The New Mental Health Law, A Hoax Or Reality?

I lumbered from the taxicab at the junction on Sunday morning and accelerated my strides in order to catch up with time at work since the morning was getting older. I was moved by an irresistible urge of sympathy and a little curiosity to assist this young woman and a boy who were struggling with a middle-aged man by the road side. The man demanded he be chauffeured home rather than in a passenger car because he claims he is a minister and must be given special treatment. I succeeded in establishing rapport and calmed this agitated man down but unbeknown to me, he had clenched his fist and hid them at his back as if an obedient child before his father, just waiting for me to move a step towards him to hit, but he was unfortunately sent down by the weight of his own blow after punching the air as I managed to swiftly dodge him. He bellowed from the ground upwards, cursing me of aiding his discharge in his previous admission on the ward. The woman told him I wasn't the one but he insisted that I was wearing a white shirt and
wearing same today too... I finally advised them to go home and come the following day.

In another scene, Mr. x came crying, toting with his bag and baggage and complained bitterly of how he is being maltreated, insulted and discriminated in all things ever since he was discharged home and pleaded that he wants to stay on the ward and wouldn't go home again. Though his speech wasn't all that coherent, one could deduce from a professional observation that there was an iota of truth in what he was saying because there has been similar cases. How would you feel if you spot the patient you once cared for, took his mental status examination (MSE) and realized he exhibits no more psychotic symptoms, have good judgement and memory, orientated in all spheres and thought it wise that he or she could be managed at home on O.P.D bases and went forth to recommend his discharge, now feeding on garbage in a Zoomlion refuse container at the Agbogbloshie market or has erected his tent in the middle of N1 highway road, distracting vehicular movements or displaying some antics in the middle of Kwame Nkrumah Circle Roundabout. Do you feel self stigmatized as a psychiatric nurse? Do you even see the profession as a rightfully chosen one? Yes, I guess so, because "nursing is a call".

The passage of the Mental Health Act 2012 by parliament on the 2nd of March 2012 did not only register smiles on the faces of sympathizers and aficionados of psychiatric nursing in Ghana, but also an earnest expectation of a new face of nursing in the sector within the shortest possible time as far as the care of people living with mental illness are concern. The enthusiasm that greeted mental health practitioners across the country upon the passage of the law created an ambiance of hope that the new law will prim mental health care in Ghana. It is the hope of all that the new law will address the perennial challenges bedeviling the sector since it contains some antidote in its provisions capable of mitigating those challenges including the protection of the fundamental human right of people with mental disorders in Ghana. The new law demanded that within a six month period of its passage certain structures be operationalized to give it full steam. Which means that the Mental Health Board would have been established within that time frame with the key function of overseeing the drafting of a legislative instrument to operationalize the new law. But nineteen months down the lane since its passage, has anything changed? Or maybe the good news is in the pipeline. Thanks to the late president, Professor John Evans Fiifi Atta Mills for appending his signature on the Mental Health law 2012 on the 31st of May 2012, just within two months of its passage.

Why the Mental Health Act 2012? (Act 846).
According to the Mental Health Memorandum, the Bill has become necessary because the 1972 legislation is out of date and does not accord with the World Health Organisation best practice standard for mental health legislation. The WHO World Report of 2001 which concentrated on mental health, exposed the weaknesses in mental health care delivery in developing countries. The modern trend of mental health legislation is to protect, promote and improve the lives and well being of citizens with mental disorder. People with mental disorder are or can be vulnerable to abuse and violation of their rights. Progressive legislation which acknowledges the modern trend on human rights can be an effective tool to promote access to mental health care as well as to promote and protect the rights of people with mental disorder. The Bill adopts a human rights based approach in accordance with the objective of the U.N. charter and international agreements for the health care needs of a person with mental disorder. These are to prevent discrimination in all its forms and offer equal opportunities to people with mental disorder. Many human rights violations occur in private facilities, the new Bill includes the private sector in mental health as a novelty. Formerly, there were only state run institutions but that position has changed. Furthermore, the  Mental Health Decree 1972, (NRCD 30) excluded traditional and spiritual mental health care. There has been a proliferation of charismatic churches since the early 1980s some of which specialize in the healing of mental disorder and there is a need to regulate these establishments by law. The Bill ensures that standard conditions and rights are relevant for all facilities in order to prevent the abuse of people with mental disorder including physical and sexual abuse.

As it has been the policy of the Ministry of Health Ghana, mental health treatment under the new legislation will be shifted from the only three state recognized psychiatric hospitals to the community level where persons with mental disorders will be readily identified and given prompt treatment to reduce the stigma attached in attending psychiatric hospital.This approach also reduces the cost of patient care and prevents the influx of persons to the three state run psychiatric institutions. To accomplish this provision under the new law, it will ensure the establishment of a 50-bed psychiatric hospital in each region across the country; provide four Drug Rehabilitation Centers and 20 bed psychiatric wards in each of Regional hospital. (see http://www.ghanabusinessnews.com/2012/6/journalists- schooled-on-new-mental-health-law).

Experts and analysts have outlined some challenges that are likely to impede the smooth implemention

of this new law, these include: health system organisational challenge, mental health human resource challenge, social services challenge, legal and judicial challenge, mental health information system challenge and financial challenge. With these possible challenges, how prepared and willing are
the institutions concern in meeting these challenges? The Chief Psychiatrist, Dr. Akwesi Osei in an interview with Sodzi Sodzi-Tettey in 2012, seems to have answers to the Mental Health Human Resource challenge: “We have 14 psychiatrists now. In 5-10 years, we hope to train 80-100. We have eight Medical Assistants inPsychiatry now. We hope to train 50-80 in 5-10 years. We have three clinical psychologists in
 public health service now. We hope to train 50-80 in 5-10 years. We have no occupational therapists now. We hope to train 20 in 5-10 years. We have 600 psychiatric nurses now. We hope to train more than 4000 in 5-10 years. We will do this either through expanding existing facilities or establishing more or both.”

The introductory scenes among others are clear caricatures of the status quo in various situations of the plight of mental patients across the country and the new law is the only apparatus that can salvage this situation. Ghanaians are therefore waiting patiently to see the full implementation of this "new dawn" and hope and pray that it will not be left fallow as it betided its previous laws.

https://m.facebook.com/chibaro.ali

chibaronet@gmail.com

Day Break Africa

Night throws its darkness apart
Like things fall apart
Leaving no stars in the sky
Cocks crow down and high
Calling dawn to bright
Birds flap their wings in style
Ready to kick and dig
For their daily bread

Wake up from the slumber
And go forth
For your bread and butter
Child of African soil
Shake off that numbness of sleep
Do not slack
In the shadow of your dreams
Chase the fantasies of your dreams
For time waits for no man
Your land has many things
Including honey and milk
Hovered across the continent
So don't go to french cap in hand
Nor dream of overnight richness
Toil and gain
Don't coil and loose
You may labour in pain
But will not be in vain

You can now see from faraway
So you must get on the way
See no obstacle on your pathway
For God is behind you
In all your ways
Shake off your fears
And clean your tears
And be ready to steer

The genesis of your toil
Began in the Garden of Eden
So worry not
About life' nemesis
Don't be pessimist
Think about the benefits
And be your own pharmacist
Oh child of Africa
Son of black skin
Step out of that goomy bed
Work for Mother Africa
Goodness and mercy
Shall follow you
In all your endeavours
Day break African!

https://m.facebook.com/chibaro.ali

My First Day In The Psychiatric Ward

Having been nurtured, groomed and certified by Nurses' and Midvives Council of Ghana as a staff nurse, after undergoing a programme in tropical health nursing for three consecutive years, plus one controversial year called internship or national service, I was unquiet to enter the ward and see for myself once again the usual bizarre behavior associated with the patients in the acute wards in a psychiatric hospital. It was common at first to see patients in the acute wards prowling within the inner parameters of the ward and some welcoming you in a deja vu manner. The grandiose delusion patients are often seen hitching their shoulders as if they are trying to shift the weight of the world to a more manageable position. In the female wards, you are likely to be welcomed with a gleeful smile by those with "de Clerambault's syndrome" (erotomanic delusion) as if their dreams have finally been realised. I was expecting to see most of the countless signs and symptoms that I have imbibed over the years in the classroom and put into practice the theory-based learning that is typical of African educational systems.

As I strode towards the ward on the day of reporting, I met many faces with strange behaviors, upon approaching the security gate, one hefty man shabbily dressed in traditional colours approached me with a rueful expression on his face and told me he was once a patient in this hospital, before I could ask any question, he wended his way through the bush like a palm wine tapper, I noticed all wasn't well with him. In the hospital premises I spotted 2 of them on the road, one holding bible vigorously preaching in a trancelike state and the other one whining in tears while peeping through the windows of the ward dormitory (perhaps missing his psychotropic drugs or favourite delicious meals). Little did I know that those patients have managed to escape the eyes of the security men at the gate into the hospital premises.

On the ward, I saw 3 patients in the midst of 27 affilliates and 4 rotational nurses at the TV parlour, all I thought was may be the rest of the patients have been treated and discharge home in good faith. That would have been a good news, because it is the dream of every sound minded health worker to see their patient/ client treated and discharge home to continue his or her occupational functions without any psychological or physiological challenges. As I was taken round the ward for orientation I saw seven patients taking a cosy rest on their beds, so I asked to find out the total number of patients in the ward, and there I was told the unfortunate news; the rest of the patients have all been discharged home last year and the hospitals are no more admitting patients because they are not receiving enough funds from the government to cater for their feedings. The ward used to admit over 100 patients but as at the time of writing this material it has only 10 patients. All my hope as a health worker ebbed, and dwindle suddenly like a punctured balloon in the sky, then the questions kept boggling and flooding my mind like an angry labour union threatening a general strike: what if in the next one or two years, this problem is still not addressed, the fews patients left have also been discharged home leaving the wards empty and the mental health bill also not implemented by then? what will happen to the psychiatric nurses on the wards? are they going to be incorperated into the general health care settings or the already congested OPD's? why should the sector even be experiencing this at a time when the mental health bill has been passed into law with provissions to shift the focus of mental health treatment from institutionalised care to the development of community services with the care of persons with mental disorder in general health care settings. Could the ideology behind the mental health bill be the reason for the current malady afflicting the sector or a real financial problem? If that is the case, then the government should expedite action on the formation of the mental health board so that psychiatric nursing will for once see the light of the day. This is how the Chief Psychiatrist, Dr. Akwesi Osei described the situation; "Already Ankaful and Pantang have stopped admissions and Ankaful, for instance, has less than 50 patients on the wards which earlier had 300 patients. The rest of the patients, as may be expected, are on the streets in their homes or in chains in the prayer camps, further worsening our human rights record."

There is now pressure on the few psychiatric units in our hospitals across the country and many have found their way onto the streets and some at the prayer camps where they are being subjected to inhumane treatments; chained under the sun and rains, forced to drink concoctions and beating in all forms of exorcisms, further abusing their human rights. It is time the government and other corporate agencies turn their attention to the sector because the image of psychiatric nursing in Ghana seems to have been dragging through the mud for far too long. Mental illness is no respector of persons, today it's somebody tomorrow it could be you! May God bless all nurses in Ghana.

The Ghanaian Nurse

Nursing is a call (vocation) to serve. It is an art of utilizing the environment of a patient so as to assist him in his recovery. This includes care of the whole patient, his mind and body, the care of the patient's environment and to provide health education and other health services to the individual, family and society for the prevention of disease and promotion of good health.
The International Council of Nurses (I.C.N) accepted the defination of nursing as "the unique function of the nurse, that is to assist the individual (sick or well) in the performance of those activities contributing to health or its recovery that he could perform unaided if he had the necessary strength, will or knowledge". "Service" to the mankind is the primary function of the nurses and the reason for the existence of nursing profession. To be a nurse is like being a mother; like a nursing mother who loves, cares and protects her baby from injury and sickness, like the hen that shields its chicks from it's predators, the Ghanaian nurse in the hospital protects his or her patient/client from sickness and our greatest enemy - death, by rendering the best of basic nursing care within their means to bring back life to dying souls. The Ghanaian nurse rehabilitate and restore normal function to patients who have either been physically or psychologically incapacitated to reintegrate them into the society. If one's death is destined, the nurse nurses him to a peaceful death (dying without pain or distress). I once withnessed an old man in his late 80's who in the process of dying was smiling at the nurses because of the good nursing care the nurses rendered to him. The nurse receive the sick and the wounded with open arms, sooth their pain, comfort them and nurse them back to life. Nurses in Ghana love their profession no matter the odds, they make effort to put aside the frustrations they encounter as nurses and perform perfectly for the sake of mankind. Such are epitomised characteristics of the good nurses in Ghana who are always working around the clock to save life.

On the other side of the coin are the few bad ones. Those who are constantly dragging the image of the profession into the mud and as the saying goes in Akan, in every house there is "Mensah", they are those who fell into the profession by accident and some too by the "stepping stone phenomema." They roar at the sick at the least provocation as if they have land dispute problems with them. They either do not understand the nurses' pledge or attach any significance to it which states in stanza three " I promise to respect at all times the dignity of the patient in my charge". The Ghanaian nurse since time immemorial have worked tremendously for the sake of mankind. Their work deserve better remuneration, better condition of service, respect and publicity. When their two sisters in the health sector embarked on strike demanding what others described as "avaricious demand", the Ghanaian nurse for the sake of mankind was in the ward attending to that unconscious patient who have soiled himself from head to toe with vomitus, urine and faecal matter, dressing that stinky gangrenous wound, carrying bedpan and what have you. Those in the psychiatric wards are sometimes physically attacked by restless, anxious and deluded patients. Some staffs have even lost their eyes, teeth, others with broken limbs some of which eventually led to their deaths, without any insurance cover nor “risk allowance”. As for the rotation nurses, the little you talk of them the better. Ghanaian nurses need a sturdy associatin with leaders who can always mount the negotiation table and hold the bull by the horns for the betterment of their condition of service than the status quo May God bless all nurses in Ghana and the hand that cares for the sick. Ghanaian nurses, AYEKOO, your reward is in heaven.