Making mental healthcare accessible and affordable in Ghana13 September 2023 London School of Hygiene & Tropical Medicine London School of Hygiene & Tropical Medicine https://lshtm.ac.uk/themes/custom/lshtm/images/lshtm-logo-black.png
In 2017, I was a medical student in University of Ghana. I was a freelance newspaper columnist for the Mirror Newspaper and in commemoration of World Health Day that year, I featured an article on depression in a column. Consequently, the publication made rounds and I had a teacher reach out to me for help. Essentially, the teacher lived in a remote part of Ghana and she had identified herself as experiencing some of the problems I had published and she reached out to me for help. She had experienced some recent loss and found herself in a turbulent relationship. From my interactions with her and in attempt to help her get the needed professional help, I realised that there was a widespread challenge of the unaffordability and inaccessibility of mental healthcare in Ghana.
Also, there was a marked challenge of stigma associated with mental health conditions and this disincentivised people from seeking professional care for their mental health challenges. This experience led me into a foray of exploring the mental health situation of Ghana and made me realise the paucity of mental health professionals in the country, and the poor access to mental health facilities. To wit, at the time, in 2017, there were only 16 psychiatrists that served a population of 25 million Ghanaians, with only 5 tertiary psychiatric units in the country. This meant that people who needed help had to travel very long distances to seek advanced care for severe cases which were not covered by the National Health Insurance Scheme at the time. (Ghana’s flagship tax-based health insurance scheme).
Starting a telemental health service to bridge the gap
How to make care accessible and affordable for the ordinary Ghanaian became my cynosure as I began to ‘ferret out’ a way to help bridge the gap of affordability and accessibility to mental healthcare in Ghana. I explored Ghana’s mental health system and realised that the Government of Ghana had instituted a community mental health programme that was hinged on task sharing and task shifting. In this intervention, they capitalised on the ubiquity of community mental health units to decentralise mental healthcare. By training community mental health officers and nurses in mental healthcare, they established community mental health units in the district hospitals where these staff would provide mental healthcare to people who presented with cases whose severity they could manage.
Having found this, I sought of a way to leverage this intervention, I thought of a way to bridge the mental healthcare gap and in this, I began MindIT GH, a telemental health service that signposts people to where they can get affordable and accessible mental healthcare. It required me to convene an eclectic team of friends and family who would contribute some relevant sills pro bono to start the service. Almost six years down the line, we have been able to not only the create a nationwide toll-free mental health short code and have also established our mental health call centre and a budding innovation corner which will be housed within the same facility. In the context of very limited resources, we had to brainstorm to devise ways to run a service that was not only going to be efficient but effective also. Today, MindIT GH has been successful in screening over 6000 thousand Ghanaians and facilitated affordable care for those who required professional help.
Also, I capitalised on my newspaper column to feature articles that sought to provide mental health education and advocate for the adoption of best practices in mental healthcare in Ghana.
Repeal of Ghana's Anti-Suicide Law
Following my advocacy work on mental healthcare in Ghana, on Wednesday 7th June 2023, I had the honour of being invited by the BBC to discuss the repeal of Ghana’s anti-suicide law, what it meant for mental health in the country and the work my telemedicine programme (MindITGH) is doing to prevent suicides in Ghana. Sometime in May this year, the law that criminalised attempted suicides was repealed in Ghana. Previously, in section 57(2) of the Criminal and Other Offences Act, 1960 (Act 29), “A person who attempts to commit suicide commits a misdemeanour” and such persons could be handed a custodial sentence. Seeing that 98% of suicides are linked to underlying mental health conditions, it is indeed unfair to prosecute such persons. “In Ghana, about 1500 suicide cases are reported annually, and in each reported case of suicide are four unreported cases, summing the number of unreported cases to almost 6000 yearly” (Daily Graphic, 2015).
Attempted suicide is, in its simplest form, a cry for help. The repeal means that people who attempt to take their lives by suicide won’t be prosecuted, and such persons when identified by the law enforcement agencies will be referred for mental health evaluation. This landmark change is reflective of the fair and appropriate treatment of people who attempt to take their lives as well as the significant progress made in the scientific community about the pathophysiology of suicidal behaviour.
Pursuing MSc Health Policy, Planning & Financing
My experience in helping Ghanaians gain access to affordable and accessible mental healthcare significantly piqued my interest in how I could leverage the concept of health financing to help broaden access to affordable healthcare in African communities. This led to my enrolment in the joint MSc Health Policy, Planning & Financing by London School of Hygiene & Tropical Medicine (LSHTM) and The London School of Economics & Political Science (LSE).
Today, having had an extremely enriching and stimulating education at LSHTM/LSE on the MSc, I feel adequately equipped to not only appreciate the nuances involved with healthcare affordability and access across various countries, but to also draft and advise on policies about health financing and policy. Having completed the programme, I excitedly look forward to any roles which would enable me contribute meaningfully to reforming health financing or policy schemes. Whilst working at towards that, I would leverage the learnings from the MSc Health Policy, Planning & Financing to improve on my telemental programme in Ghana. In additional to our call centre, my team intends creating a research unit where we would under ethical considerations, churn out the user statistics we have received into meaning data to inform mental health policy in Ghana. Additionally, we are almost done with a development of a mental health board game which consummately incorporates all the learnings from the mental health service to educate players on how to recognise mental health challenges and offer support to persons experiencing mental health challenges.
It’s been an enriching journey so far. It’s amazing how experiences can shape the trajectory of our lives and careers.