Pass The Mental Health Bill Now

Parliament has risen and the mental health law was not passed. This is a great disappointment. The importance of mental health cannot be overemphasised.

One in five persons worldwide including Ghana suffers from one form or another of mental illness at any given time.

Consequences of mental ill-health include reducing the quality of life, predisposing to various physical illnesses, reducing individual and national productivity and ultimately adversely affecting the national economy.

Mental ill-health also accounts for a lot of social unrests and vices, crime wave, child delinquency, school drop-out, streetism, violence, drug abuse, drug trafficking, child abuse, child defilement, rape, paedophilia, suicide, etc.

The mentally ill, especially those with the severe form, tend to be among the vulnerable in society.

Their rights are abused every day through rape, chaining and flogging ostensibly to exorcise the demon in them. Depressed women are incarcerated in 'witches' camps in various parts of the country.

Even at the psychiatric hospitals, mentally ill people may be given injections not always as treatment but to sometimes punish them because they are naughty to the staff.

All this is violation of human rights and maltreatment of the mentally ill because they are vulnerable and cannot defend themselves.

Congestion in mental health institutions and inadequate funding to attend to the inmates equally amount to abuse of the rights of these patients — officially sponsored abuse, if you like.

Legislation to the rescue

Given this scenario, there is the need to put in place deliberate measures to protect these people, including those on the streets, in the homes, in public institutions, prayer camps, church premises and traditional healing homes, and to protect the rights of those who have ever been afflicted in terms of their work, accommodation and other civil rights.

Policies can work to some extent, but may not be binding enough. Worldwide legislation is that which protects the rights of the vulnerable in society including the mentally ill.

This informs the need to have a mental health law and this requirement is not only needed in Ghana but the rest of also in the world.

On February 4, 1888 when the Lunatic Asylum Act was passed for the mentally ill, it was the first-ever law on health in this country.

It empowered the authorities to arrest vagrant mentally ill persons as special prisoners for safe custody.

This Act eventually led to the building of the Accra Psychiatric Hospital in 1906, initially as an Asylum.

The Act was for the vagrant mentally ill. It only started undergoing a major revision in 1969 in the Second Republic regime of Prof. Busia culminating in the passing of NRCD 30 by the Acheampong regime in 1972. (Passing the law after three years, they did better than us as we have failed to pass ours after four years.)

The 1972 NRCD 30 decree was a vast improvement over the 1888 Act in the sense that it regarded the mentally ill not as special prisoners warranting arrest but as patients requiring treatment.

Even so it still recognised only the mentally ill patients in the psychiatric hospitals.

This explains why the vagrant patients on the streets seem not to have anybody attending to them — the decree did not cater for them.

It made no mention of human rights of patients and so there was no legitimate attempt to check the vulnerability of patients.

In the light of current knowledge, development and understanding of good governance we see a great defect in the 1972 Decree requiring correction.

Yet that is the legislation we are operating with to date and there has not been any modification to it.

The 2006 draft bill

In 2003, the need to revise the 1972 Mental Health Decree dawned on us. At the same time the World Health Organisation (WHO) had also initiated a programme of getting various countries across the world to pass mental health laws or improve upon them where they existed.

So that was an interesting coincidence.

Under the leadership of the then Chief Psychiatrist, Dr J. B. Asare, plans were initiated and eventually a technical drafting committee was formed by the Minister of Health and inaugurated in March 2004.

The same day it began its work. That marked the formal process of the writing of the new law. The inauguration was attended by a Deputy Minister of Health and other top ranking personnel from the Ministry of Health and Ghana Health Service.

WHO also sent a high-powered team of experts from the US, UK, South Africa, Zimbabwe and Geneva to team up with local experts and all these were at the inauguration and the first meeting.

 Early on the WHO had sent a checklist and other literature for use in the process of the drafting.

Through consultation with various stakeholders like the security forces, teachers, legal experts, traditional and faith healers, mental and non-mental health workers, 10 drafts were produced until the final was considered acceptable to all — the WHO technical support team, the local drafting committee and other stakeholders.

The Attorney-General converted this into the legal language. They produced six such drafts.

The final one was sent to the Minister of Health who gave his comments, concerns and inputs and these were factored into the draft.

A third such draft completed in January 2006 was eventually considered final. This draft has since been lying on the desk of the Minister of Health.

What does the bill say?

Among other provisions the Bill establishes an authority to govern mental health service and emphasises community care as against institutional care. It establishes mental health tribunal to adjudicate on cases of abuse against the mentally ill and to protect mental health workers.

It establishes visiting committees to inspect orthodox public and private mental health institutions and traditional and faith-based healers' camps to ensure that the rights of patients everywhere are respected with the best possible care being given.

 It clearly spells out the rights of the mentally ill including the right to marriage, occupation, accommodation and the right to vote and be voted for if competent enough as judged by the attending psychiatrists.

It talks about non-discrimination, the minimum standard of treatment, protection of the vulnerable groups like children, females, the aged and persons with handicap or incompetence for whom it establishes guardianship. It ensures regular and adequate release of funding for the care of the mentally ill.

Its significance — What is new?

The Bill is already a toast of the WHO which is touting it as the best law on mental health in the developing world and among the best anywhere else.

The WHO loves it because it prescribes best practice mental health care. They are eager to use it as a template for other countries but until it gets to Parliament they cannot do it.

Among the reasons why they are in love with it are the fact that it takes full care of the human rights of the mentally ill and is innovative in recognising, regulating and harnessing the potentials of traditional and faith-based healers in mental health care at the primary and community levels.

Mental health care in the country as it is now is unsustainable and if we do not change things, mental health care will totally collapse in the next few years.

This is because financial inputs continue to dwindle. The Bill, by prescribing restructuring of the mental health system to place emphasis on community care, makes mental health less expensive than it is now, which should have been an incentive to pass the law by now.

Where is the Draft Bill now?

The Bill has been on the desk of the Minister of Health since January 2006. From the minister, the Bill is supposed to go to the Cabinet before it goes to Parliament, assuming the Cabinet has no question on it. But it has to leave the Minister's office! So why is it still there?

In fairness when the Bill went to the minister there were three concerns: there were other health-related bills which were being drafted and the minister wanted them all to be completed and sent to the Cabinet at the same time for reasons of cross-referencing.

And when they were finished they were 18 bills and the Cabinet wanted them to be put together into eight bills, with mental health as a stand-alone Bill. This has been done.

Then there was the concern that we (in the mental health sector) seem to be creating a parallel system rather than an integrated health system.

The fears have been dispelled. What is left now is that the ministry wants to bring all its implementing agencies, like Ghana Health Service and the teaching hospitals, under one umbrella as a unified health system.

A consultant has been engaged to work this out and I suppose this is what is currently delaying the process. But the Bill can be passed while waiting for the resolution of the impasse.

The responsibility to pass the Bill now rests with three parties: the Minister of Health, the Cabinet and Parliament.

If the minister does not forward it, the Cabinet can call for it, for they must have heard of the Bill all along. Parliament can also call the minister for the Bill and if it is not being passed they cannot dodge the blame.

This bill is so crucial that it cannot remain on the shelf for too long. Somebody will pass it, today or tomorrow, this administration or another.

The question, however, is, Will the present players, the minister, the Cabinet and Parliament, pass it and earn the thanks of posterity, or we will resist its passage today only for another regime, another generation or another set of players to pass it and earn the credit, and for it to be said of us that we are the generation that resisted its passage for a time yet could not resist it forever?

The choice is ours. Every single day that the Bill remains unpassed into law, we are abusing somebody's rights and are contributing to the collapse of mental health care in the country.

Let us pass the Mental Health Bill now.

By Dr Akwasi Osei

• The writer is the acting Chief Psychiatrist of the Ghana Health Service.