Mental health is a very misunderstood concept especially in the developing world. To many an African, mental health connotes insanity and related illnesses. However the mental well being of a person is an integral component of the holistic well being of the person. Therefore developing countries ought to pay more attention to this area of health since it invariably translates into the development of a country. Indeed the international community continues to recognise the importance of mental health as a component of general health and continues to attempt to take steps to safeguard the rights of persons with mental disorders.
Ghana has not been left out in the global recognition of the need to cater for mental health in its national agenda. This is typified by the fact that there has been a mental health law in the country since 1972 ? the Mental Health Decree, 1972 (NRCD 30). Even more recently, the parliament of Ghana is considering a new bill to replace NRCD 30, the bill if passed will not only safeguard the rights of persons suffering from mental disorders but ultimately strengthen mental health care delivery in Ghana which is currently suffering several drawbacks by amongst others integrating mental health care into existing general healthcare facilities. Although the bill is a well intended one, something must be said about the financial implications of the bill vis its sustainability within the government?s current fiscal arrangement, and to ensure that the bill achieves the necessary social change that the lawmaker and indeed the people of Ghana desire.
Under the current financial regime, the mental health sector is funded primarily by government supplemented by a minute amount of internally generated funds and donations. The budgetary support for Ghana?s mental health service is woefully inadequate and is largely the reason behind the deficiencies in the mental healthcare delivery system. Research conducted by ?Basic Needs?, an international NGO providing mental health services in Ghana indicates that between the years 2003 and 2008 an average of 2.59% of the total health budget was spent on mental health. Although this is higher than the WHO estimates in other developing countries, the reality is that this is unable to meet the needs of the mental health sector resulting in a gradual decline in the quality of service rendered in mental health sector.
The new bill seeks to introduce several new components to mental health delivery which would require an augmentation of the sector?s financial base if it is to be workable. It for instance proposes the establishment of a Mental Health Authority with a governing board and several departments to perform roles that are parallel to the Ghana Health Service. It also proposes the setting up of visiting committees in all ten regions to conduct period inspection of mental health facilities. If all these administrative bodies are to be adequately catered for, the meagre fiscal arrangement that currently exists will not suffice to sustain the new regime, and would increase the burden of the already overburdened national budget.
The financial burden which would result from the creation of these new institutions can be curtailed by extending the mandate of some existing institutions and strengthening their capacity to deal with Mental Health related matters. For instance the role that the proposed visiting committees are to perform can be conveniently performed by the Commission on Human Rights and Administrative Justice (CHRAJ), through its existing regional and district offices. This would go a long way not only to reduce the cost of implementing the objectives of the Mental Health law, but the logistical improvements that would be required to build the capacity of CHRAJ to undertake its new mandate would also improve the capacity of CHRAJ to perform its existing mandate.
Although the bill proposes the setting up of a mental health fund, it is unclear how this fund is to be sourced and maintained. The government in its 2012 budget intimated that the total amount allocated to the health sector was informed amongst others by the intention to pass the mental health bill, however it is imperative to ask whether the drafters of the proposed bill projected the cost implications of implementing the bill. If so, how much of the national budget on health would be allocated for the implementation of the bill?
Furthermore, a critical analysis of the bill would reveal that the problem of mental health is not just a ?health matter?, but has ?social? implications as well. In this regard, the financing of mental health care should not be the sole responsibility of the Ministry of Health. There should be some collaboration between the Ministries of Employment and Social Welfare, Finance and Economic Planning and Local Government since they have or ought to have some responsibility and interest in the matter. The ministries of Employment and Social Welfare and Local Government are expected under the bill to work towards the rehabilitation of persons suffering from mental disorder. Is it expected that the mental health budget should cater for the creation and maintenance of these rehabilitation centres?
Having regard to the fact that 3% of the District Assembly Common fund is allocated to persons with disability, the bill should create the necessary linkages to the Disability Act through the National Council for Persons with Disability on one hand and the District Assemblies so as to enable the access to portions of the District Assembly Common Fund to fund the some of the overheads which would result from the implementation of the Mental Health Bill. This can only be done if the bill recognises the fact that mental illness has its associated disabilities, and therefore the definition of disability within the context of the law should include mental disability.
An additional source of funding for the mental health sector is revenue from national lottery. The National Lotto Act, 2006 envisages the setting up of a lottery for the purposes of supporting the mental health budget. Six years since the enactment of the law, it appears that aspect of the law has been ignored even in the face of the crises bedevilling the mental health sector.
Giving these considerations, can Ghana afford a sustainable autonomous Mental Health Regime? Parliament and interested stakeholders should therefore give the matter a second thought, even as we as a country blaze the trail yet again to meet national and international developmental goals.
By Nelson Akondo
nell_agh@yahoo.com
