The Mantle of Mental Health Recovery

THERE ARE 400 people waiting to leave Accra Psychiatric Hospital.

Some of them stay there all day, and some go about their normal businesses in town and return to the hospital in the evening. The hospital is the only home they can have.

According to Dr. Akwasi Osei, Acting Chief Psychiatrist of the Accra Psychiatric Hospital, quite a number of the patients are in very good condition and have long been discharged but their homes. Yet, they must remain at the hospital because their homes are closed to them due to the stigma attached to mental illness. He says this is a situation typical of Africans and particularly Ghanaians due to ignorance on the topic of mental illness.

Recovered patients are often left at the hospital because of the lukewarm attitude they receive from their own families. Society treats them in a way that makes them feel unwanted, rejected and desolate when they return home which obviously makes the hospital a better place for their living, said Osei.

One of these 400 people is Akosua Biamah. The 45-year-old woman hails from Asante Akyem Dampong in the Eastern Region, and is now struggling to rebuild her life in the hospital.

She has been in and out of the hospital since 1984, but since 2002, Biamah has recovered, been released and can start life all over again.

Yet despite her good health, she has been confined to the hospital for the last three years.

"Anytime I went home, my family did not give me the best care and attention, so my sickness came back. I know that when I go this time around, it will not take long for me to come back here so I have decided to stay," Biamah said.

When she was in the hospital as a result of mental disorder, her relatives visited her on a few occasions, but since 2002, none of them have been to the hospital though there Three of Madam Biamah's five siblings are in Accra.

She said, "When I go home, my relatives and other people in the village do not treat me as well as compared to when I had no mental problem.

"The major thing they do that hurts me is that when there is any problem in the family, my suggestions are always rejected on the basis that I am not in the right frame of mind even when it is a meaningful contribution," she continued. "Though I do cook for the family to eat, I feel very sad when at the least provocation, they refer to my illness even though I know I am alright."

This, she said, always made her feel rejected and moody.

She loses her sense of belonging to the extent that she relapses. According to her, that feeling is what always brought her back to the hospital

"I do not feel too happy being in here because it's a place where you are supposed to come for treatment and go back home," Biamah said. "Here, whether you are well or not, you will be fed three times in a day but it is not like eating your own food in the house.

"There is supervision here, so you are allowed to go for church programmes outside the hospital only on Sundays." However Biamah belongs to the Asylum Down Pentecost Church and would love to join in all the daily prayer sessions to strengthen her spiritual life.

Despite her situation, she prefers being in the hospital than having to go home because the hospital's staff and other recovered patients treat her better than her family back in the village.

In the hospital she has established a daily routine for herself.

"When I wake up in the morning, I join the others to sweep, attend morning devotion in the yard, bathe and then help the nurses in taking care of the other patients, such as help in serving the food."

She used to sit idle after this normal routine daily because she has no technical or vocational training.

Fortunately, last year a member of her church taught her how to make groundnut cake, which she now devotes her time to do after helping the nurses in the morning.

She said the main ingredients used are groundnut and sugar but from the beginning, she needed a coal pot and a few other things. In order to purchase these, "I contacted one of my brothers in Accra who gave me ¢50,000 and also collected some money from a lady who owned me some money," she said.

Biamah sells this in and around the hospital environs in ¢200 and ¢500 pieces, and on a good day makes a profit of about ¢ 7,000. Recently she started saving ¢5000 of her daily profit. With her business, she is now able to add to the hospital donations she receives by buying some small things she needs like soap, pomade, powder, and clothing She hopes to save enough money to resettle outside the hospital with her 18-year-old son from a previous marriage. Currently he lives with her grandmother in Agora Mensah Krom.

"If I had been saving from the start, I would have been having enough money by now," she said. "I do not want to go back home because I do not want to live with any of my relatives. What I want now is to get a place in Accra, then I will go in for my son and live with him."

Currently Biamah lacks enough money for the advance needed to rent a small place to live, but said if anyone offered her the financial assistance for the advance, she would move out of the hospital to start a new life.

According to Biamah, the neglect they suffer is very much unbearable and adding that it is possible for people who get mental illness to fully recover and live a normal life like any other person in society.

Patients like Biamah worry practitioners like Dr. Osei because the recovered patients add to the overcrowding problem of the hospital. They are fed and occupy wards and demand that they are attended to like those who had not recovered.

He said, "to a large extent, it reduces the proper and comprehensive administration of care to all patients, which results in the long period it sometimes took patients to recover."

He also added that because mental health care is generally free, any other illness related to is also administered freely. Most patients who do not get the best of care from relatives and society choose to make the hospital their home.

According to him, stigmatization and other negative attitudes towards people with mental illness in most countries, including Ghana, is a result of lack of education and it cuts across class boundaries.

"Culturally, some people don't have the concept of [illnesses like] depression," Dr. Osei said.

He regretted particularly, the situation where mental illness was always attributed to evil forces and the strong belief in superstition. This, he stressed hindered efforts of the psychiatric service to demystify mental illness.

Despite the constraints, mental healthcare practitioners are still making efforts at reducing the number of patients at the various psychiatric institutions in the country.

According to Dr. Osei, they were currently trying to set up a rehabilitation and vocational center in the central region.

"It would be a place for most of these people to learn a trade so they would be given capital to start life." He said of the planned center.

The hospital has also repaired an 18-seat bus that would be used to send most of these patients home by their social workers. Previous attempts to send them home have failed because most relatives give wrong addresses when they bring patients for admission, Dr. Osei said.

In recent times, psychiatric professionals and other members in the health sector have relentlessly called on the government to provide adequate resources and improve the standard of mental health care in the country. These people have underlined the need for effective education on the subject of mental health; particularly in the area of drug abuse, the stigma attached to mental illnesses, and the total neglect of patients when admitted to the hospital.