Letter to the chief psychiatrist;

A matter of tactics

Dear Dr. Akwasi Osei,
I apologize for my recent silence brought on mainly by ill health and other pressing
matters. I am in much better shape now though. It would appear from my last sighting
that you are fast acquiring more than your fair flock of grey hair. You might be
aware of the linkages drawn between the pressures of political office and grey hair
with President Obama as its latest victim. It would appear therefore that the
pressures of presiding over the affairs of mental health in Ghana are entirely
blamable for the color of your hair.

Your hair is however unlikely to assume a darker hue, at least not in the near
future. If one in four people will suffer mental ill health, then your handful of
ten actively practicing psychiatrists are already assured of five million patients.
Never mind your current acute over 50% shortage in psychiatric nurses. Frankly, I
cannot see how your grey hair will ever reverse. Unless of course Sir, you do pick a
cue from a certain Honorable Minister who if KSM is to be believed, has a buffer
stock of quality hair dyes which keep him perpetually young. The drawback though is
that you may not have the financial wherewithal to compete with the politician.
Combining current challenges with lack of financial muscle therefore, it can be
safely predicted that not only will your grey blossom, it will spread to engulf your
moustache, beard, eyebrows and last but by no means the least, the very hair in your
nostrils!

Last week, the Daily Graphic reported that the Mental Health Bill has finally been
sent to Cabinet by health minister Dr Kumbuor. Additional sources have it that
President Mills is equally eager to push it to Parliament. The bill’s passage into
law is an important step in our broader agenda of mental health reform in Ghana. It
is also significant given that the bill has floundered through the corridors of the
Ministry of Health for over four years. It is in order to commend the government for
demonstrating in a practical way its commitment to passing the mental health bill as
pledged in the NDC manifesto.

Sir, I feel burdened however to tell you how strongly I feel that we as the
Coalition of Mental Health advocates ought to be more adaptive in our operational
tactics to address emerging trends in the sociopolitical arena. I have a certain
fear that we might succeed in getting the bill passed, the government will score
major political points for succeeding where others have failed and yet the practice
of mental health as we currently know it may not significantly be altered. As
important as the passage of the bill is, it is important that we sustain the
pressure till the face of mental health care practice in Ghana actually changes for
the better. As you would recall, others have raised concerns about sustainable
funding, human resource shortages, an overarching advocacy plan etc. I am hoping
that together, we can achieve some consensus and clarity on these matters.

It is also crucial at this point to remind ourselves of the full extent of the
promise as contained in the NDC manifesto to enable us name and claim it. This was
important high level commitment and in more ways than one, represents our best bet
in a long while to make some real progress. If we make a mess of it, posterity will
never forgive us. The government pledged to “Step up the fight against the drug
trade, to combat mental illness of addicts and to prevent harm from violent crime”
plus a commitment to “rapidly pass the Mental Health Bill, sponsor training for
doctors and nurses in psychiatry and train mental health care providers to address
growing problems in drug addiction.”

Talking about the government Sir, it is my personal observation that this current
NDC government is too tactically aware. Anyone who deals with this government and
does not display similar tactical awareness or takes them for granted may be in for
a rude shock. I will cite two examples to buttress my point. In the past, we have
literally run riot on radio blaming the Minister of Health in the past
administration for his lackadaisical approach to mental health. Typically, it was
not found necessary by the government to respond to our concerns. Not so the NDC
official; which is why not too long ago, after you had raised certain cogent issues,
Dr Kumbuor provided an instant robust reply pledging government’s commitment to
mental healthcare. It was what he said afterwards that alerted me to the fact that
Kumbuor, representing government is a tactically ‘dangerous opponent.’

He said that a meeting with you had agreed that you would submit a concept paper and
up till that time, still had not heard from you. In effect therefore, the government
publicly threw the ball right back into our court, laying any perceived delays
squarely at our feet.

The second example that demonstrates the superior tactical ability of the government
in comparison to the coalition’s efforts pertains to the circumstances surrounding
the recent visit of the President to the Accra Psychiatric Hospital. The cryptic
chameleon Anas had just released his explosive “Mad House” story leaving in its wake
a heartbreaking tale of unprofessionalism and sheer thievery. In my view, the
coalition of mental health advocates did not sufficiently capitalize on the
opportunity the investigative expose presented. With better planning, we ought to
have turned the screws on government, built and sustained serious momentum for some
tangible gains. Rather, the government seized the initiative and conducted itself in
such a manner as to put the management of the Accra Psychiatric Hospital publicly on
the defensive. This was ironic given that no secret had ever been made of the sorry
state of affairs at our psychiatric hospitals. In fact a few weeks prior to the
report, the Coalition had organized a press interaction at which open invitations to
visit the wards were extended as you are well aware.

It was rather Kumbuor who speedily set up a committee to investigate what was
already known. This measure pleased the public no less and dulled Anas’ story as it
gave the impression that something was being done. As it turned out, the world of
psychiatry was left carrying the can. There was no need for us to be put on the
defensive. On or around the same time, psychiatry in Ghana started experiencing
serious shortages in drugs.

Then came the rather well timed visit of the President. I can tell you that the
President scored major political points with that single first surprise visit. First
of all, you yourself praised him for being the first President in ages to physically
show his concern for the plight of our patients. Secondly, a President who had
hitherto been seen as inactive and holed up in the Castle was suddenly being praised
on major media networks for his “hands on style of leadership.” Thirdly, and this is
the most significant; many relatives and patients expressed true appreciation to the
President for his tangible effect on the availability of normally expensive but
subsidized drugs. It could have been by fate or design but to the patients who were
experiencing shortages, who couldn’t afford expensive psychiatric drugs on the open
market and following the visit now had the same drugs in the Psychiatric hospitals
at unbelievably subsidized rates, they couldn’t care less whose hands had forced the
President’s visit.

Once again Sir, I may be wrong but I am still asking myself whether we are milking
enough the opportunity that the visit presented? My point is this, that on the
matter of the passage of the bill, we share the same strategic objective as the
government but I am equally certain that there are clear tactical differences and we
must optimize our opportunities by fully deploying the talents, abilities and sheer
might of the individuals and organizations that make up the Coalition. My fear, Sir
is that if we do not succeed within this tenure of President Mills to make real
progress in mental health, this government will again out fox us and do everything
possible to distance itself from that failing. I do not entertain a shred of doubt
from the examples cited above that the blame will be laid squarely at the feet of
squabbling health professionals who woefully failed to secure consensus on the way
forward for mental health reform in Ghana and not because of lack of political
commitment.

Hopefully, with the bill now going to Cabinet and with questions on a robust
advocacy plan, human resources and sustainable financing being pondered, the
prospects of mental health will be far brighter than the state of your hair.

Thanks for your attention, Sir.

Yours,
Efo