
al
locat
ed
in
K
um
asi
wh
ic
h
at
te
nd
s
to
t
he
healt
h
nee
ds
of
people
in
the
Ash
a
nti
Re
gion
of
G
ha
na
an
d
the
re
st
of
N
or
t
hern
pa
rt
of
Gh
a
na
.
The
ho
s
pital
is
m
and
at
ed
to
pro
vid
e
s
peci
al
ist
cl
inica
l
c
are
ser
vices,
tr
ai
n
m
edical
st
ud
e
n
ts
a
nd
un
der
ta
ke
researc
h
i
nto
e
m
erg
in
g
healt
h
issues
i
n
Gh
a
na.
T
he
hos
pital
has
se
ver
al
dep
a
rtm
ents
including
t
he
pa
ediat
ric,
su
r
gical
,
m
at
er
nal,
ps
yc
hiatry
,
a
m
on
g
oth
e
rs
.
The
ap
pa
ren
t
decen
t
rali
sed
na
ture
of
the
va
r
iou
s
dep
a
rtm
e
nts
of
the
ho
s
pital
en
su
re
s
the
ef
fect
ive
of
sp
eci
al
is
ed
healt
h
ca
re
serv
ic
es
.
Howe
ver,
the
ho
s
pital
ser
ves
m
ai
nly
as
a
ref
e
rr
al
ho
s
pita
l,
he
nce
cat
er
f
or
em
erg
e
ncy
and
crit
ic
al
co
nd
it
io
ns
.
The
psy
chiat
ry
de
pa
rtm
ent
of
the
hosp
it
al
is
by
far
the
on
ly
gove
r
nme
nt
m
ental
healt
h
facil
i
ty
serv
i
ng
the
who
le
of
the
nort
hern
pa
rt
of
Gh
a
na,
includi
ng
As
ha
nti,
Bron
g
A
ha
fo,
N
or
t
hern,
Uppe
r
East
,
U
pp
e
r
W
e
st
an
d
par
t
of
V
olta
Re
gion.
K
AT
H
is
the
seco
nd
la
r
gest
ref
e
rr
al
hosp
it
a
l
in
Gh
ana.
At
the
tim
e
of
res
earch
,
the
head
of
the
Psychia
tric
Un
it
of
K
ATH
was
Dr.
Gordo
n
Don
nir.
He
lam
ented
gr
eat
ly
about
th
e
sta
te
of
the
K
om
fo
Ano
kye
psy
chiat
ric
unit
.
He
once
lam
ented
abou
t
the
intense
pr
ess
ure
on
th
e
facil
it
y
to
pr
ovide
m
ental
healt
h
ser
vice
to
the
incre
asi
ng
popula
ti
on
in
Ku
m
asi
and
it
s
env
i
rons.
A
c
cordin
g
to
him
,
the
pr
e
valence
of
m
ental
healt
h
disease
s
in
the
country
is
on
the
increa
se
an
d
high
inci
dence
of
dr
ug
relat
ed
m
ental
healt
h
cases
are
be
ing
re
porte
d
at
the
ps
yc
hiatri
c
fac
il
ity
at
the
ho
s
pital
.
This
he
ind
ic
at
ed
has
ham
per
ed
the
hosp
it
al
’s
a
bili
t
y
to
fu
lfil
it
s
m
and
at
e
of providi
ng s
pe
ci
al
ist
cli
nical
care
for
al
l
persons in
the c
ou
ntry [
36
].
The
ge
ne
ral
sit
uation
in
G
ha
na
is
al
so
dire.
In
2007,
the
World
Healt
h
Orga
nisati
on
r
eported
t
hat
about
three
pe
rcen
t
of
the
to
ta
l
po
pula
ti
on
wer
e
s
uf
fer
i
ng
fr
om
seriou
s
m
ental
diso
r
de
rs,
w
hiles
ab
out
10
per
ce
nt
of
G
ha
naians
suffe
r
ed
f
r
om
m
od
erate
to
m
il
d
m
ental
dis
order
s
[3
7
]
.
Wh
il
e
t
he
bur
den
of
m
ental
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
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:
2252
-
8806
IJPHS
V
ol.
6
, No
.
4
,
Decem
ber
20
1
7
:
299
–
313
306
healt
h
ca
re
is
a
public
healt
h
con
ce
r
n
world
wide,
the
re
is
a
sig
nificant
ga
p
betwee
n
t
he
l
evel
of
m
e
ntal
healt
h
needs
and
the
avail
abili
ty
of
qu
al
it
y
serv
ic
e
s
to
aptly
add
r
ess
these
needs
.
In
K
um
asi
an
d
to
a
gr
eat
er
e
xtent,
the
w
ho
le
of
G
han
a
,
m
ental
healt
h
is
of
te
n
gi
ven
the
lo
west
healt
h
pri
or
it
y
by
auth
or
it
ie
s
and
t
his
so
m
et
i
m
es
deep
e
n
t
he
sti
gm
a and
discri
m
inati
on
f
ace
d by
people
with m
ental
p
r
ob
l
e
m
s.
In
G
ha
na,
pers
on
s
wit
h
m
ental
disorde
rs,
m
ental
healt
h
serv
ic
es
,
m
ental
healt
h
pro
fe
ssion
al
s
an
d
even
t
he
ver
y
con
c
ept
of
m
ental
healt
h
re
cei
ve
ne
gative
publici
ty
and
are
sti
gm
at
ized
an
d
discri
m
inate
d
ag
ai
ns
t
in
s
pite
of
gro
wing
evide
nce
of
th
e
i
m
po
rtance
of
m
ental
healt
h
f
or
dev
el
opm
ent.
For
this
reas
on
m
any
peo
ple
r
efu
se
to
work
as
m
ental
health
pro
fessio
nals
.
The
K
om
fo
Ano
kye
Teach
ing
H
ospit
al
currently
has
only
three
resi
den
t
ps
yc
hiatri
c
doct
or
s
,
six
co
nsult
an
ts
an
d
nin
et
ee
n
ps
yc
hiatri
c
nurses.
Gen
e
ra
ll
y,
in
Gh
a
na,
the
re
a
re
few
e
r
tha
n
necessa
ry
ps
yc
hiatri
sts,
ps
yc
hiatri
c
nurses,
cl
inica
l
ps
yc
ho
lo
gists,
ps
yc
hi
at
ric
so
ci
al
w
orkers
an
d
occ
upat
io
nal
thera
pists.
It
is
est
i
m
at
ed
that
each
ps
yc
hiatri
sts
in
G
ha
na
is
burd
e
ne
d
wit
h
about
hundre
d t
hous
a
nd m
ent
al
h
eal
th
patie
nt
s [
38
].
The
fiel
d
s
urv
ey
for
this
stu
dy
ha
s
re
veale
d
that
t
he
m
ental
healt
h
care
ser
vice
in
G
ha
na
is
face
d
with
two
m
ai
n
chall
eng
es
.
T
his
pro
blem
includes
the
pro
blem
of
inadequate
facil
it
ie
s
wh
ic
h
oft
en
re
su
lt
s
in
congesti
on
at
the
var
i
ou
s
psy
chiat
ric
ho
s
pi
ta
ls.
Curr
e
ntly
,
there
are
on
l
y
twel
ve
bed
s
(six
m
al
es
and
six
fem
al
es’
bed
s)
at
the
ps
yc
hi
at
ry
un
it
of
t
he
K
om
fo
A
nokye
Teac
hing
H
ospit
al
.
A
ccordin
g
to
a
nurs
e
respo
nd
e
nt
I
ha
ve
a
nonim
ise
d
as
Ma
rie,
“
t
he
c
ongestio
n
of
pati
ents
w
ard
and
their
li
vi
ng
c
onditi
on
s
ar
e
hum
an rig
hts v
iolati
ons in
an
d of the
mselves
” [
39
]
.
Anothe
r
pro
ble
m
of
healt
h
c
are
se
rv
ic
e
i
n
the
stu
dy
area
had
to
do
with
inade
quat
e
m
ental
healt
h
prof
e
ssio
nals t
o
cat
er
f
or
t
he heal
th
needs
of the m
ental
h
eal
th p
at
ie
nts.
Dr
. Do
nn
ir
in
dicat
ed
that,
“the s
ti
gma
attache
d
to
me
nta
l
he
alth
in
gen
e
ra
l
does
not
encour
age
people
to
take
up
a
profe
ssio
n
in
me
nta
l
he
alth
”
.
Ma
ny o
f
t
he
ps
yc
hiatri
c n
urse
s ar
e ex
pose
d
to d
a
nger
of
bei
ng
ha
rm
ed
by ag
gressi
ve
pati
ents. For
t
his rea
son,
m
ental
healt
h
officers
a
re
un
able
to
giv
e
a
de
qu
at
e
ca
re
to
their
patie
nts
.
It
is
cl
ea
r
that
the
healt
h
a
nd
well
-
bein
g of t
he
m
ental
h
eal
th
staff, that
is,
doct
or
s
and
nurse
s
in p
a
rtic
ular
ar
e j
e
op
a
r
dised f
ro
m
tim
e to ti
m
e.
The
m
ental
he
al
th
sect
ion
of
KA
T
H
i
n
par
ti
cular
pays
at
te
ntion
to
t
he
s
pa
ci
ng
of
bed
s
a
nd
ef
fecti
ve
care
of
the
m
e
ntal
ly
i
ll
,
the
reali
ty
is
that
m
a
ny
m
or
e
patie
nt
s
are
turn
e
d
a
way
wh
e
n
they
com
e
to
the
ho
sp
it
al
to
seek
m
ental
healt
h
car
e.
A
par
t
f
r
om
the
Ou
t
-
Pati
ent
De
par
tm
ent
(O
P
D)
case
s
that
a
re
ha
ndle
d
by
the
unit
on
daily
basis
i
s
huge
.
N
urse
Ma
rie
rev
eal
e
d
that,
seve
ral
pa
ti
ents
who
out
to
be
a
dm
i
tt
e
d
are
t
urne
d
a
way
by
the
unit
beca
use
of
la
ck
of
sp
ace.
Sh
e
sta
te
d
that,
“we
ha
ve
only
six
beds
at
the
bo
th
m
ale
an
d
fe
ma
l
e
ward
s…
i
n
c
ase
there
is
a
pati
ent
wi
th
ser
iou
s
me
nta
l
he
alth
need
an
d
the
pl
ace
is
fu
ll
where
do
w
e
keep
him… we
have
to tur
n him
a
w
ay… it
is not
our f
au
lt
”[
4
0
].
The
ps
yc
hiatry
unit
is
fou
nd
nex
t
t
o
the
ho
sp
it
al
’s
pha
rm
acy
.
The
sp
ace
avail
able
to
the
Un
it
was
fou
nd
t
o
be
w
oe
fu
ll
y
inade
qu
at
e.
N
ur
se
Ma
r
y,
po
i
ntin
g
to
t
he
O
PD
sta
te
d
that
“someti
me
s
we
ser
ve
as
many
as
one
hundre
d
and
tw
enty
pati
ents…
these
pe
op
le
often
ha
ve
to
wait
at
the
s
ma
ll
s
pa
ce
alloc
ated
to
OP
D
pa
ti
ents…
Som
et
imes
pati
ents
ar
e
made
to
s
tand
at
t
he
cor
rido
r
bec
ause
of
lack
of
spac
e
at
the
OPD”
[4
0
]
The
m
ai
n
chall
eng
es
c
onfro
nt
ing
m
ent
al
healt
h
serv
ic
e
de
li
ver
y
at
Ko
m
fo
A
nokye
Tea
chin
g
H
ospit
al
wer
e
thu
s
f
ound
to
be
inade
quat
e
sp
ace
an
d
la
ck
of
ps
yc
hiatri
c
healt
h
prof
e
ssion
al
s
to
at
te
nd
to
the
nee
ds
of
patie
nts.
3.6.3.
Le
gislat
i
on
s
on men
ta
l
heal
t
h t
h
at h
ave be
en en
act
e
d in
Ghana
f
r
om 1
900 t
o
2012
In
orde
r
to
do
a p
r
oper a
naly
s
is of
t
he vario
us l
egisla
ti
on
s
on m
ental
h
eal
th that
hav
e
b
ee
n
e
nacted in
Gh
a
na
from
1900,
the
resea
rc
her
c
onduct
ed
a
docum
entary
analy
sis
of
the
m
ental
healt
h
le
gislat
ion
usi
ng
the
World
Healt
h
Orga
nisati
on
Checkli
st
f
o
r
Me
ntal
Healt
h
Legisla
ti
on.
T
his
chec
klist
is
desig
ne
d
to
as
sess
the
con
te
nt
an
d
de
velo
pm
ent
of
m
ental
healt
h
le
gislat
ion
base
d
on
certai
n
pe
rtinent
crit
eria
[4
1
]
.
As
e
xpla
ined
i
n
sect
ion
2.1
.2
of
this
stud
y,
th
r
ee
diff
e
ren
t
le
gi
sla
ti
on
s
on
m
e
ntal
healt
h
ha
ve
been
pa
ssed
i
n
G
han
a
.
H
owever,
the
researc
her
on
ly
had
acc
ess
to
two
of
su
ch
le
gislat
ion
s
durin
g
th
e
fiel
d
su
r
vey.
Thu
s
the
res
earche
r
evaluate
d
the
1972 Me
ntal He
al
th D
ec
ree a
nd the
Mental
H
eal
th A
ct
of 20
12.
Sect
ion
12
of
the
Me
ntal
He
al
th
Decr
ee
of
1972
m
ade
pro
visio
n
f
or
th
e
adm
issi
on
of
su
s
pected
m
ental
healt
h
patie
nts
agai
nst
their
will
(in
vo
l
un
ta
ry
adm
issi
on).
E
ven
t
hough
s
uc
h
pe
rsons
had
a
righ
t
t
o
app
eal
pro
vid
e
d
for
them
in
the
pr
ov
isi
on
(
Sect
ion
12b).
Additi
on
al
ly
,
t
he
Me
ntal
He
al
th
Dec
ree
o
f
1972
pro
vid
e
d
accre
ditat
ion
of
pro
fessio
nals
a
nd
facil
it
ie
s,
enfo
rcem
ent
of
j
ud
ic
ia
l
issues
f
or
pe
op
le
with
m
ental
il
lness and m
echan
ism
s to
im
plem
ent the p
r
ov
isi
on
s
of m
ental
h
eal
th
legi
sla
ti
on
.
The
m
ental
he
al
th
decr
ee
wa
s
j
uxta
pose
d
with
the
WH
O
Check
li
st
on
Me
ntal
Healt
h
Legisla
ti
on.
This
c
om
par
ison
e
xpose
d
va
rio
us
s
hortfall
s
in
the
m
ental
healt
h
decr
ee
.
Eve
n
th
ough
the
WH
O
che
cklist
ca
m
e
at
a
la
te
r
tim
e,
it
becam
e
the
ben
c
hm
ark
by
wh
ic
h
al
l
m
ental
healt
h
le
gislat
ion
s
of
al
l
WHO
m
e
m
ber
countries
we
re
to
be
m
easur
e
d.
Am
on
g
so
m
e
of
the
sho
rtfa
ll
s
identifie
d
pe
r
the
re
view
i
nclu
ded
the
a
ppare
nt
neg
le
ct
t
o
the
pro
visions
of
the
protect
ion
of
hu
m
an
ri
gh
ts
of
the
m
ental
healt
h
patie
nts.
The
la
w
f
or
in
sta
nce
did
not
inclu
de
the
righ
t
to
hum
ane
treatm
e
nt
for
t
he
m
ent
al
healt
h
patie
nts.
They
al
so
lost
basic
rig
hts
li
ke
the
protect
io
n
of
pr
iv
acy
and
confide
ntial
it
y,
the
rig
hts
of
c
arers
a
nd
fam
i
l
ie
s
of
the
m
ental
healt
h
patie
nts
t
o
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N:
22
52
-
8806
Mental
He
alth
Service i
n G
ha
na:
A
Revi
ew
of
the Ca
se
(S
amuel
Ad
u
-
Gy
amfi
)
307
hav
e
acce
ss
t
o
their
relat
iv
es.
Additi
onal
ly
,
the
m
ental
healt
h
patie
nt
s
cou
ld
be
de
ta
ined
with
out
their
inf
or
m
ed
co
nse
nt.
T
he
m
ental
healt
h
dec
ree
had
li
tt
le
reg
ard
for
the
prot
ect
ion
of
t
he
m
ental
healt
h
patie
nts.
It
rather
sa
w
the
m
ental
heal
th
patie
nt
as
a
dange
r
to
the
r
est
of
so
ci
et
y.
He
ha
d
to
be
a
ppre
hende
d
by
any
m
eans.
T
his r
a
t
her
le
gitim
ise
d
the use
of
forc
e to r
est
rain
m
ental
h
eal
th
pat
ie
nts.
Se
ver
al
e
vid
e
nce
wer
e
f
ound
durin
g
the
fiel
d
sur
vey
of
how
m
ental
health
patie
nts
unde
r
both
insti
tuti
on
al
car
e
an
d
tradit
io
nal
healt
h
car
e
wer
e
eit
her
sec
lud
e
d or restrai
ned.
Eve
n
th
oug
h
the
m
ental
healt
h
decre
e
w
as
insti
tuti
on
or
ie
nted
with
no
co
ns
i
der
a
ti
on
to
ward
com
m
un
it
y
m
e
ntal
healt
h
a
nd
reh
a
bili
ta
ti
on
of
t
he
m
ental
ly
il
l,
there
was
no
pro
visio
n
f
or
a
de
qu
at
e
fa
ci
li
ti
es
in
the
ge
ner
al
ho
s
pital
s.
T
he
m
ental
healt
h
decr
ee
al
so
di
d
not
m
ake
pro
vi
sion
for
t
he
ca
re
of
t
he
m
ental
ly
ill
ou
tsi
de
the
p
sy
chiat
ric hos
pital
s in
area
s li
ke t
he
tra
diti
on
al
heali
ng ce
ntres
and s
piritual
hom
es.
In
fact
the
dec
r
ee
m
ade
li
tt
le
pro
vision
f
or
t
he
pr
otect
ion
of
the
ri
gh
ts
of
t
he
vulne
ra
ble
gro
up
s
s
uc
h
as
m
ino
rs
a
nd
wo
m
en
w
ho
m
ay
be
m
entally
il
l.
Ad
diti
onal
ly
,
fu
ndin
g
for
m
ental
healt
h
is
a
m
ajo
r
c
halle
ng
e
.
The
decr
ee
did
no
t
m
ake
pro
visio
n
f
or
fina
ncin
g
of
m
ental
healt
h
ser
vic
e
in
the
hosp
it
al
s.
Acc
ordin
g
to
D
r.
Osei,
w
ho
is
a
cl
inica
l
ps
yc
hiatri
st,
le
ss
t
han
on
e
pe
rce
nt
of
the
budg
et
a
ry
al
locat
ion
to
th
e
m
inist
ry
of
healt
h
is ded
ic
at
ed
to
m
ental
h
eal
th ser
vices [
42
]
. Th
e m
ental
h
eal
t
h
ser
vice in g
e
ner
al
is so
un
de
r
-
resou
rced
th
at
the
patie
nts
do
not
feed
t
hr
ee
squ
are
m
eal
s
a
day.
So
m
et
i
m
es
they
eat
on
ce
a
day
an
d
wh
e
n
they
a
re
f
or
t
un
at
e
they
g
et
a
seco
nd m
eal
.
The
obvi
ous
unde
r
-
fina
ncin
g
of
this
sect
or
of
healt
h
care
al
so
a
ff
ect
s
ac
cess
to
dru
gs
f
or
patie
nts
.
Accor
ding
to
Ba
aba
Bl
an
kson,
“t
he
hos
pital
is
un
a
ble
to
bu
y
t
he
ne
c
essary
psy
ch
otropic
dr
ug
s
f
or
t
he
patie
nts”.
Sh
e
aske
d
rathe
r
rh
et
or
ic
al
ly
th
at
“w
hen
a
pa
ti
ent
is
bei
ng
ag
gr
es
sive
a
nd
yo
u
do
not
ha
ve
tran
qu
il
iz
er
t
o
keep
him
so
be
r
w
hat
ca
n
yo
u
do...
All
you
do
is
to
r
un
a
wa
y
from
the
ward
a
nd
ho
pe
by
so
m
e
m
iracl
e
he
will
beco
m
e
so
be
r
[
43
]
.”
The
m
ent
al
healt
h
draft
was
only
a
pap
e
r
do
c
um
e
nt
with
f
or
m
bu
t
ha
d
no
t
s
ub
sta
nce.
Wh
e
n
re
view
ed
in
the
ey
es
of
the
WHO
check
li
st
of
m
ental
healt
h
le
gislat
ion
,
the
decr
ee
la
cked
the
a
bili
ty
to
br
in
g
res
pite
to
the
su
f
f
erin
g
of
t
he
m
ental
healt
h
pa
ti
ents.
Re
hab
il
it
at
ion
was
rat
he
r
le
ft
ou
t
of
the
opti
on
s
a
nd
m
ental
ly
i
ll
peo
ple
w
ere
treat
ed
as
thou
gh
m
ental
i
ll
ness
was
a
te
rm
inal
disease
wh
ic
h
cou
l
d
never
be
cu
red.
T
he
la
w
was
s
uc
h
th
at
,
there
wa
s
no
pro
vision
m
ade
for
t
he
in
volvem
ent
of
us
ers
of
m
ental
healt
h
s
erv
i
ces,
fam
il
i
es
an
d
ca
rer
s
in
m
ental
healt
h
po
li
cy
an
d
le
gislat
ion
de
velop
m
ent
an
d
plann
i
ng.
On
ce
a
per
s
on
is detai
ne
d,
he was treat
e
d
as
thou
gh h
e
w
a
s i
n pr
is
on w
it
ho
ut an
y
rig
ht
or
dignit
y.
The
m
ental
h
eal
th act of
2012 ho
wev
e
r was
f
orm
ulate
d
with the gui
dan
ce
o
f
t
he WH
O m
ental
h
eal
t
h
le
gislat
ion
c
he
cklist
;
hen
ce
this
la
w
to
ok
c
are
of
ve
ry
im
portant
hum
an
rig
ht
iss
ues
t
ha
t
wer
e
ig
nore
d
by
the
m
ental
healt
h
dec
ree
of
1972.
Howe
ver,
w
hilst
so
m
e
respo
nd
e
nts
fe
lt
that
the
ne
w
m
ental
hea
lt
h
act
addresse
d
m
any
o
f
the
de
fici
ts
in
m
ental
healt
h
care
in
Gh
a
na,
i
nclu
din
g
regulat
in
g
tradit
ion
al
a
nd
fait
h
healers,
a
nd
addressi
ng
sti
gm
a
and
so
ci
al
exclusio
n,
s
om
e
exp
resse
d
scepti
ci
s
m
as
t
o
w
hethe
r
ther
e
wer
e
adequate
res
ources,
a
s
well
as
the
poli
ti
cal
will
,
to
im
ple
m
e
n
t
the
la
w.
A
r
epeate
d
them
e
a
m
on
g
pa
rtic
ip
ants
is
that
there
is
a
ga
p
betwee
n
po
li
cy
or
le
gisl
at
ion
a
nd
it
s
im
ple
m
entat
ion
in
pr
act
ic
e
du
e
to
la
ck
of
poli
ti
cal
com
m
itm
ent
or
res
ource
co
nst
raints.
O
ne
r
esp
onde
nt,
note
d
reto
rted
t
ha
t,
“in
G
hana,
we
ha
ve
fi
ne
l
aws
but
the
im
pleme
nta
ti
on
is
often
poor.
In
f
act
wh
en
y
ou
lo
ok
at
the
me
nta
l
he
al
th
act,
y
ou
migh
t
t
hin
k
G
hana
has
perfect
he
alth
syste
m.
Everyt
hing
has
bee
n
catered
f
or
in
the
law.
T
here
is
no
t
mu
c
h
e
du
c
atio
n
on
m
ental
hea
lt
h
nursin
g
for
the
or
di
na
ry
G
hanaia
n,
y
ou
unde
rsta
nd?
Eve
n
poli
cy
imple
men
te
rs
,
people
are
not
really
we
ll
inform
ed
about
men
t
al
he
alth
pro
gr
am
mes.
F
or
this
r
eas
on
eve
n
th
ough
we
have
the
me
nta
l
he
al
th
act
addr
essi
ng
s
ome
of
the
hu
m
an
rig
ht
abus
e
s,
the
me
nta
ll
y
il
l
person
does
not
hav
e
the
c
apacity
to
cl
ai
m
his
or
her
ri
gh
t
”
[
41
].
The
Me
ntal
He
al
th
Act
ad
opts
a
hum
an
righ
t
s
ap
proac
h
to
m
ental
healt
h,
in
acco
rd
a
nce
with
the
U
N
Charter
on
H
um
an
Ri
gh
ts
a
nd
inte
rn
at
io
nal
co
ns
e
ns
us
on
the
healt
h
ca
re
need
s
of
a
per
s
on
with
m
ental
disorde
r.
The
Act
ai
m
s
to
pr
eve
nt
disc
rim
inati
on
a
nd
pr
ov
i
de
e
qu
al
oppo
rtu
niti
es
for
pe
ople
with
m
ental
disorde
r.
It
a
ddress
es
m
any
of
t
he
wea
kn
e
sses
of
t
he
Me
ntal
Healt
h
De
cree,
pro
vid
in
g
f
or
a
m
ental
healt
h
auth
or
it
y,
a
m
ental
healt
h
re
view
t
rib
un
al
,
and
the
prote
c
ti
on
of
the
rig
hts
of
pe
ople
with
m
ental
diso
r
de
r
,
includi
ng the
principle
of the
least
r
est
rict
ive
env
i
ronm
ent an
d t
he rig
ht to
inf
or
m
at
ion
and
par
ti
ci
patio
n.
The
la
w
prom
otes
the
de
cent
rali
sat
ion
of
m
ental
healt
h
se
rv
ic
es
an
d
c
om
m
un
it
y
m
ent
al
healt
h
ca
r
e
and
regulat
es
tradit
io
nal
and
fait
h
-
base
d
he
al
ing
pract
ic
es.
A
m
issi
ng
el
e
m
ent
of
the
la
w,
ide
ntifie
d
by
the
WHO
c
hec
klist
is
that
al
th
ough
the
re
is
m
ention
of
t
he
s
ources
of
fun
di
ng
f
or
the
m
e
ntal
healt
h
aut
hority
,
there
is
no
sti
pu
la
ti
on
on
m
ini
m
u
m
fun
di
ng
re
qu
i
rem
ents
for
m
ental
healt
h
se
rv
ic
es
.
F
or
t
his
rea
s
on
the
current
Act
al
s
o
faces
m
ajo
r
chall
enges
includi
ng
ina
de
quat
e
finan
ci
ng,
sti
gm
a
and
the
absen
ce
of
lo
gisti
cal
su
pp
or
t t
o
im
pl
e
m
ent the poli
cy
. D
r
. Osei
int
i
m
at
ed
that,
“t
here is
an
ab
s
e
nce
of
fra
mew
or
k f
or
men
t
al
hea
lt
h
servi
ce.
Th
e
m
anpowe
r
reso
urc
e
ava
il
able
is
ob
vi
ou
sly
li
m
it
ed,
bec
au
se
not
too
many
spe
ci
alist
s
ar
e
in
tha
t
ar
e
a.
Very
fe
w
pe
op
le
ar
e
i
nt
erest
ed
in
t
hat.
Th
e
sti
gma
attache
d
t
o
th
e
me
nta
l
hea
lt
h
definit
el
y
is
also
a
ba
r
rie
r.
Th
ere
ar
e
barriers
i
n
te
rms
of
f
undi
ng
for
va
rio
us
servi
ces
”
[
42
]
.
He
f
ur
t
her
sta
te
d
th
at
,
“
not
al
l
the
people
ar
e
i
nterest
ed
in
me
nt
al
he
alth,
es
pe
ci
ally
most
of
t
he
public
hea
lt
h
do
ct
or
s,
pe
ople
wh
o
st
ud
y
public
hea
lt
h,
y
ou
me
ntion
me
nta
l
he
alth
and
y
ou
a
re
just
i
gnor
e
d
be
ca
us
e
y
ou’
re
not
de
alin
g
wi
th
good
people
or
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IS
S
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:
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8806
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V
ol.
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, No
.
4
,
Decem
ber
20
1
7
:
299
–
313
308
no
r
m
al
pe
op
le
,
so
they
try
to
sti
gmatize
the
insti
tuti
on
”
.
Th
ese
are
obvi
ous
chall
eng
e
s
th
at
m
us
t
be
ov
e
rco
m
e
in
orde
r
to
e
f
fecti
vely
i
m
pl
e
m
ent
the
m
e
ntal
healt
h
ac
t
of
2012.
T
he
re
is
the
nee
d
f
or
i
nter
-
se
ct
or
al
colla
borati
on
in
orde
r
to
fu
ll
y
i
m
ple
m
ent
t
he
m
ental
heal
th
Act
of
20
12.
A
war
e
ness
c
r
eat
ion
an
d
a
de
qu
at
e
fun
ding
are
ke
y
in
the
ef
fecti
ve
im
ple
m
enta
ti
on
of
the
Act
in
orde
r
to
prot
ect
the
hum
an
rig
hts
an
d
dign
it
y
of
m
ental
h
eal
th
patie
nt
s.
3.7.
The
im
plem
en
tation o
f the c
urrent
men
ta
l
hea
l
th
act
of
Ghana
On
Ma
rc
h
2012,
G
han
a
jum
ped
a
sigi
nifc
nt
hu
rd
le
i
n
m
ental
healt
hca
r
e.
T
he
Me
ntal
Healt
h
Act
(20
12),
Act
84
6
was
pa
ssed
t
o
rep
la
ce
the
de
funct
Me
ntal
Healt
h
Dec
ree
of
19
72.
The
pa
ssage
was
see
n
as
a
m
ajo
r
ac
hieve
m
ent
in
the
strug
gle
for
the
prom
otion
of
the
fun
dam
ental
hu
m
an
righ
ts
of
al
l
Gh
a
naian
s
includi
ng
pe
rs
on
s
with
m
ental
diso
r
de
rs.
This
was
a
fter
forty
ye
ars
of
the
operati
ona
li
sat
ion
of
t
he
m
ental
healt
h decree
wh
ic
h
c
ur
ta
il
ed
in
div
i
du
a
l
li
be
rtie
s and
fr
ee
do
m
o
f
the m
ental
ly
il
l.
The
la
w
m
ade
prov
isi
ons
f
or
the
ap
po
i
ntm
ent
of
the
H
os
pital
Direct
or
an
d
Cl
inica
l
Coo
r
din
at
or
ps
yc
hiatri
c
of
al
l
ps
yc
hiatri
c
hosp
it
al
s.
T
he
body
m
and
a
te
d
by
la
w
t
o
appoint
t
he
Ho
s
pital
Direc
tor
a
nd
Cl
inica
l
coo
r
din
at
or
was
t
he
Gove
rn
i
ng
B
oa
rd
of
t
he
Me
ntal
Healt
h
A
ut
hority
instea
d
of
the
pr
e
side
nt,
a
s
existe
d
i
n
the
previ
ou
s
d
ec
ree.
“
On
t
he
iss
ue
of
secl
us
i
on
and
restr
ain
i
ng
of
me
nta
l
he
alth
pa
ti
ents,
the
cur
rent
l
aw,
Act
846,
abolishe
d
the
un
l
awful
dete
nt
ion
of
men
t
al
hea
lt
h
pati
ents.
Th
is
w
as
w
it
hd
r
awn
fo
r
r
eas
on
s
of
pra
ct
ic
al
impossibil
it
ie
s
and
t
he
nee
d
not
to
le
gisl
ate
the
pract
ic
e.
T
he
fra
mers
of
t
he
law
belie
ved
th
at
pe
rson
ne
l
of
the
facil
it
y
sh
ou
l
d
be
given
so
me
discret
ion
to
e
nable
them
asse
ss
e
ach
sit
uati
on
and
ap
ply
the
best
pr
oc
ed
ur
e f
or
an
y
g
iv
e
n
sit
ua
ti
on
”
[4
2
].
In
te
rm
s
of
e
m
plo
yme
nt
righ
ts
,
Dr.
Osei
exp
la
ine
d
tha
t,
the
Me
ntal
Healt
h
Act
im
plo
red
the
e
m
plo
ye
rs
to
pro
vid
e
assist
ance
to
em
plo
yees
pr
es
um
ed
to
be
suffe
rin
g
from
m
ental
il
lness.
As
a
resu
l
t
Cl
ause
63
of
t
he
m
ental
healt
h
act
s
peaks
e
xtensi
vely
to
t
he
em
plo
ym
en
t
rig
hts
of
t
he
m
ental
healt
h
patie
nts.
The
ne
w
Act
al
so
s
ugge
sts
the
est
a
blishm
ent
of
t
he
Me
ntal
Heal
th
F
und
w
hich
is
ta
s
ked
with
th
e
respo
ns
ibil
it
y
of
m
anag
in
g
al
l
fu
nds
an
d
r
ai
sing
f
unds
usi
ng
a
num
ber
of
sta
te
d
ave
nu
e
s.
The
pr
i
ncipal
obj
ect
ive
of
t
he
Me
ntal
Healt
h
F
und
is
to
pr
ov
i
de
fi
nan
ci
al
resou
rces
f
or
the
care
a
nd
m
a
nag
em
ent
of
pe
op
le
who
s
uffe
r
f
r
om
m
ental
il
lne
ss.
Eve
n
th
ough,
t
he
pro
visio
ns
i
n
t
he
Me
ntal
Healt
h
Act
(2012
)
m
igh
t
be
reg
ar
de
d
as
pr
om
oting
th
e
fun
dam
ental
hu
m
an
rig
hts
of
m
ental
healt
h
patie
nts,
it
s
i
m
ple
m
entat
ion
has
not
al
wa
ys
bee
n
sm
oo
t
h.
The
nex
t
sub
-
sect
io
n
lo
oks at s
pec
ific
areas
of th
e i
m
ple
m
entat
i
on of t
he
m
ental
h
eal
th act.
3.7.1.
Financin
g
me
nt
al
he
alth
ser
vice
s in
Gh
ana
Sect
ion
88 o
f
t
he
m
ental
healt
h
act
sta
te
em
ph
at
ic
al
ly
that
“m
ental
healt
hc
are
is
f
ree”. I
t go
e
s
f
ur
t
her
to
ex
plain
that
a
per
s
on
suffe
rin
g
from
a
m
ental
disorde
r
with
a
physi
cal
conditi
on
is
entit
le
s
to
fr
ee
healt
h
care
unde
r
the
Nati
on
al
Heal
th
In
s
ur
a
nce.
The
fina
ncin
g
for
fr
ee
he
al
th
care
fo
r
m
ental
patie
nts
is
d
erive
d
from
m
u
lt
iple
so
urces
of
re
venue
incl
ud
i
ng
m
on
ey
s
approve
d
by
par
li
a
m
ent;
m
on
ey
der
ive
d
f
ro
m
fees;
donatio
ns
,
gra
nts
an
d
gifts;
m
on
ey
s
der
ive
d
f
ro
m
inv
est
m
ents
and
a
ny
oth
e
r
m
on
ey
s
that
are
a
ppr
oved
by
t
he
Mi
nister r
es
po
ns
ible
for fi
na
nc
e.
Desp
it
e
the
ge
ner
al
pro
visi
on
in
sect
io
n
88
of
the
Me
ntal
Healt
h
A
ct
,
the
healt
h
care
ser
vice
avail
able
f
or
t
he
m
ental
l
y
ill
is
no
t
i
m
plem
ented
in
acc
orda
nce
with
the
fu
ll
pr
ov
is
ion
of
the
la
w.
F
or
instance,
w
hilst
the
Sect
ions
21,
22,
a
nd
23
of
t
he
cu
rr
e
n
t
la
w
sta
te
s
em
ph
asi
zes
the
com
m
itm
e
nt
to
a
decen
t
rali
zed
healt
h
ca
re
an
d
the
t
rainin
g
of
m
ental
healt
h
pro
fessi
on
al
s,
the
ir
re
gu
la
r
flo
w
of
fun
d
i
nto
t
he
so
urces
of
re
ve
nu
e
sta
te
d
a
bove
,
par
ti
cular
ly
at
the
reg
i
onal
an
d
distric
t
le
vels
m
eans
that
m
ental
h
eal
th
po
li
cy
rem
ai
ns
far
rem
ov
ed
f
ro
m
the
reali
ty
of
the
pract
ic
e.
Fr
ee
m
ental
healt
h
se
rv
ic
e
pro
vision
only
exist
s
on
pa
per.
The
reali
ty
is
that
m
ental
ho
s
pital
s
are
poorl
y
r
eso
ur
ce
d
in
G
han
a
.
T
he
la
w
is
well
form
ul
at
ed
but
cannot
be
sai
d
to
be
on
the
l
is
t
of
t
he
pr
i
ori
ti
es
of
Mi
nist
ry
of
Healt
h
of
G
ha
na.
D
r.
Osei
e
xp
la
ine
d
that,
“there
ar
e
a
l
ot
of
li
p
servi
ce
in
te
rms
of
the
commit
me
nt
to
the
full
imple
men
t
ation
of
th
e
men
t
al
he
alth
act.
Its im
pleme
ntat
ion
has
been faced
wi
th seri
ous fi
na
ncial
and
lo
gist
ic
al c
hall
eng
e
s.”
Nurse
Ma
rie
a
lso
sta
te
d
that,
m
ental
healt
h
patie
nts
a
re
r
equ
i
red
to
pay
G
hC
36
f
or
a
ps
yc
ho
ti
c
m
edici
ne.
T
his
was
s
uppose
d
to
be
f
ree
acc
ordi
ng
t
o
the
m
e
ntal
healt
h
act
.
Th
e
im
plica
ti
o
n
of
t
his
res
po
ns
e
is
that,
even
th
ou
gh
the
m
inist
ry
of
healt
h
has
identifie
d
m
e
ntal
healt
h
ser
vices
as
essent
ia
l
in
the
health
care
delivery
syst
e
m
,
ver
y
li
t
tl
e
has
bee
n
done
to
res
ource
t
he
sect
or
,
both
at
the
le
vel
of
the
insti
tuti
on
s
a
nd
at
the
com
m
un
it
y l
evel.
Mi
ss
Ma
rie
in
dicat
ed
t
hat,
“
ha
vi
ng
wo
rked
wi
th
the
me
nt
al
hea
lt
h
unit
f
or
a
w
hile,
I
have
c
ome
to
the
realizati
on
tha
t
the
sect
or
is
hig
hly
handi
cappe
d
in
te
rm
s
of
fi
na
nces
and
the
insti
tuti
onal
support
to
r
un
the m
e
nta
l he
al
th instit
ution
s
and
s
o
I
c
an
s
ay
it
in
no
t easy
for the
hos
pital
a
dminist
r
atio
n
to c
omply wi
th the
full
pr
ovisio
ns
of
the
law.
It
is
hig
hly
diff
ic
ult
to
integra
te
m
ental
he
alth
int
o
pr
i
ma
ry
he
alth
care.
T
he
K
om
f
o
An
okye
Te
ach
i
ng
H
os
pital
has
desig
nate
d
15
be
ds
to
me
nta
l
he
alth
an
d
a
ded
ic
ated
w
ard.
So
i
n
te
rms
of
the
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