Hailed by President Obama as a “model for Africa” with a peaceful democracy and national health insurance, Ghana has recently added a progressive new mental health law to its list of achievements. The new law will update its 1972 predecessor by including key players in the mental health system, such as private providers and faith healers, who were excluded in the past. But the main thrust of the new legislation is to integrate mental health across all levels of the country’s health system, rather than relegating it to specialists in the wards of psychiatric hospitals.
In order to implement Ghana’s new mental health law, the relationship between mental and physical health and the social factors underlying them must be well understood by policy makers and clinicians locally.
A new publication in Ghana Medical Journal, jointly written by researchers from LSE Health, the Chief Psychiatrist of the Ghana Health Service, the director of a mental health NGO in Ghana, BasicNeeds, and researchers from the Harvard School of Public Health and the University of Ghana, sheds light on the relationship between mental distress and physical ill health in urban women.
The study, conducted in the capital city Accra among over 2,800 women, found that mental distress correlated with headaches and sleep disturbances, both common complaints that often go misdiagnosed by GPs. Chronic disease (as indicated by taking medications) also correlated strongly with symptoms of common mental disorders. Education and employment were found to be strong protective factors.
Whereas over half of women (59%) attended a health centre in the previous year, only 0.4% had attended a specialist mental health provider, which represents merely 1% of those needing treatment. The shortage of specialized providers – Ghana Health Services employs 4 psychiatrists and only 500 psychiatric nurses for a population of 22 million – contributes to the treatment gap.
People with a common mental health problem may also be avoiding specialised care because of a reluctance to go to a psychiatric hospital, which was the staple treatment under the old law. Centring care in psychiatric hospitals has tended to stigmatize the treatment of mental disorders, by conflating all mental ill health with psychosis, and by providing care in often insalubrious conditions – both problems that should be improved under the new law.
One of the troubles with not treating mental health problems, from the angle of policy, is that it increases health costs. As noted by Michael Parsonage in a discussion on this blog, there is an average increase of 60% in long-term health costs for people in the UK with co-occurring mental health problems. The implication for policy makers is that more health providers of all types need mental health training, so as to start filling the vast treatment gap. One strategic way to make this happen would be to integrate mental health into national policy on chronic disease, which the WHO expects to surpass infectious disease and maternal mortality as the most common cause of death in Africa by 2030.
The implication of this study for Ghanaian healthcare providers is that physical and mental health are closely related. Simple screening questions around mental health (e.g. “In the last month, how often have you been feeling nervous or depressed?”) could be a useful addition to a general health consultation, particularly with women complaining of headaches or sleep problems.
From the perspective of research, this study marks a first: the two questionnaires used to measure mental health (K6 and SF36) have never before been tested in a Ghanaian population. Both tools appear valid, though the cut-off for determining pathology (illness as opposed to distress) needs to be determined.
de Menil V, Osei A, Douptcheva N, Hill A, Yaro P, de-Graft Aikins A (2012) Symptoms of common mental disorders and their correlates among women in Accra, Ghana: A population-based survey, Ghana Medical Journal, 46, 2, supplement.
The article is available through open access from Ghana Medical Journal and through LSE Research Online.