The World Health Organisation (WHO) defines Mental Health as “A state of well-being in which the individual realises his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution(s) to his or her community”.
Mental health can also be said to be the level of psychological well-being or an absence of any mental illness. It is the state of someone who is functioning at a satisfactory level of emotional and behavioural adjustment “.
The WHO estimates that one in four people will experience a mental health condition in their lifetime. There have been growing recognition that neurological health and mental wellness, or lack thereof, is both a cause of and source of global issues like violence, poverty and overall health.
The Global Burden of Mental Disorder
According to the WHO 2005 report, 31.7% of all years lived with disability is attributed to Mental, Neurological and Substance (MNS) use disorders. MNS disorders in many countries are among the ten leading causes of disease burdens in Lower- and Middle-Income Countries (LAMICs). The WHO in 2017 declared major depressive illness as a leading cause of disability worldwide, whiles schizophrenia, alcohol misuse were also identified as key causes of disability.
In discussing funding to support mental health, it is relevant to point out that, as a country, a tremendous amount of visionary thinking, scientific research, governmental leadership and public readiness has led us to where we are today. And now there is a need to focus on concrete solutions and steps to integrating a mental health budget line into the work of achieving the Sustainable Development Goals (SDGs).
The need for Greater Focus on Mental Health
Despite the obvious importance of mental health, it continues to occupy the back seat when it comes to the allocation of resources. This is due to the burden of infectious and non-communicable diseases which are given priority over mental health.
There are fundamental reasons why mental health needs to be a greater priority in development. First is that copious reference can be made to studies which show that of people with disability, people with psychosocial disability are the poorest and the most unemployed. The rates of unemployment among people with mental illness who have stabilized in their conditions remain unacceptably high in many countries including Ghana.
Good mental health has implications for personal, community and even national development. If 1 in 4 people in their lifetime have a mental health problem and if that is not dealt with properly, quickly, effectively, then it is likely to even affect their family’s income catastrophically. And it will also impact the capacity of a country’s economy to grow. In a nutshell, the development of this country could be held back by the level of cases of untreated mental illness. Meanwhile, pathetically, budget or funding allocations for mental health remain scandalous and it is broadly encapsulated by stigma and ignorance. We continue to still witness pitiful contribution of money to mental health care — less than 1 percent of health budgets. That ought to u change, quickly!
Why Greater Mental Health Investment Is Necessary
In the first place, many make the argument that It makes economic sense to invest more in mental health. This is so because when cost- effective community level treatment is available, there is substantial improvement in workforce productivity. The WHO & World Economic Forum (WEF) estimate that the global impact of mental disorders will amount to loss of economic output of US$16 billion!
Secondly, an improved mental health budget has the potential to articulate what physical and human resources are required to deliver a mental health service that is effective, efficient, accessible and of acceptable quality. Budgetary allocations to mental health will honour the various perspectives in the field, while inspiring a united vision of a person’s right to dignity and right to care and facilitate effective development of policies, strategic plans and programmes. An increased mental health budget will bring forward those marginalized by psychosocial disability and those who have worked beside them to share their own unique experiences and insights on the intersection between mental health and poverty, health and peace.
Financing Mental Health
Ghana’s mental health is funded primarily by the Government of Ghana and is supplemented to a small extent by internally generated funds and donations.
It is estimated that of the nearly 30 million people living in Ghana, about 3 million suffer from mental illness. Meanwhile, a major challenge of mental health remains funding. Even though it is difficult to calculate the total amount spent on mental health, it is generally accepted that mental health is the least prioritized. The lack of priority has consistently led to insufficient funding. In 2012, total health expenditure as a percentage of gross domestic product was 5.2 percent—the agreed target is 15 percent. In 2010, 1.3 percent of this figure was spent on mental health, very low when compared to the (global) estimate of 13 percent of total burden of disease attributable to mental, neurological, and substance use disorders
The Issue of Access: Some System Factors Impacting Access to Mental Health Services
It is to be admitted that progressive change in mental health services cannot happen in a vacuum and is dependent on the existing health infrastructure, particularly if there is a commitment to investing in sustainable change through integration in mainstream structures. Similarly, comprehensive mental health services must provide access to biological, psychological, and social interventions (or facilitate access to such services for those who need them).
• Access to biological treatments: the point that needs to be made is that having professionals in the right place with the right skills to prescribe appropriate medications is, without doubt, important, but cannot be done without a reliable supply of medications. This is particularly the case for severe mental disorders such as schizophrenia, bipolar affective disorder, moderate and severe depression, and epilepsy. Unfortunately, shortages of psychotropic medicines are commonplace, and this serves as serious drawback to effective treatment. Access to treatment is a right that cannot be denied.
• Access to psychological treatments: In general, there has been a tendency for mental health services to mainly focus on biological treatments. There are a number of reasons for this: training is biologically focused, and there are few trained psychologists; patients expect and value medication; availability of appropriate, practical talking therapies has been limited even in international guidelines. Besides, it is logistically more complex and expensive to provide talking treatments.
Despite this, the evidence is growing for low-intensity, often group or peer, models of therapy, which are important interventions in many disorders where the evidence implies talking therapies are equally or more effective than medications. Sadly, clinical psychologists are nearly absent from Ghana. Clinical psychologists in Ghana number around 100, but fewer than 20 work in the public sector and are accessible mostly to people living in the two biggest cities of Accra and Kumasi. This means any solution would require lay providers of simple psychological interventions.
• Access to Social Interventions: In general, there is inadequate intersectoral collaboration in providing the broad care that many people with mental health challenges need. Apart from the few community-based rehabilitation (CBR) programs, health, education, social welfare, and livelihood services do not engage well together. However, the existence and activities of organizations such as MindFreedom Ghana which continue to engage inter alia in mental health advocacy and awareness creation made up of multiple stakeholders is a positive development that has certainly helped to break down some of the traditional vertical siloes in which different sectors work. The coming of the Mental Health Law has also ensured some collaborative work across agencies.
In the aftermath of the coronavirus pandemic, many creative solutions have been offered to increase access to mental health services, including integrating behavioral health services into primary or community-based care, augmenting the workforce. Through task-shifting (for example utilizing community health workers or peer navigators to provide some services), imparting training and supervision to novel providers via the internet or delivering services to people where they live.
But isn’t it surprising that given all we know about how to expand access, one would ask why access is not a priority given existing rates of untreated mental health and substance use disorders? Have we not, as civil society, made a compelling case yet to government, policy makers, the general population or healthcare system managers concerning the lack of adequate financing towards mental health? Do we need more evidence than the opioid epidemic, the massive incarceration of people with mental health conditions or suicide?
Now, more than ever before, maximizing patient outcomes will require reaching out to patients earlier in their illness trajectory, helping them recognize their mental health needs, and making them co-leaders in their care. it might necessitate psycho-education dissemination campaigns, home visits and continuous communication to understand what patients prefer as higher value healthcare delivery.
It is within the context of the foregoing- including the need for collaboration for effective advocacy towards mental health and other disability issues- that we recognize and appreciate the funding support MindFreedom Ghana, has received from the Open Society Initiative for West Africa (OSIWA) to implement a two-year project (2020-2022).
The project, which is titled: “Institutional Strengthening And Awareness Raising To Fight COVID-19 And Its Impact On People With Lived Experiences In Ghana”,when completed will support in strengthening the capacity of MindFreedom Ghana for advocacy and awareness creation, which are aimed at addressing the scourge of stigma and discrimination (associated with the disease) that patients, as well as relatives of the pandemic, suffer. Further, the project will help build awareness among the general public as a way to support the fight against the coronavirus pandemic in the country, through the development of well thought through and innovative programmes to reduce morbidity and mortality due to coronavirus (COVID- 19).
By Dan Taylor