mental health project-communityinterventionreport2015

TAKING ACTION | INVESTING IN SOLUTIONS

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TAKING ACTION INVESTING IN SOLUTIONS

Written by:

Pauline Anaman

Ernest Armah


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Table of Contents

Introduction ........................................................................................................................................................................................................................ 2

The Problem .......................................................................................................................................................................................................................... 2

Evolutionary account of MHP-Ghana ...................................................................................................................................................................... 5

Community Intervention Project ............................................................................................................................................................................... 7

About Narhman Community ................................................................................................................................................................................................ 7

Objectives.............................................................................................................................................................................................................................. 7

Methodology ......................................................................................................................................................................................................................... 7

Key Findings .......................................................................................................................................................................................................................... 8

Finances ............................................................................................................................................................................................................................... 11

Project Limitations: Lessons for the Future ........................................................................................................................................................ 12

Our Progress so Far ........................................................................................................................................................................................................ 13

The Future .......................................................................................................................................................................................................................... 14

Conclusion .......................................................................................................................................................................................................................... 15

The Team ............................................................................................................................................................................................................................ 16


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INTRODUCTION

ental health is invariably an important element of a person’s overall wellbeing that should receive equal attention in health care provision.

The World Health Organization defines health as “…a state of complete physical, mental and social well-being and not merely the absence

of disease or infirmity.1" In a mentally healthy state, every individual is able to realize his or her own potential, cope with the stressors of

life, work productively and fruitfully, and make a meaningful contribution to her or his community2. The saying that there is no health

without mental health indeed holds true.

THE PROBLEM Many Ghanaians are not aware of their mental health needs. The general understanding of mental illness has been confined to schizophrenia (popularly

known as ‘madness’). Even with schizophrenia, the illness is reported to a Psychiatric hospital only when the problem is well-advanced. Ignorance of

mental illness and the lack of effective coping systems have had serious implications for the country’s mental health systems and on victims.

1 Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the

representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

2 http://www.who.int/mediacentre/factsheets/fs220/en/ Accessed on 28 April 2015

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http://www.who.int/mediacentre/factsheets/fs220/en/


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After Ghana’s independence in 1957, part of a comprehensive plan for the health sector was the construction of five new mental hospitals backed by

Psychiatric units - to be ready by 1970- to accommodate over 1,000 people. At the time, Ghana’s population was below 8 million.3 Currently, there are

only three public psychiatric hospitals (Accra, Pantang and Ankaful) and four privately operated ones to a population of about 25 million people. All

Psychiatric hospitals are based in the South. Also, there are only about 18 Psychiatrists across the country with only one Psychiatrist serving the three

Northern regions (Northern, Upper West and Upper East regions). Meanwhile, an estimated 3.2 million of Ghana’s population is likely to experience

mental disorder at a point in time.4 But, the situation in the Psychiatric hospitals falls short of institutional capacity to handle such enormous numbers

across the country: medications and logistics are inadequate whilst Psychiatric nurses have embarked on numerous strikes due to poor conditions of

service, amongst others.

There is stigma hovering around mental health illness and this is explained by the high level of ignorance about the subject. This manifests in the harsh

treatment and neglect of the mentally ill. The recently passed Mental Health Act (Act 846), which replaced the Mental Health Decree of 1972, lacks teeth

to bite. According to the Director of the Mental Health Society of Ghana, Humphrey Kofie, “the rights of mental health patients are continually abused

or trampled upon because there is no LI (Legislative Instrument) to enforce the Mental Health Act (Act 846) and there are no resources for the governing

board (Mental Health Board) to operate.”5 Implementation of the provisions contained in the Act which include improvement in the access to in-patient

and out-patient mental health care in the communities in which people live, regulation of mental health practitioners and traditional leaders, fight

3 Dark Days in Ghana by Dr Kwame Nkrumah

4 Human Rights Watch (2014); NGO appeals to government to prioritize mental health service. Ghana News Agency, March 5, 2014;

5 The Africa Report. November 12, 2014.


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against stigmatization and discrimination

against the mentally ill and protection of

their rights cannot happen by sheer

enthusiasm alone; it requires financial

and human resources.6

Since the mental health system is

positioned in a curative paradigm, there

is no conscious effort on the part of the

Psychiatric hospitals to reach out to the

public. Besides, absence of adequate

funds would make it difficult for them to

be proactive in preventing an escalation

of mental illness.

This report is an account of our first

community intervention project on

depression at Narhman, Accra. A

6 http://www.thekintampoproject.org/news/2012/12/22/ghanas-new-mental-health-act-a-brief-guide.html

http://www.thekintampoproject.org/news/2012/12/22/ghanas-new-mental-health-act-a-brief-guide.html


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summary of our finances and the future as we see it are also featured. But preceding all of these is a brief account of how MHP-Ghana came to be.

Prevention in the rise of mental illness is the challenge the Mental Health Project Ghana (MHP-Ghana) is taking up. MHP-Ghana is on a mission to put

people in their optimal state of mind for a better life. It is geared towards preventive, proactive, decentralized, and community-led approaches to mental

health with the overall objectives of ensuring mental fitness, resilience and productivity, as well as changing the negative perception and stigmatization

of the mentally ill and mental illness in general. MHP -Ghana is a response to the human resource, financial and structural challenges confronting Ghana’s

mental health sector.

EVOLUTIONARY ACCOUNT OF MHP-GHANA

ental Health Project-Ghana is an epitome of the rare successes of social media. Before the group organized in 2014, some members were

friends in real life. Others were encountered virtually - initially commenting, questioning and/or ‘liking’ one another’s Facebook posts. This

group of young professionals are primarily involved in diverse occupations that are predominantly not mental-health-related.

Nevertheless, the common denominator that brought the team together was, and continues to be, the passion for mental health

education and awareness in Ghana. This collective passion has been shaped by members’ personal mental health experiences, academic

background, professional experiences and their fascination about the power of the human mind. We believe that mental health matters

for Ghana’s productivity and sustainable development.

On 8th December 2014, a Facebook page was created to facilitate an open discussion about the challenges, causes and treatment of mental health

within the local and global contexts. Few of the issues already discussed include superstition and lack of mental health education; the shocking revelation

of ‘concealed depression’; the link between talent and eccentricity; why mental illness is on the rise in academia; and mental problems associated with

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frequent power outages in Ghana. There have also been knowledge-sharing about the link between physical exercise and cognitive abilities, tit-bits on

how to learn faster, amongst others which have proved handy for self-awareness of members and their networks in practical every-day living. The page

also features posts and articles written by members regarding the mental health status quo, with pragmatic suggestions on structural, behavioral and

institutional changes that are needed to improve the mental health situation in Ghana.

These activities and more brought to fore an appreciation of the extent to which mental health awareness and preventative mental health care have

been reduced in importance in the Ghanaian setting. Having had a sense of the leading mental disorders in Accra (see infograph below), MHP–Ghana

decided to undertake its first community intervention project to help the ordinary Ghanaian to understand and deal with depression (the most occurring

mental health disorder in 2010).


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COMMUNITY INTERVENTION PROJECT ON DEPRESSION

ABOUT NARHMAN COMMUNITY arhman is located in the Ga East district of the Greater Accra region. It is cosmopolitan due to its multi-ethnic settlers. Crop farming and small

scale enterprises in the form of provision stores and table top eateries dominate economic activity. Infrastructure development at Narhman is

yet to take shape. The roads are untarred, mobile network connectivity is weak and public utilities (water and electricity) are inadequate. It is

thus a relatively poor community where minimum standard of living quality life is hardly met. We were convinced that helping people take

control over their minds, personal circumstances and daily experiences in such a community could have a spill-over effect on the community’s

overall positive development.

OBJECTIVES

Our objectives for the community intervention were three fold;

1. To identify peculiar factors on the ground which make people depressed,

2. To help people utilize their internal resources to make appropriate adjustments in the face of stressors

3. To identify severe cases which require referral to mental health specialists.

METHODOLOGY Our initial decision to conduct in-focus group discussion was replaced by one-on-one interactions and in one particular case, a group discussion. In our

interaction with members of the community, we observed demographic differences among participants (age, family status, and experiential

differences). Our team members were thus divided into cohorts to match with participants’ differences. Out of a total of 23 participants, 14 were females

and nine were males; three were in a relationship, six were single, 13 were married with kids and one was a widow.

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We developed a working definition for depression which was, “an extreme

sadness as a result of certain factors that makes a person less functional”.7

As simplistic as it may sound, this definition allowed us to translate the term

easily into the local dialect of participants (predominantly Ga and Twi).

Facilitators explained prior to the session, the impact of depression on

behavior and how they could affect our professional and social lives.

We used the Cognitive Behavioral Therapy (CBT) technique for the

intervention. The theoretical foundation of the CBT is that our thought

patterns directly influence our behavior. Three systematic processes are

involved: recognition of destructive thinking (negative thought patterns),

evaluation of the validity of thought patterns and replacement of

destructive thoughts with healthier, simple and better ways of thinking

(constructive thinking).

KEY FINDINGS

Most of the responses elicited from participants revolved around mild depression (mostly due to the ongoing power crisis), poor self-esteem, panic and

anxiety attacks. Some participants were hesitant at the beginning to come to terms with their situation and placed more emphasis on how external

7 This definition was coined by the team to make it easy for participants (mostly with little or no education to understand)


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factors (how people relate to them and treated them in the past) are contributing to their predicament. A case in point is Serwaa (not the real name)

whose heart was broken about three years ago.

After that terrible experience, Serwaa is finding it difficult to be in another relationship. During the session, she said she was unworthy of love severally

and stressed the maltreatment the former boyfriend meted out to her. However, after going through the various steps in CBT, she came to realize how

baseless her thoughts of unworthiness are and the destructive effects they were having on her life. She was introduced to the practice of positive

affirmations as well.

Moreover, some of the cases due to the severity of its nature were handed to our experienced Psychiatric Nurses. The session for these individuals were

conducted in an enclosed area with no access to cameras. The cases in this regard included suicidal tendencies, drug abuse and family issues.

Not all participants were entirely helpless in their circumstances. Some were already using a number of coping mechanisms to stay resilient in the face

of challenges. Mr Addo (not the real name) is a quintessence in this regard.

“I had a kid with my boyfriend…but his family did not approve of the

relationship…the situation made me very sad. Especially when I came to know that

he had three other ladies aside me. The relationship ended about 3 years ago… but

when I was with him, he spoke to me anyhow, even in public…calling me all manner

of names…negative things. Right now, I feel bad about myself…my experience with

him has affected my subsequent relationships. Right now, I am scared of men. I

don’t even think I am worthy of love. When someone says he loves me, I would find

it very difficult to believe…”

Serwaa, an apprentice in late twenties


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We had a session for children from the ages of 12 to assess how their social ecology affects their learning and psycho-social development. Their strengths

as well as weaknesses in various subjects were explored. Feedback was given to the headmaster of their school to enable their parents and teachers

make the necessary adjustments.

“I had this chronic sickness. Even after recovery, I feel these strange

sensations; my heart beats fast, chronic headaches and negative thoughts

(thoughts of death). This has been happening to me in the past three

months. I realized that when I talk to people, it helps. And I also have this

gospel song that I sing anytime I start having these thoughts.”

Mr Addo, a Mason in mid-thirties


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FINANCES

53%47%

REVENUE

Internally Generated Funds

Externally Generated Funds

20%

50%

5%

17%

8%

EXPENSES

Transport

Refreshment (food, drinksand water)

Logistics (Canopies)

Video & Photography

Miscellaneous

GHS 620

GHS 550

TOTAL: GHS 1,170

GHS 230

TOTAL: GHS 1,170

GHS 580

GHS 60

GHS 200

GHS 100


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PROJECT LIMITATIONS: LESSONS FOR THE FUTURE

ur major drawback was financing. At the time the community project was executed (i.e. 21st March 2015), we were barely three months old

and still finding our feet. The team was mostly about sharing ideas internally and raising awareness of mental health issues through social

media. The community project idea had already been discussed. But we did not envisage that it would happen too soon. The enthusiasm of

team members sparked through knowledge sharing and the signaling of strong commitment towards the cause led to planning and executing

the project under 1 month. This also meant that the time to raise funds was very limited.

Even with limited time to plan and raise funds, we aimed very high. Our initial budget was five times bigger than the budget we finally adopted. Because

funds were not forthcoming (as many potential donors found our project interesting but our financial proposal quite impromptu), a large portion of the

funds were generated internally. With our passion still high, we quickly adjusted our plan to suit the budget. The implication was to cut down on a number

of inputs, including number of volunteers and also our target audience.

Looking back, the community intervention project on depression at Narhman has been a success. Our ability to carry the project through despite our

financial challenge is an indication of the tenacity of a committed and passionate team. We are convinced that in the future, with ample time for

planning, we would have even greater outcomes.

We see the Narhman project as a tester for future projects. We have tested the waters to know what works and what does not work. Now we know that

having passion and commitment is great, but having adequate time and financial resources are equally important to making greater impacts. What this

means for us is to adopt a proactive and innovative fund-raising avenues that will also be sustainable.

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OUR PROGRESS SO FAR

uccess for us means more people taking responsibility for their mental wellbeing, understanding the risks and protective factors involved in

mental health, understanding the fact that mental illness is just like any other illness, and a significant reduction in the mystification and

stigmatization of victims of mental illness.

Our strategy to achieving these successes continues to be eclectic: we do not limit ourselves to any model or algorithmic mental health strategy.

We have worked with- and keep exploring for- what works, what has a sound scientific basis and what promises significant impact. We started

off by setting specific strategies to execute a mental health advocacy from the community level, manage a website and social media platform for

publicity, write and publish articles, and form partnership with experts and organizations in the field.

So far, aside the community intervention project executed at Narhman on 21st March 2015, MHP-Ghana launched a mental health awareness platform

on Facebook in January 2015 which is open to the general public. This page (Mental Health Project Ghana) is separate from the closed group page

(Mental Health Project) that was established in December 2014 for internal communications and ideas-sharing. MHP-Ghana page currently has 430

‘likes’, a significant improvement from 161 ‘likes’ in March, 2015. Our 6 facts infograph of the mental health situation in Ghana also received over 2000

‘views’ in less than three days after it was posted on the page. The infograph was also shared by about 8 similar community groups. Our post on the

leading mental disorders in Accra was also shared by 20 individuals between 31st March and 16th April. We also blog on the wordpress platform

(https://mentalhealthprojectgh.wordpress.com/) where some of our members have published their articles. The most recent are ‘Dealing with

depression’ and ‘The Ghanaian mind’.

S

https://mentalhealthprojectgh.wordpress.com/


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THE FUTURE


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CONCLUSION

e have learnt useful lessons from our first community intervention project. We did not give ample time for fundraising which affected

some aspects of the project. We could not also draw in on expected collaborations due to limited time. In subsequent projects, these

issues would be given adequate attention.

Notwithstanding our challenges, our objectives were achieved. We were able to equip people with techniques to make positive

adjustments in challenging times. We also identified serious cases which were referred to mental health specialists as well as factors

which makes people depressed (most of which were already captured in our literature review).

We are not giving room for complacency though. We are determined to leverage on our first step for the miles ahead.

More research needs to be done especially in the area of epidemiology (prevalence and distribution) of mental illness in Ghana. Government must also

take mental health needs of Ghanaians seriously be giving it equal attention in terms of funding and infrastructure development. The loss of about 7

percent of our Gross Domestic Product as a result of psychological distress could be curbed if we invest more in preventative mental health.8

We believe change happens from within; in the very guts and bones of our being. There is no way we can change if we do not appreciate the power of

our mind in the process. This is the message we are taking to everyone in our quest to make people mentally fit, resilient and productive.

8 Canavan, M., Sipsma, H., Adhvaryu, A., Ofori-Atta, A., Jack, H., Udry, C., Osei-Akoto, I., & Bradley, E. (2013). Psychological Distress in Ghana:

Associations with employment and lost productivity. International Journal of Mental Health Systems 2013, 7:9

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THE TEAM

Armah Ernest Adwoa Ewuenye

Armah Ernest is the Programs Manager at IMANI Center for Policy and

Education. He was part of the team that conducted feasibility studies of the

impact of the proposed 40 percent SHS expansion plan by the government of

Ghana. He was also involved in the drafting process of the National Employment

Policy (NEP). He was part of the 2013 class of Young Leaders Programme by the

Commonwealth Secretariat.

As an individual passionate about positive change and development, Ernest has

served on various platforms - as President of the University of Ghana Association

of Psychology Students (City Campus), interim convener of Ghana Youth

Parliament, and representative of the SRC. Ernest is the founder of Mental Health

Project Ghana. Contact: [email protected]

Kobby Blay

Kobby Blay is a Practicing Nurse with a specialty in mental health. He is a leading

online voice for healthcare in Ghana with focus on Digital Health, Mental Health,

Public Health and Health Communication.

His blog (ghanahealthnest.com) was voted as the best blog at the 2015 Ghana

Blogging and Social Media Awards. Contact: [email protected]

Adwoa Ewuenye recently graduated from the University of Bergen in Norway

with MPhil. in Health Promotion and Development. She was formerly a

consulting room assistant to the Psychiatrist at the Psychiatric unit of the

Tamale Teaching Hospital.

Ms Ewuenye hopes to work more with children with special needs and

hopefully help to improve the conditions for such children in the Northern

region of Ghana. Contact: [email protected]

Pauline Anaman

Pauline Anaman is the Assistant to the Director at TrustWorks Global Ltd; a UK-

based consultancy that provides research, capacity building and mediation

services to organizations in the natural resources sector, operating in

developing regions and medium/high risk markets. She currently leads

an outreach task in Peru, Mynamar and the DRC, and

provides research, business development and administrative support to the

Director and Senior Associates.

mailto:[email protected]




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Prior to joining TrustWorks Global, Ms Anaman worked within the Government,

Public Affairs and Policy Unit at Tullow Oil plc's Chiswick headquarters. There, she

contributed to an assessment of the company's impact on the Ghanaian

economy since its presence in the country.

Pauline recently completed the Master of Public Policy Programme at the

University of Oxford. Ms Anaman is passionate about a wide range of issues,

including governance and public sector management, natural resources

governance and cognitive science. Contact: [email protected]

Charlene Bello

Charlene bello holds a Masters Degree from SOAS, University of London. She

began her active citizenship life as a member of the NSPCC UK’s inaugural Youth

Adviosry Board which advise on charity and government policy. She then became

an ambassador for the Charity advising on black and minority ethnic issues and

speaking on its behalf. She was named the second most outstanding Black

Graduate in the UK.

She has been living in Ghana since 2013 and has worked for IMANI Center for

Policy and Education and Ringier Ghana Limited in that time. She writes at

Journey. Learn. Speak. And SomethingBeginningwithGh and enjoys amateur

photography and football. Contact: [email protected]

David Selorm Atsu

David Selorm Atsu is a budding social entrepreneur who has special interest in

youth advocacy and gender issues. He is someone who is fundamentally

committed to good practice and innovation and who is very much a team player

and loves to engage in volunteer activities.

Always engaged in continuous learning in order to broaden his knowledge and

experience, he is confident, passionate and enthusiastic about working with

people from different backgrounds. He works as a volunteer on several projects

and currently he is a Project Coordinator/Peer Educator for Marie Stopes

International on the “NO YAWA PROJECT’’.

David is a final year Bachelor of Science, Marketing student at the University

of Professional Studies, Accra (UPSA) where he also serves as the Students

Representative Council’s (SRC) Vice President. David is also technology savvy,

loves to read and an avid social media fun. Contact:

[email protected]

Lolan Ekow Sagoe Moses

Lolan is currently a Law Student at Leeds University. He was formerly the

President of the UVA Organization of African students and University Service

Chairman of the collegiate 100 Society of Virginia.

In his quest to understand Africa and his role in its development, Lolan has

pursued various leadership and professional opportunities including work to

establish an African Studies major at University of Virgirnia and identifying





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leaders in the African Diaspora for the African Leadership Network. Lolan is a

proud member of the Harambe Entrepreneurs Alliance.

Contact: [email protected]

Solomon Yamoah

Solomon Yamoah holds MSc in Educational Studies from the University of

Glasgow. He also worked as an intern at the Scottish Parliament.

He is passionate about poverty alleviation, human rights, politics, social services,

education, civil rights and children.

He runs Wisdom Ways Academy; a social enterprise that seeks to provide high

quality education to the children of Narhman. Contact: [email protected]



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