- Lack of capacity of MOH to provide access to and quality community based mental health care services,
- Lack of provision of mental health services integrated into primary health care including maternal health care
- Near absence of non-drug therapeutic services to support recovery and rehabilitation, including lack of secure livelihoods opportunities for people with mental illness or epilepsy and their primary care-givers and poor capacities of SHGs of mentally ill people and their care-givers to influence district level plans and policies
- The low prioritisation and investments in mental health by local and central government to address mental health issues and an ingrained public lack of understanding that has not made it possible for effective understanding of mental health problems, and this includes low understanding amongst policy makers on inclusion of mental health in development processes.
On the whole, Ghana’s mental health system is highly institutionalised, highly medicalised and highly centralised and lacks integration into general health care, especially at PHC level. It is plagued with inadequate personnel, serious shortages of psychotropic and anti-epilepsy medicines, and poor logistics and infrastructure.
Mental illness is both a cause and consequence of poverty and PWMIE and their households are amongst the most marginalised groups in Ghana due to ill-health, social stigma and vulnerability, and reduced ability to earn an income. With a population of almost 25 million, basing on the WHO estimates, over 2.5 million Ghanaians will suffer mental illness in their lifetime, with debilitating effects on their families’ ability to secure a livelihood. In a study by Raja & Boyce (2007), 71% of PWMIE who were primary earners in the household reported a decrease in their (already minimal) income in the previous year (and of the remaining 30% who perceived an increase in income, most had benefitted from a small business loan from BasicNeeds). 80% of PWMIE reached by BNGh are estimated to be living on less than $1.25 a day. Many families have been forced to sell productive assets to pay for treatment whilst PWMIE and carers have lost jobs due to untreated illness and the burden of care respectively. At the same time, training and credit schemes largely exclude PWMIE as they are perceived to be risky, even after they have recovered or stabilised their condition. Despite the impact of mental health on poverty levels, as well as on broader health outcomes, mental health is a highly neglected area of public health resulting in an extreme lack of access (geographical and financial) to treatment. In order to effect a reduction in household poverty, the efficient delivery of integrated mental health services is necessary to enable PWMIE to stabilise their condition.
The project therefore proposes to build capacity at community level including setting up new psychiatric services within PHC settings (local clinics) and training CHNs, CPNs and mid-wives, traditional healers and other alternative/private health care providers (maternity homes and private clinics) to integrate mental health care in their services in order to enhance access and quality comprehensive services to the population, especially in hard-to-reach communities/ locations. BNGh experience has shown that whilst poverty affects both men and women with mental illness or epilepsy, women with mental illness also experience additional disadvantage as a result of gender stereotyping and discrimination reducing their access to the few available services. This has serious consequences for their general health and wellbeing of their families.
The new Mental Health Law coupled with the ever-growing public interest on mental health issues and the limited community mental health services, including BNGh’s own operations, present reasonable grounds to build on enhancing mental health care services and for that matter the quality of life everyone should enjoy.
This project will thus strengthen capacity at primary health care level to deliver appropriate mental health treatment services to persons with mental illness or epilepsy. This project therefore also expects to contribute to reducing to strengthening Ghana’s mental health system and to reduce poverty and disadvantage among the poor people with mental illness or epilepsy and their primary carers and families. This project will also work to improve gender equity and women’s empowerment (MDG3) through participation of women in skills trainings and access to financial credit and services and the promotion of female leadership of SHGs. In brief, the gaps in service delivery identified include inadequate mental health services at the PHC level; low capacities of PWMIE to organise and self-advocate; and lack of financial services and vocational skills opportunities to improve health and secure livelihoods of poor PWMIE and their families across the project areas, and an engrained public ignorance and low political government of government (at both central and local levels) to invest in mental health policy and service delivery. There a number of pro-poor initiatives in place to address the general population. The GSGDA is building on the Ghana Growth and Poverty Reduction Strategy which was the country’s blueprint response to achieving the MDGs and led to the development of social interventions including LEAP, Capitation Grants and Free Maternal Health Care.
Whilst modest achievements towards some MDGs have been recorded, any benefits have eluded poor PWMIE and their families who have been largely excluded from development processes due to their extreme social exclusion. BNGh and its partners are amongst the only actors focusing on this neglected group and will work in close collaboration with the government and its associated initiatives to ensure the project dovetails with mainstream efforts to reduce poverty and improve maternal health more generally. This will include integrating mental health services into existing government services and supporting PWMIE to access existing development initiatives and funds.
The project seeks to expand from the current operational areas that BNGh already covers, to the entire country, for that matter from the current six regions with sixty eight districts to reach all the regions and their related DMMAs. Beyond the regional and district capitals most of the communities are hard-to-reach. For example, locations are among the poorest in the country. 70%, 80% and 90% of the populations of Northern, Upper East and Upper West regions respectively are poor. Central Region follows in the heels of these locations, whilst deprived hard-to-reach-communities abound. By 2006 when there was marked drop in poverty in Ghana, the Greater Accra and Upper West regions worsened (UNDP 2010), and they have the highest maternal and child mortality rates in the country. The urban settlements of Greater Accra have high levels of household poverty, gender-based violence, unemployment, use of hard drugs, and low levels of access to maternal health services,.
BNGh has built strong community relations over the past eight years including with the traditional and political leadership, SHGs, and health and development authorities. It is now timely to build on previous successes and learning in implementing BN’s Model for Mental Health and Development to expand services, as well as to promote a special focus on the well-being of women most neglected by mainstream development processes.
 Raja and Boyce (2007) Demographic and Economic Characteristics of People with Mental Illness - A Study in Ghana, BasicNeeds
 Ghana Poverty Reduction Strategy (2003) GPRS 2003-2005 – An Agenda for Growth and Prosperity
 Akyeampong K, J. Djangmah, A. Oduro, A. Seidu & F. Hunt (2007) Access to Basic Education in Ghana: The Evidence and Issues – Country Analytic, retrieved May 10, 2011 http://www.create-rpc.org/pdf_documents/Ghana_CAR.pdf
 GPRS (2003) Poverty Diagnostics and Components of the Strategy