10 Years of Mental Health Act, 2012 (Act 846): Impact, challenges, way forward
March 2, 2022, marks a decade of the enactment of Ghana’s Mental Health Act, 2012 (Act 846), a legislation considered as among the best anywhere in the world.
The first legislation in Ghana to make mention of persons with mental illness was the Prisons Ordinance of 1876 in the then Gold Coast. It considered such persons as criminals to be incarcerated in prisons.
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Then the Lunatic Asylum Ordinance was passed in 1888 to legitimise the Victoriabourg Castle Asylum established in 1887 and to recognise such persons as requiring special custodial care. This enabled the building of the Gold Coast Central Asylum inaugurated in 1906, which eventually came to be known as the Accra Psychiatric Hospital.
The Lunatic Asylum Ordinance was slightly amended in 1940. In 1965, the Easmon Commission recommended a review of the 1888 Lunatic Asylum Ordinance. The review started in 1969 and was passed as the NRCD 30 of 1972.
This decree regarded persons with mental health conditions as being medically ill and not criminals but it laid no emphasis on their human rights. Efforts at amendment in 1994 and 1996 did not go through.
Enactment process
Mental health workers, recognising the poor state of mental health care with attendant human rights abuses, have for long, felt the need for a review of the 1972 law NRCD 30. In 2001 WHO recommended that all countries should enact mental health laws and those which had should review them if they were older than 10 to 20 years.
Ours was 29 years old. The Cabinet was approached in 2003 and approval was given. A committee was formed in 2004. WHO trained local experts and also provided consultants from various countries, including Zimbabwe, Canada, the United Kingdom (UK), and Switzerland to support the drafting of a bill. The draft was completed in 2006.
The enactment got stalled for various reasons. Many people did not see the need for a law in mental health when there was no law in child health or general health care. Others felt we would be creating a parallel structure to the Ghana Health Service (GHS), and many more reasons.
These protests got to the parliamentarians who, for a solution, went to other countries to learn of their system. After their tour they agreed the proposed mental health law was in order.
Meanwhile, mental health workers and advocates, both within and outside the country, stepped up their advocacy and lobby. Articles were written and published in the papers, others organised signatures of 6,000 people all over the world advocating the passage. Anas Aremeyaw Anas’ documentary on the rot at the psychiatric hospitals got then President Atta Mills to visit to see things for himself.
He saw and was touched. On March 2, 2012, Parliament passed the bill into an Act and on May 31, same year, the then President signed it into a law, the Mental Health Act, 2012 (Act 846), as a major milestone in mental health care. In June, the law was gazetted and six months later, it came into force.
Impact
The enactment of the Act gave birth to the Mental Health Authority as an agency under the Ministry of Health to be responsible for mental health care in the country, to decentralise and spread mental health services all over the country.
Now, every health facility can provide some level of mental health care, every district hospital has a psychiatric unit, every regional hospital has provision for admission of persons with mental illness requiring admission, more mental health workers have been trained, from 12 psychiatrists in 2012 to 51 in 2022 with about 20 doctors in training who will all come out in three years to add to the numbers.
Modern medicines are now used and are more readily available than in the past. Mental health care has improved in quality and treatment gap has correspondingly reduced. There are regional mental health coordinators helping with ensuring mental health care in the regions.
Mental health awareness has increased, human rights of patients are being observed, quality rights are now part of mental health care and there is an increasing confidence in orthodox mental health care. There is now less stigma and discrimination. Chaining and flogging of patients at prayer camps have reduced. We have more NGOs and advocates in mental health.
What is left to be achieved?
The success of the law, from the beginning, was tied to three things – the establishment of the Mental Health Board, the passage of the legislative instrument and the establishment of the mental health levy.
The first board was formed one and half years after the law was passed, the second board lived for only one year and was dissolved alongside other boards in January 2021 and since then we do not have a board.
The mental health levy, which was supposed to provide funding to the mental health fund, is yet to be established, leaving a huge gap in funding. To date, we do not have the review tribunal and visiting committees to help with human rights enforcement and this is a major problem.
Persons with severe mental illness are still roaming the streets. In spite of the law saying mental health care should be free, patients still pay at the psychiatric hospitals. The establishment of the levy will ensure enough funding to finance the care and the charges at the hospital will cease.
Lessons learnt and way forward
We have learnt that we need to implement the law in full and that includes establishing the levy. The levy will provide funding for all services.
We all need to own mental health care. We have a collective responsibility in this enterprise. We need to persist in our new paradigm of community mental health care rather than institutional care.
We are grateful for the government’s plan to build two new psychiatric hospitals in the middle and northern belts of the country, redevelop Accra Psychiatric Hospital and Pantang Hospital.
The future is bright for mental health but the levy must be established; and in the short term, the mental health board must be formed.
The writers are Chief Executive, Mental Health Authority & Head of Communication, Mental Health Authority.
