Psychiatry in Ghana
The prospects in Psychiatry
Psychiatry in Ghana is of recent origin. Prior to 1951, there were no psychiatrists in the country, except for a brief period in 1929, when Dr. Maclagan, was appointed alienist to the Asylum at Accra, a position he held for a short time before his transfer to head office.
In the very early days when mental patients began to be segregated, they were kept in prisons, as in other parts of Africa.
The first African Psychiatrist appeared on the mental health scene in Africa, south of the Sahara in 1951, and was posted to the then Gold Coast, to the mental hospital at Accra. Prior to his appointment the need for the establishment of some form of scientific treatment for the mentally sick, and an appraisal of the extent and distribution of mental illness in the country, had been felt.
In 1946, Dr. G. Tooth came out to the Gold Coast from the United Kingdom, and conducted a survey, the result of which awakened some interest in the Government of the day, to embark on a programme to improve the lot of the mentally disordered patients.
For nine years, there was only one psychiatrist in the country. About this period too, there were only four African Psychiatrists on the continent, one in Nigeria, and two in the Sudan. This paucity of Specialists in this field reflected the general attitude of the African toward psychiatry, and the importance placed on this branch of medicine which, locally had been shrouded in withchraft, juju, taboos, religious cults, fetish and Zar influences.
It was felt that the local treatment facilities at the hands of fetish priests, native doctors and other charlatans, were adequate to cope with the situation. Particularly as some of the patients were regarded as being in a state of religious possession and were to be revered. Those who, unfortunately were regarded as agents of demons, then deserved whatever fate lay in wait for them, because they were being punished for their sins. This has been the turbulent sea in the midst of which psychiatry had tried to raise its critical head. This also explains the reluctance of the young medical officer to take up the specialty. Some doctors have sought reassurance that constant association with the mentally ill patients was not in itself conducive to a breakdown.
There has been a slow and gradual change of heart towards psychiatry in Africa, and now a number of Africans are in training in the United Kingdom, Canada and elsewhere. The attitude of the general population is also undergoing a gradual change and the so-called western method of treatment is being given a fair chance. This is reflected in the number of people now seeking treatment as voluntary patients. In 1960 there were 317 such patients in hospital compared with 1951 when there was none. This attitude however, does not mean that the native doctors and others, have ceased to function. They still carry on their several practices, but do not now enjoy the monopoly of having the first chance with the patient, leaving the hospital to deal with their failures.
The function of the fetish priests continues to exist, for after the patient has been discharged from hospital improved, this is regarded as only partial, becoming complete only after the performance of certain customary rites.
During the year 1906, the available accommodation for mental patients was considered inadequate and a new hospital was built on the site of the present Mental Hospital at Accra. The hospital was built of concrete, was well sited just outside the town and was surrounded by good arable land, but owing to a shortage of water the patients were not transferred from the old court building until 1907. The new hospital consisted of an administrative block, a dispensary, an office for the visiting doctor, a store, a gate keeper's room, a night warder's room and a kitchen. In addition there were two large court yards which measured 250 feet by 150 feet, and 131 feet by 150 feet and around these court yards were built the dormitories, wash houses and toilets.
One hundred and ten patients were admitted into the new hospital and they were looked after by sixteen untrained nurses, and a visiting doctor who was also in charge of the prisons. The patients' meals were prepared by the criminal lunatics, under the supervision of the nurses. At this time, some form of treatment which was described as the “exhibition of mind suiting drugs” was apparently given to the patients. These drugs were chiefly arsenicals. The restless and violent patients were restrained by the use of handcuffs and leg irons, or by seclusion in single cells. Patients who were able to work carried on vegetable farming as a form of occupational therapy.
The Mental Hospital in Accra, was the only one in the entire country and by 1909, only two years after it was opened, it was already catering for 275 patients — more than double the number of patients it was built to accommodate. This problem of overcrowding has continued ever since and to-day, in spite of extensions and additions to the Hospital it is still not solved.
The problem of mental health is one of re-educating people in the whole sphere of inter-personal relationships in such a way as to give them insight into their own behaviour and that of others. While early childhood may offer the best opportunities for education it is essential that education should be carried on among people of all ages and walks of life.
On the practical side it is clear that in order to reduce the period of morbidity to a minimum there must be facilities for early hospitalisation and treatment of patients. To achieve this, a number of small mental hospitals will be built, to house about two hundred and fifty to three hundred patients. These hospitals will be distributed in such a way that every Region will be adequately served.
The question arises whether native-African Psychiatrists should be given a specialized training with an African culture bias, or whether the present training which takes place outside Africa is adequate and appropriate? My view is that the present training of Psychiatrists which consists of an indoctrination of the basic principles of psychiatry, divorced from any specified cultural orientation, has much to recommend it.
The future of psychiatry in Ghana is bright, not only because of the proposed improved facilities for the care and treatment of the mentally disturbed, but also because among the population there is now an increasing awareness of the services that psychiatry offers. It may also be expected that the all round improvement in the general health of the population by the provision of good housing, good water supply and adequate food, together with the intensification of agricultural production and the diversification of industry to minimise migration of wage labour, will contribute a great deal to modify stresses and tensions and thereby reduce the incidence of mental illness in Ghana.
Owing to the shortage of Psychiatrists in Africa and the uphill endeavour to establish a good mental health scheme, not only in Ghana but in Africa as a whole, Psychiatrists are in great demand throughout the continent and we in Ghana would welcome assistance in the form of short term attachment to our institutions for the purposes of much needed research into our psychiatric problems.