Closing the mental health treatment gap to reduce human rights violations

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Poor mental health is both a cause and effect of poverty, gender inequality, violence and ill-health. Mental health problems impede the ability of affected people to work productively, to realise their potential and to contribute to their communities (The UN Division for Social Policy and Development Disability). Mental health is both a public health and human rights issue- rights are often violated, and the availability of treatment is limited.

In commemoration of World Mental Health Day, we reflect on two Australia Awards alumni, Ghanaian Frederick Nsatimba and Liberian Angie Tarr Nyakoon, at the forefront of promoting equal human rights, for people with mental health disabilities, in their respective countries.

Ghana’s Mental Health Act, Act No 846 of 2012, emphasises the need for community care, which is a departure from institutional care. However, these structures do not exist, and inadequate funding to support community care make access to mental healthcare in Ghana expensive. Most people go to hospitals as there is a lack of psychotropic medication and specialists in their communities. The benefits of providing local psychotropic medication and care include maintaining the mental stability of recovered patients and preventing relapse.

Frederick Nsatimba, the principal health tutor at the Pantang Nurses Training College in Accra, completed an Advanced Master of Public Health at Southern Cross University in Australia. The skills he acquired, through Australia Awards, allow him to identify developmental gaps in Ghana and to develop strategies to close these gaps.

In 2015, he developed a nursing mental health curriculum for the Nursing and Midwifery Council of Ghana. ‘It is a significant document that equips students with the right tools to provide appropriate health education and care, he says. Nursing training schools, throughout Ghana, have implemented the curriculum.

He has also successfully developed a handbook for the College entitled Nurses’ Training College Pantang Handbook for Registered Mental Health and Psychiatric Nursing. The nursing students who pass through his classroom now understand psychiatric nursing and can pass on the information and empower their communities on mental health issues and treatment options.

Frederick’s teaching and curriculum development activities play a significant role in the development of Ghana’s mental health sector.

‘I believe that mental health is a human rights issue that deserves attention,’ Frederick asserts.

One in five Liberians suffers a mild to moderate mental disorder (WHO). Despite the prevalence of mental disorders, Liberia only has one registered psychiatrist. Also, health workers’ limited understanding of mental illness and the limited opportunities for the specialised training of health workers to meet the public demand for mental healthcare compound challenges.

Liberian alumna Angie Tarr Nyakoon, who completed a Master of Mental Health at the University of Queensland, is the Director of the Mental Health Unit at the Ministry of Health. She coordinated the development of Liberia’s Mental Health Policy and Strategic Plan: 2016-2021.

This Mental Health Policy mandates the integration of mental healthcare into the primary health care system to minimise the cost of service provision and optimise the efficiency of human resources. The policy also recognises the recognition of people with mental illnesses’ human rights and advocates for their treatment to be more accessible.

The policy development work formed part of Angie’s Reintegration Action Plan, on completion of her Australian qualification. She engaged the WHO office in Liberia to provide financial and technical support for this initiative and lobbied the involvement of the Carter Centre and the Mental Health Leadership Advocacy Program (mhLAP).

With the assistance of international and local partners, Angie adopted the Mental Health Gap Action Program (mhGAP) Intervention Guide to the Liberian context, in 2015. This WHO tool is used in low- to middle-income countries to train primary healthcare (PHC), workers. In addition to adapting the tool, Angie also coordinated the mhGAP trainers-of-trainers program, where participants learnt to present the program’s curriculum to PHC professionals.

‘This training is ongoing. We have trained over 500 PHC workers in 13 of the 15 counties that are involved in the program. It has improved human resource capacity during mental health services delivery, which helps to bridge the treatment gap,’ she explains.

Angie has become a leading advocate for mental health law in Liberia. She successfully lobbied for the draft Act to be passed into law, in June 2017.

Both Frederick and Angie are making great strides in addressing mental health treatment issues in Ghana and Liberia through the skills that they acquired in Australia. They have both empowered PHC workers with the relevant skills to provide accessible and specialised mental healthcare. Their work highlights the importance of access to humane treatment for all people, irrespective of their state of mind.

This article was first published in Australia Awards–Africa Alumni News, which highlights the development contributions made by alumni as a result of Australia Awards.

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