By Angela Johnston
At the Accra Psychiatric Hospital in Ghana’s capital city, 10 former patients are waiting for a bus near the hospital gates. Some sit silently. Some sing. Some pray. They have medicine in their pockets, and a few dollars’ worth of Ghanaian cedis for the ride.
Some have stayed here for more than a decade. Now, they will return home. Within half a year, 600 patients are going to be “repatriated” from the psychiatric hospital. The program is both a response to overcrowding at the hospital, and a move towards de-institutionalizing mental health care in Ghana, according to doctors. But others say they are worried about its long-term success.
Abraham Borketey, a former patient, says he is excited to leave after a six-week stay. His family brought him here because he was behaving strangely and fighting in his community. Now, he is eager to start working again.
Others are not as keen. One woman, who says she’s been at the hospital for 15 years, is being forced on to the bus. She yells out in protest.
“None of these nurses asking me to go home were here [when I arrived], so I don’t understand what they are doing,” she says in a local language, Ga, before a hospital staffer closes the bus door.
No concrete numbers exist on the number of Ghanaians living with mental illness, but the World Health Organization estimates it affects 10 per cent of the population, or more than two million people.
And access to care is mixed. All three government psychiatric hospitals are in the country’s more developed south. A dozen psychiatrists work in a country that officials say needs more than three times as many.
So far, the Ghana Health Service’s chief psychiatrist, Dr. Akwasi Osei, is calling the repatriation program a success. Of seventy patients that have been repatriated, three have come back to the hospital.
Osei says the program is designed to de-institutionalize mental health care here, but he knows the patients may face challenges outside the hospital, where stigma remains a problem.
“When people see them, they may say, 'ah, this is one of them,'" Osei says. “You can’t stop people from pointing fingers at you, but you can change the way you react to their pointing fingers at you. That is part of the education that we give them [before leaving].”
But some NGOs say it is too early to call the exercise a success. Basic Needs Ghana works with people living with mental illness. Country manager, Peter Yaro, supports a move to community care, but has concerns.
Yaro says access to reliable medicine and health care outside the hospital is mixed, and patients could relapse.
“The worst is that they would become destitute,” says Yaro. “When you don’t get the support from the family level, they find that kind of solace on the streets, or under the bridges.”
Osei says routine reviews are scheduled with patients, and nurses will work with them in their communities.
But he also says mental health care would be given a much-needed boost if the government passed the mental health bill, which would emphasize community-based care, and get more psychiatric professionals trained.
Ghana’s president, John Evans Atta Mills, recently referenced passing the bill in his annual State of the Nation address. Still, no government has done it in about five years.
Back at the hospital, the doors to the bus close, and its engine ignites. The bus starts to head out of the hospital gates; the beginning of a new journey for the ten patients inside.
Listen to a radio report about the repatriation program from Citi FM's Martin Aseidu in Accra: