The Equal and the Unequal: Mental Health Inequalities in Ghana

In 1948, the world Health Organisation's defined health as '' a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.'' To the World Health Organisation, health is not just being sick-and positive mental health is noted a requirement of overall health. This definition was reaffirmed in the declaration of Alma Ata in 1978. As commonly said 'there is no health without mental health' (WHO,1954). The WHO further defines mental health as 'a state of wellbeing in which individual realizes his or her own abilities, can cope with normal stresses of life, can work productively and fruitfully, and is able to make contribution to his or her community'.

The prevalence and social distribution of mental disorders have been well documented in high-income countries. While there is growing recognition of the problem in low- and middle-income countries, a significant gap still exists in research to measure the problem, and in strategies, policies and programmes to prevent mental disorders. There is a considerable need to raise the priority given to the prevention of mental disorders and to the promotion of mental health through action on the social determinants of health (WHO, 2014).

Research by Ofori- Atta, (2010) demonstrates the inequalities in the provision of mental health care in Ghana including insufficient numbers of mental health professionals, aging infrastructure, widespread stigma, inadequate funding and an inequitable geographical distribution of services.

Ghana has an estimated population of 30.9 million (Ghana Statistical Service) with a medium human development index (HDI rank of 138) and a life expectancy of 64.1 years (UNDP, World Bank). In terms of the Sustainable Development Goals (SDGs), Ghana has an index score of 65.4%, with a global ranking of 100 out of 166 countries (UNDP). Regarding Ghana's burden of disease, research shows that, although medical/physical health conditions (e.g., malaria, HIV/AIDS, etc.) constitute the leading causes of premature deaths, mental health conditions (e.g., depressive disorders) are in the lead for years lived with disability (YLDs) in the country (Sipsma et al, 2013). For example, lower respiratory infections, malaria, HIV/AIDS, stroke, ischemic heart disease, protein-energy malnutrition, neonatal sepsis, road injuries, preterm birth complications, and neonatal encephalopathy are the top 10 causes of premature deaths in Ghana (Institute of Health Metrics and Evaluation). The top 10 leading causes of years lived with disability have been identified as depressive disorders, lower back and neck pain, iron-deficiency anaemia, sense organ diseases, and skin diseases. Notably, it has been observed that, comparatively, “depression continues to be a major contributor to Ghana's burden of disabling conditions and was responsible for three times more YLDs in 2013 than malaria” (Institute of Health Metrics and Evaluation). Ghana has the most comprehensive mental health legislation within West Africa (Esan, 2014; Walker, 2015) however, the country's mental health system faces many severe challenges, including infrastructural constraints, acute human resource (workforce) shortage, social services challenges, organisational, legal and judicial, research and information system and financial challenges, as well as considerable institutionalised stigma (Reads, 2012; Roberts 2014). In terms of access to mental healthcare by the public, only 2.8% of mentally ill persons are able to access treatment, with most mental health patients unable to receive professional care (Roberts, 2014). Relative to the WHO benchmark of one psychiatrist/100,000 population, Ghana's psychiatrist to population ratio is 0.058 per 100,000 population, and 0.065 psychologists per 100,000 population (WHO Global Health Observatory Data Repository). Ghana's psychiatrist/population ratio is comparable to what exists in neighbouring Togo (0.054/100,000), Burkina Faso (0.039/100,000), and Ivory Coast (0.130/100,000), even though all are less than enough (WHO Global Health Observatory Data Repository). The key evidence is that, compared to the physical/medical health sub-sector, the mental health sub-sector of the country remains under-served and under-resourced, and continues to be less prioritised on the national development agenda by government (Asare,2010; Roberts 2014).

As a society we are aware of the mental health difficulties and inequalities that many of the people face, but we might not always be aware of the role inequalities contributes to the experience people have in the delivery of mental health services. The Covid-19 pandemic has exposed the world of the inequalities of mental health to include but not limited to loneliness, stigma, Inadequate funding, inadequate staffing and the lack of mental health facilities and many others.

Some groups of people have far poorer mental health than others, often reflecting social disadvantage. In many cases, those same groups of people have less access to effective and relevant support for their mental health, and when they do get support, their experiences and outcomes are often poorer, in some circumstances causing harm.

Studies have shown that mental health care is no longer the domain of psychiatrists, but is now a responsibility of primary care providers, community health workers, educators, law enforcement and other diverse stakeholders, championing the engagement and the development and delivery of services. Since mental health affects all sectors of life within the country, there is the need for an integrated approach that will inform a robust policy implementation that seeks to address mental health inequalities within the country.

Author

Pascal Landindome Navelle
Mind 'N' Health Foundation Ghana
Email: [email protected]
Email: [email protected]

The writer is with Mind 'N' Health Foundation (www.mindnhealthfoundationgh.com), a registered non-profit mental health company that provides mental health advocacy, research, and consultancy. This piece is written to mark the world mental health day celebration.