The challenges
Approximately 10% of Ghanaians have a mental health condition or psychosocial,
intellectual, or cognitive disability. The Ghanaian mental health system has been
appraised by the World Health Organization in 2013 and 2020 and both appraisals
found high rates of coercive practices in both formal and informal mental health
services, including involuntary admission or treatment.
At the time of our programme inception in 2020, Ghana had not yet established the
legal body identified in the 2012 Mental Health Act to oversee the rights of people
involuntarily held in institutions across the country, that is, the Mental Health Review
Tribunal.
The solution
Holding people with mental health conditions without their consent is permitted in
some countries when certain situations are defined and an independent body has
been set up to carefully consider cases based on principles of human rights. This
body, often called a Mental Health Review Tribunal, is quasi judicial, has powers of
discharge, and is critical to the wellbeing and safeguarding of rights for many people
with mental health conditions globally. Ghana’s Mental Health Act 2012 states that a
Mental Health Review Tribunal must be established.
What did the programme do?
Technical assistance
We worked collaboratively with the Mental Health Authority to establish a Mental
Health Review Tribunal. We provided effective technical assistance to enable the
establishment and implementation of the Review Tribunal, with the support of a
facilitator with extensive experience in this area.
Our assistance helped to:
- understand the legal framework for establishing the Mental HealthReview Tribunal
- agree a nomination process for Review Tribunal members
- appoint and inaugurate the Review Tribunal members from three selected pilot regions
- train members
- develop a guidance manual
- develop a framework for monitoring and evaluation
- provide practical support for the Review Tribunal to begin its work
- support a review of early implementation challenges
- convene key stakeholders to share learnings and agree next steps for the Review Tribunal following the end of Ghana Somubi Dwumadie
Regional pilots
Although the Review Tribunal is a national body, it requires members from each region
of the country, structured in regional branches, to allow people to access the Review
Tribunal locally. Three regions with psychiatric hospitals or departments were chosen
to pilot the regional branches, that is, Ashanti, Central and Greater Accra regions.
The Review Tribunal worked very closely with Regional Mental Health Visiting
Committees. Visiting Committees also have a human rights function and are
mandated to inspect any formal facilities (such as psychiatric hospitals) or informal
facilities (such as prayer camps) where people are held. We also provided technical
support to establish five pilot Regional Visiting Committees.
Visiting Committees
Working alongside the Mental Health Authority, we also provided significant technical
assistance to the Regional Mental Health Visiting Committees, a structure that
is detailed in the 2012 Mental Health Act, but had faced challenges in becoming
operational. Delivering training with consortium partners, we equipped Visiting
Committee members with the knowledge and confidence to carry out their mandates
successfully. The training, delivered in five out of 16 regions in Ghana, sought to
uphold the standards set out in the United Nations Convention on the Rights
of Persons with Disabilities and the guidance offered by the World Health
Organization’s Quality Rights toolkit to ensure the highest attainable standard of
healthcare, adapted to the context in Ghana. We supported one Visiting Committee
to run as a trial, and from 2023 the Mental Health Authority has fully taken over
responsibility for the running of the Visiting Committees
Five key steps to establishing a Review Tribunal
- We divided the work into five key focus areas
- Appointment of the Review Tribunal members with transparency and
wide consultation - Comprehensive orientation and training
Developing the Review Tribunal Manual with the Review Tribunal members
to ensure context-relevant approaches and conformity with the Mental Health
Act 2012 - Supporting the Mental Health Authority, which is legally responsible for the
Review Tribunal, to move to implementation and address challenges - Monitoring and evaluation, including recording experiences and collating
information from the work of the Review Tribunal to improve practices
How the programme made a difference
The establishment of a Mental Health Review Tribunal is groundbreaking; a Review
Tribunal had never previously existed in Ghana, and its establishment in 2022
represented a major breakthrough for human rights work in the country. The Review
Tribunal is a critical structure for the promotion and protection of human rights
of persons with mental health conditions.
We have documented lessons learned through the establishment of the Review
Tribunal in Ghana to share with other countries intending to set up such bodies,
especially Low- and Middle-Income Countries, as many other countries do not have
similar protections for people with mental health conditions.
The Chairperson of the Mental Health Authority Board wrote a foreword to the Manual
which demonstrates endorsement of the commitment and buy-in from the Authority to
the workings and future of the Review Tribunal
Lessons learned
- The existence of legislation that creates a mandatory Mental Health Review
Tribunal is fundamental. Without being included in law, it is unlikely that the
human rights protection offered by a Review Tribunal will be realised. - The country and the authority that establishes the Mental Health Review
Tribunal must take the leadership role, even though external support and
expertise can be helpful for navigating complexity. - Phasing the Tribunal through pilots in select regions provides a gradual start
that is less overwhelming. - A stepped methodology, with clear and manageable objectives, is critical to the
establishment and effective functioning of the Review Tribunal. - Fully involve Tribunal members and the lead authority in the design and
development of the Review Tribunal’s operation manual, to ensure that the
result is fit for purpose and accessible. - Develop a monitoring, evaluation and learning system to support the Review
Tribunal’s continual improvement
