How informed is the average Ghanaian on the issue of mental health? Is he aware of early warning signs of mental health problems? How often are kids taught to express their feelings?

These questions and more need to be asked when creating awareness about mental health, especially during periods of stress, loss, and worse, uncertainty and fear at a time when the world is battling with the COVID-19 pandemic.

According to the World Health Organization, "Mental health is a state of well-being in which an individual realizes his or her abilities, can cope with the normal stresses of life, can work productively, and can make a contribution to his or her community."

This definition encompasses ones physical, emotional, psychological and social well-being. It addresses how a person thinks, feels, acts and reacts. It stresses the need to know and embrace oneself and the limits one can go while going about one's business and in contributing to society.

This definition is, however, limiting, with the assumption being made that mental health is always positive, without taking account of usual human feelings of anger, disappointment, sadness or guilt.

It places that young teenager who is shy to take part in group activities or any other persons with a condition preventing them from working productively, on a spectrum of mental disorder.

For instance, the age-old rivalry between Ashantis and Ewes may make an Ashanti worker easily victimized in a Ewe-dominated company; and this may affect the Ashanti worker's productivity.

Following the definition by the WHO, such individual's low level of productivity may be as a result of a mental health problem.

It is thus important to understand that mental health is beyond the absence of "mental disorders". In fact, "well-being" may be inadequate to be considered as a key factor in determining mental health, due to the many challenging situations human beings face, like the death of a loved one, or the loss of a cherished job during a recession or a divorce, and most recently, dealing with a pandemic like the COVID-19.

Seeing the diverse nature of human beings and their behaviour, especially as the latter is greatly affected by one's community, mental health should be understood in terms of one's culture, values and social background. It is also important that consideration is given to different life stages which inadvertently affect how people react to life situations. Mental health must thus include not only avoiding certain kinds of emotions or feelings, but searching for a continuous stable state of wellness, happiness, and fulfilment.

According to the World Health Organisation, it is estimated that of the 21.6 million people living in Ghana, 650,000 are suffering from a severe mental disorder and a further 2,166, 000 are suffering from a moderate to mild mental disorder. Mental health illnesses range from a generalized anxiety disorder, depression, schizophrenia, social anxiety disorder, paranoid personality disorder, obsessive-compulsive disorder, post-traumatic stress disorder, paranoia amongst others. Unfortunately, in the Ghanaian society, mental health is a rarely discussed topic. It makes people uncomfortable and a large number of people are oblivious of what mental health entails and how to even care for the mentally ill.

While mental illness may not always be apparent, especially in its early stages, it does not invalidate it. People who suffer from mental illness may find it difficult to express themselves, relate to others and function properly. A person who feels depressed may be unwilling to express their feelings, because at some point when they did, their feelings were disregarded, or they may have been laughed at. In our setting, the men are told to "man up!" while a lady may be seen as wanting too much attention.

Despite people's advancement in terms of social exposure and the constant shift towards western culture and style, people are still unable to express any feelings which may relate to their state of mental health for fear of being stigmatized and tagged as "crazy", and in extreme conditions, chained in a camp and exorcised. The system does not allow for people to freely walk into a facility and discuss their mental state. There aren't even conducive facilities to do so. People, therefore, choose to remain silent and suffer. These silenced voices often lead to suicide. According to Ghanaweb, from the beginning of 2020 up till now, there has been a record of seven suicide cases. Among them are a 10-year-old child, a 22-year-old farmer, and a 44-year-old teacher who reportedly committed suicide by hanging. In 2017, a level 400 university student jumped to her death.

Conversations about mental health need to be had. It is crucial to our existence. Health/mental health facilities and departments in universities must champion this. Symposia must be organized to educate the populace about mental health and mental illness.

Rather than looking to gather accurate statistics about suicide cases, state agencies must look at creating avenues where citizens can freely speak out, and in cases where a person is confirmed to be mentally ill, the facility where they are kept must be able to aid recovery. Unfortunately, psychiatric hospitals only service a small proportion of Ghana's population and the state of government-owned hospitals leave more to be desired.

As a nation, we must progress from flogging, injecting or chaining mentally ill individuals in bushes or "churches" as section 57 subsection (3) of the Mental Health Act 2012 states clearly that "A person with mental disorder shall not be subjected to torture, cruelty, forced labour and any other inhuman treatment." In addition to this, the only basis for involuntary seclusion of such an individual is if they pose an imminent danger to themselves or others. Owing to the importance of this social issue, Act 846 Section 54-62 of the Ghana Mental Health Act 2012 outlines succinctly the rights of persons with mental disorders.

It includes non-discrimination, enjoyment of basic human rights including access to the highest attainable standard of mental health care, access to information and employment rights.

To understand mental illness is to be properly equipped with the arsenals to handle it. A recent study explains that the exact causes of most mental illnesses are not known, however, it is caused by a combination of biological, psychological, and environmental factors. Over time, people who have not been listened to get stuck/lost in their thoughts, which leads to overthinking. Overthinking leads to psychological stress and that is usually the starting point of mental illness.

When approached by one who is going through depression, anxiety, or any mental illness, it is not about having the right things to say, as there is never a right thing to say. It more about listening to them, validating their feelings, and then assisting them to seek the right help. It is important that as a society, we humanize mental illness, to successfully handle it.

Mental Health amidst COVID-19

The COVID-19 pandemic can stir up all sorts of feelings like fear, stress, or anxiety, especially being aware of the rate at which the virus spreads, and worse, the ever-increasing numbers of deaths in several parts of the world. In event of a likely loss of a loved one to the disease, there may be feelings of guilt, with the family of the deceased unable to forgive themselves, especially when it is a child who has passed. All these, coupled with the restrictions placed by the government on movement and other social engagements, as a measure to flatten the pandemic curve, worsens it all.

Indeed, a little stress can be helpful as it can be a motivator for people to self-isolate, observe proper hygiene, especially in terms of washing hands frequently and sanitizing one's spaces regularly. These may affect people's mental state, especially from overthinking one's safety. It is thus important that individuals make conscious efforts to look after their mental health. People must embrace the new realities of having to work from home or even losing a job, home-schooling children, and having little contact with extended family members.

While the overflow of emotions, especially of sadness and stress is inevitable, how these are handled would go a long way to determine how people will fare once the pandemic ends, because it will end. People must take note that constantly high levels of stress can be very detrimental to one's mental and physical health. Being constantly exposed to upsetting information about the pandemic is likely to trigger stress in one's body. Hence, as much as people want to stay informed about the situation in one's country or vicinity, it must be done cautiously. People must choose to follow the actions being put in place by the government to ensure a reduction in the spread, rather than focusing on death tolls.

Conclusion

Taking care of our mental health and talking about mental illnesses in our society should be a continuous conversation. Schools must have trained counsellors that can educate students on issues concerning mental wellness and mental illnesses; parents must encourage their children to be transparent with their feelings; religious leaders should consider devoting time to engage adherents on issues concerning emotional and mental wellbeing, and the government should equip hospitals with well-trained medical staff that truly understand the proper management of mental health.

In the face of this pandemic, people must learn to self-care and LIVE. People must learn to take control over what they can, like caring for themselves, their personal spaces, and using their nose masks if they have to be in public spaces.

People should also utilize technology to keep in touch with their loved ones and even lean on personal faith for support. Where people seem to be getting overwhelmed with emotions they can't seem to control, they must speak to a professional.

This means the government must make available easily accessible mental health facilities/staff who must step in to help people take control of their mental state. Generally, there must be an ongoing conversation about mental health throughout the pandemic.

Indeed, if we would place greater emphasis on mental health education as a preventive measure against mental illness, the closer we are to protecting our mental health. There is no health without mental health.