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Mental Health Legacies in Ghana with Dr. Magnus Mfoafo-M’Carthy

Updated: Mar 18

Note: Guests of The Psychedelic Blog do not endorse, support, or otherwise advocate on behalf of any particular treatment approach for mental illnesses unless stated otherwise. The views expressed during this interview do not necessarily reflect the opinions or endorsement of The Psychedelic Blog. Readers should always consult with qualified healthcare professionals and conduct their own research before considering any treatment options. The blog and its authors are not responsible for any decisions made based on the information provided by the guests.


Guest
Dr. Magnus Mfoafo-M’Carthy

I have more than 15 years of social work practice experience in New York, British Columbia and Ontario. I have worked with individuals diagnosed with serious mental illness and HIV/AIDS, adolescent sex offenders, youth in conflict with the law and community based mental health. I have taught the following courses at Wilfrid Laurier University in Ontario, Canada: Research Methods; Diversity, Marginalization and Oppression (DMO);

Community Interventions; and Health and Mental Health.


I received my PhD in Social Work from the University of Toronto in 2010 and my Masters´ Degree in Social Work from Columbia University in New York City, New York in 1998.

I joined Wilfrid Laurier University in 2011 as an assistant Professor and received tenure in 2016, and now I am an Associate Professor. My research focuses on community-based mental health practice, global mental health, disability, inclusive education, international social work, and Afrocentric social work practice. My funded projects examine serious mental illness and stigma among immigrant communities. I am also interested in post-colonial and critical race theories, social justice and anti-oppressive practice. I have held numerous Canadian research grants exploring stigma, mental health, and disability. I travel regularly to Ghana and other African countries where I research mental health and disability.


Prior to joining Laurier, I was a postdoctoral fellow at the Center for Addiction and Mental Health’s Social Aetiology of Mental Illness (SAMI) program at the University of

Toronto (2010-2011).

 
Girl jumping
Image by Crea8t from Pixabay

"And still, I rise.”

- Maya Angelou


“Turning 20 years, a young girl has the greatest expectations of life. Dreams and aspirations—the beginning of a bright future awaiting her. It was when I turned 20 when things began to change for me. Nothing was as I expected it to be.”


P. was diagnosed with epilepsy a few years ago. She describes the condition as a disease that makes carriers lonely in society. “People were caused to think that I was cursed and even obsessed. I’ve been treated as an outcast since then.”


Not only the physical symptoms made her suffer. “‘See how she is behaving like a mad person,’ people yelled at me. They also don’t regard me as a valuable person anymore. I hear them laughing at me. And even my own family members are looking down on me.”


Sometimes people also forced her to eat while she was unconscious, which can be life-threatening. P. is not asking for much: “All I want is to be just like them. I am still hoping for changes to come my way.”


- P. from Ghana, DeconstructingStigma.org


Robert: Changes are definitely coming. The question is: how long will it take? I'm Robert Benz and I want to discover more about mental health care in the “Global South” in a country like Ghana. That’s why I'm speaking today with Magnus Mfoafo-M’Carthy. Magnus understands global mental health from the perspective of both the “Global North” and the “Global South”.


The terms “Global North” and “Global South” do not refer to specific geographical regions; instead, they are broad categorizations based on the political, socio-economic, and developmental conditions of a region. The “Global North” is generally a reference to Northern Hemisphere countries in North America, Europe, and parts of Asia considered to have higher levels of health care, economic prosperity, and education. The “Global South” usually refers to countries that are considered less economically developed in the Southern Hemisphere such as Latin America, Africa, and parts of Asia.


It should be noted that these terms are in no way fixed and are simply useful tools in comparing and contrasting systems, services, economies, and conditions in different parts of the world. “Global North” and “Global South” can help us analyze and discuss global disparities and developmental trends. While it’s easy to focus on the contrasting aspects of these two terms, progress lies in recognizing shared commonalities, embracing interconnectedness, and creating collaboration. Let’s meet our guest.


Robert: Magnus, can you talk a little about where you grew up and your early schooling?


Magnus: I'm originally from Ghana in West Africa. That is where I was born and raised. I lived in Ghana until I finished my undergrad then I moved to the United States for graduate studies.


Ghana was colonized by the British, so our education is based on the British system. English was used as the medium for teaching and very little formal education was done in local languages. The education system is westernized. We didn’t learn much about the traditional ways and knowledge in school. In high school, we had the option of learning one local language.


To understand the culture, one had to make a conscious effort to interact with the elders. Thus, going to the village on weekends to visit with grandparents. That was the only way many of us were able to learn about the culture. We also didn’t have a lot of books about Ghanaian culture. Most of the information we gathered were through oral tradition through our grandparents sharing stories.


School children
Girls enjoying class at Gbimsi Junior High in Ghana (GPE Stephan Bachenheimer) WorldBank.org

“Stigma against mental illness is a barrier that can only be broken by understanding, compassion, and knowledge."

- Kofi Annan, Former Secretary-General of the United Nations, from Ghana


Robert: What year did you go to North America for the first time?


Magnus: I left Ghana in 1992. That's when I moved to New York City. I did my Masters at Columbia University in Social Work and I eventually relocated to Canada. My teaching has been in Canada.


Robert: You have taught and researched global mental health in Ghana, Canada and in the United States. How has that influenced your understanding about differences in perceptions and approaches to mental health between the Global North and the Global South.


Magnus: Let me start with the Global North. What I realized with the Global North is the focus on the medical model. The medical model defines sickness as a chemical or physiological imbalance which can be corrected by restoring balance through medical intervention, drug therapy, or surgery. What we mean by that is, for instance, when you are diagnosed with a mental illness, you are required to see a psychiatrist who prescribes medication. You’re expected to see the psychiatrist for medication refills or when your condition deteriorates. The medical model is based on empirical research.


In 2000, Ontario, Canada introduced another form of treatment for individuals with mental illness referred to as the Community Treatment Order. It required individuals diagnosed with serious mental illness, who had long hospitalizations, to agree they would take their medication upon discharge from the hospital. That was based on the understanding that, anytime they reneged on that agreement, they would be brought back to the hospital.


 

The intensive case management services provided are based on a trauma-informed and recovery-based approach. The focus is on empowering individuals to work towards their recovery goals and achieve greater independence and wellbeing.


 

This is where the recovery model comes in. It’s an example of provisions made for individuals diagnosed with mental illness in this part of the world. We talk about individuals who may decide not to take medication for their illness. The individual takes responsibility for their mental wellbeing. They create a support group, strategize about the food they eat, herbs, and all they need to improve their condition.


Regarding the Global South, using Ghana as an example, the greatest challenge is the lack of professionals. There aren’t an adequate number of nurses, clinicians, psychiatrists or even physicians interested in serving this population. So, most individuals needing treatment depend on traditional treatment methods. This could include going to see a fetish priest. What I mean by that is someone who practices traditional medicine and ways of healing. Others may visit faith healers for healing. For some it works and for others it doesn’t. That is a challenge we have in these parts of the world. Resources are a scarce. They also don’t have well-equipped hospitals to accommodate those diagnosed with mental illness. So, they are dependent on family members, churches, or mosques.


 

Mental health activities started with the enactment of the Lunatic Asylum Ordinance in 1888 by the colonial government of the Gold Coast (as Ghana was then known). The ordinance allowed law-enforcement agencies to arrest people suspected of having a mental illness (at least those who were roaming about in towns, villages or the bush) to be confined in an abandoned prison in Accra. That facility soon became overcrowded, necessitating the provision of the Lunatic Asylum in 1906. The Asylum eventually became Accra Psychiatric Hospital. Two other purpose-built psychiatric hospitals, the Ankaful Psychiatric Hospital and Pantang Hospital, were opened in 1965 and 1975, respectively. The first President of Ghana had a vision of making Pantang a pan-African mental health village for research into neuropsychiatric conditions but his vision was not realised before his overthrow in 1966.


The country has 39 psychiatrists (0.13 per 100,000) and 244 psychologists (0.78 per 100,000). There are a larger number of Mental Health social workers (1.17 per 100,000). Despite low rates of psychiatrists and psychologists, there are significantly more mental health

nurses (8.10 per 100,000) and mental health social workers (1.17 per 100,000) who

comprise the mental health workforce. In total, there are 9.5 mental health

workers per 100,000 people in Ghana.

 

Robert: What model can work in Ghana?


Magnus: I believe what must happen is for everyone to come on board and inquire about what really works for the individuals diagnosed with a mental illness. Because what works for Individual A may not work as well for Individual B. When you look at the recovery model, a person has autonomy; you have the right to make your own decisions regarding your own wellbeing. The argument, however, among a lot of clinicians, about this method, is that when someone becomes psychotic, they may not have enough insight into their own condition, they may be incapable of making decisions about their wellbeing or illness, and claim they don’t have an illness at all. Hence, they will not follow through with treatment which is likely to worsen their condition.


I believe the way forward—and this has been adapted in Ghana, but we have yet to see the benefits—is to merge the medical and the recovery models. If we merge these, individuals would have autonomy over their mental wellbeing: you can take medication, you can decide to use herbs, you can make decisions on the food you eat and you will have support. And, you will have someone to monitor your treatment. It could either be a clinician or a social worker to guide you with these decisions and support you through the process. I think this could work.


In Ghana, what has been realized over the years is that they cannot depend on the government to solve issues relating to mental illness. What might help is for the government to work on merging traditional and faith healers with Western therapeutic modalities to provide the best treatment.


Robert: Is the Global South working together on new treatment models?


Magnus: Well, in a way because when you go to a place like Zimbabwe, they have a treatment model called, “The Friendship Bench”, which has really been effective. People have traveled from New York and other places to learn of this approach. The Friendship Bench is a form of group therapy, where grandmothers from the community gather with individuals suffering from depression and engage them. It’s about creating a community for these individuals who suffer from mental illness. According to reports, it’s really been quite effective.


So, there are innovative models but the stigma associated with mental illness remains a challenge. You know, for a lot of people, mental illness is seen as punishment from the God. Or they see it as a curse that has been invoked upon them. As a result, they tend to distance themselves from family members diagnosed with a mental illness. Some have the tendency of keeping those family members away for fear of being perceived as a curse or bad luck. But I believe that, with enough education in the Global South, where people begin to understand that mental illness is part of their human condition and a part of life we face from time to time, the approach may be very healthy and helpful.


Women
Lay health worker on the Friendship Bench, Centre for Global Mental Health

The Friendship Bench is a research based organisation that began as a research programme to investigate a low cost psychological intervention for depression, anxiety and other common mental health problems delivered by lay health workers at primary health care level (Chibanda, 2011). It was first piloted in Mbare at the polyclinic after depression and other common mental health disorders were found to be highly prevalent in the community and among clinic attendees in the early 2000s. The intervention was developed by Prof. Dixon Chibanda, a psychiatrist who was then working at Harare hospital in conjunction with

Kings College London and eventually won a Grand Challenges Canada research grant due to its innovative nature. The trust has since run a successful randomised control trial

that proved the intervention is effective.


The program has since been scaled up to include all City of Harare polyclinics, the trust has a standing Memorandum of Understanding with the City of Harare. The WHO is also supportive particularly because of its task shifting nature. The program has been

recognised as an innovative home grown solution to managing depression at community and primary health care level and as the department of mental health we have been considering how to include it in our primary health mental health care package

countrywide. The program has been recognised and is being implemented in

New York City, USA in their City Health Department.


- National Strategic Plan for Mental Health Services 2019 – 2023, Towards quality of care in mental health services, Ministry of Health and Child Care, Zimbabwe


 

Sociocultural factors influence help-seeking behaviors among people in Ghana. Ghana has been described as one of the most religious societies in the world, with most individuals identifying as Christian. Belief in supernatural or spiritual causes of mental illness is common, however, other causal beliefs exist including biomedical causes and social factors such as work stress and marital problems. Many people seek care from traditional or faith-based healing institutions. Exact estimates of help-seeking from traditional healers are dated and variable, but suggest 20-70% of individuals seek mental health care from these sources as a first-line approach. Traditional and faith-based healers use various methods such as prayer, fasting, spiritual actions performed by consumers and their families and herbal remedies. Studies have documented the financial, psychological, social and emotional burdens of caring for family members with mental health issues, which are often exacerbated by lack of social support due to stigma. Human rights challenges have been well documented within the faith-based treatment systems and persist despite governmental efforts to

eliminate practices such as chaining.

 

Robert: Magnus, I love the Friendship Bench program especially since it provides benefits for both the person being listened to and the listener.


I’ve learned that, generally, Africans place a very strong emphasis on the family. And, one of the key components to successful treatment seems to be an all-hands-on-deck approach by friends and family with the person living with a mental illness. Would this, in theory, give Africans some advantage to dealing with mental illness?


Magnus: I agree with you. In talking about Africa, I’ll use Ghana as a point of reference, I argue that it is a communal society in the way people care for one another. Even though I was raised by my parents, I can say that our neighbors also played a role in raising me. A neighbor can advise you and even punish you when there is the need. However, the story is different with mental illness. Because of the stigma associated with mental illness, people tend to distance themselves from family members or relatives who are suffering.


Robert: Can we talk about strategies for tackling stigma?


Magnus: The conclusions of much of my research is the need for continuous education about mental illness. The more we talk about it, the more we will understand it and gain more insights. There is this slogan that there is no health without mental health. I think our community must come to the point of realizing that the head/mind is also part of the body. If we can sympathize with others who have illnesses relating to other parts of the body, why not empathize with those who have illnesses of the brain? I think more education would be helpful and engaging in anti-stigma activities like community events where education is provided regarding the facts surrounding mental illnesses and to understand the kinds of supports that are available. And, I agree, even when you look at the recovery model, we still need the community to come together. Community engagement helps a lot. It’s not every form of mental illness that requires medication, some require the assurance of empathic support like the Zimbabwean model.


"Even though I was raised by my parents,

our neighbors also raised me."

- Magnus Mfoafo-M’Carthy


Robert: Has the field of global mental health been shaped by western ideologies and colonialism?


Magnus: I would think so because, when you look at what is going on in a country like Ghana, we have become dependent on western medication. I remember years ago they used to talk about the antipsychotic medications such as olanzapine and clozapine. A lot of these were developed in the west. When you develop a medication in the west—do trials, choose the subject in those trials, the environment in which these trials were done, the weather in those places—all these conditions are different from those in Africa. Yet physicians in Ghana, who prescribe medication for their patients, depend on these drugs and the guidelines under which they were developed. Of course, they were developed under different conditions.


Medications and treatments have definitely been westernized and people tend to look at western models. I think what we need is research that is locally based and having people in the Global South looking for alternatives and asking the serious questions: which direction do we need to take in providing treatment for those with depression, schizophrenia, and bipolar disorder among others, which may differ in a place like Ghana? Would their treatment differ from someone in Canada or the US? These are conversations we need to have and find ways of providing leadership and support for people locally.


Robert: Are there still aspects of colonialism that burden global mental health care?


Magnus: On paper, we can say that colonialism ended in much of the Global South starting around the late 1950s through the 1960s as countries started gaining independence. Ghana, for example, gained independence in 1957. But we should not forget that the legacy or remnants of colonialism remain. It’s still there. Even now, when you go to Ghana, people prefer wearing western clothing, in our courts judges continue to wear the head covers or bench wigs which are used in the United Kingdom. Regarding education, a person’s fluency in the Queen’s language (English) is more respected in Ghana than the person eloquent in the local language. I see these as a few of the vestiges of colonialism and this has impacted the mental health care system where there is over dependence on western diagnosis and medication.


Robert: Are there other ways colonialism could affect mental health?


Magnus: I think so. We continue to embrace the asylum system even though, in the western world, it’s deinstitutionalized. In Ghana, the first asylum was built in 1888 under British governor, Sir Edward Griffiths at the old High Court of Victoria Borg. Then the Ankaful Psychiatric Hospital was opened in 1965. Though the Accra Psychiatric hospital was originally built to accommodate 500 patients, it's now overcrowded. There are also those who have broken free because they were disowned or ostracized by their families and now find themselves walking the streets of the capital, Accra.


I remember about 10 years ago, I chanced upon the national mental health budget of Ghana and the amount was not adequate. It was just about 1.4% of the total health budget. This speaks to the mindset of policymakers and those responsible for improving the healthcare system.


Another problem that we have in Ghana, during the colonial period, we had colonial masters coming and serving in certain sensitive positions like the Governor. They had a provision where, if you fell ill, you could be sent back to England for treatment. Now, we have senior government officials who continue to benefit from this provision, where, when they fall ill, they can be sent abroad to countries like South Africa, India, the UK or the US for treatment. As a result of this, there isn’t much commitment by policymakers to improve the healthcare system in the country. The ordinary Ghanaian does not have access to this treatment. They must rely on local hospitals.


Robert: Are there ongoing efforts to help the general public understand the importance of good mental health?


Magnus: There are a number nonprofit organizations in Ghana that provide awareness in their own way, but I don’t think they have a big enough platform to be able to engage with the entire population. When you look at it critically, at the end of the day, it all comes down to funding. Policymakers must be willing to embrace and advocate for society and push for real funding.


Robert: When you say the mental health budget in a place like Ghana is small (1.4%), how does that compare to other countries?


Magnus: The US mental health budget is 6% of the total health budget, Canada is 7% and England is 13%. Scandinavian countries contribute larger amounts to their mental health budget. When you look at the numbers, the percentage of mental health budget to the total health budget speaks volumes in terms of where the priorities are.


Robert: How can collaboration and partnerships in the Global North and the Global South contribute to a more equitable and inclusive approach to global mental health?


Magnus: There a lot of organizations in the Global North that are attempting to provide some form of support to organizations in the Global South. As they say, a journey of a thousand miles begins with one step. I think there has to be considerable effort made by practitioners and clinicians to see how best they can make inroads in the south. Even though steps have been taken, and I know people have been exploring new options, we need to keep at it. Researchers are doing quite a bit of work in India and other parts of the world to bring North and South together, but we’re still stuck on the surface. In terms of our approach, we have some researchers and nonprofits making these kinds of efforts, but I haven’t seen many government initiatives that are exploring this kind of collaboration. That’s perhaps where we fall short.


Gathering of ministers
Ghana Parliament, Courtesy of the Business & Financial Times

"…it calls for us to turn to our governments

to change the approach."

- Magnus Mfoafo-M’Carthy


Robert: When we talk about international collaboration between the North and South, my mind goes to displaced groups especially as climate disasters ramp. More and more displaced people will be moving from the Global South to the North. Does that necessitate new mental health strategies especially as some people will use an increased number of immigrants as reason to discriminate, stigmatize, and hate?


Magnus: I think what you say is true. We have to change our approach as things are changing on daily basis. A few years ago, we never talked about climate change and we must have conversations about how it impacts mental wellbeing. It calls for advocacy and it calls for us to turn to our governments to change the approach.


Robert: You talked about a lack of psychiatrists and other mental health professions in Ghana. What's the reason behind that shortage?


Magnus: Well, I think it goes back to the stigma. Someone is much more likely to want to become a neurosurgeon or be a radiologist rather than specialize in mental health. The effort has been made over the past couple of years in Ghana to have medical students pursue psychiatry. Some schools in Europe are even offering scholarships for Ghanaian students to be trained in psychiatry. Overall, we still don’t have adequate staffs.


Robert: Are there models in other areas that can help us deal with stigma?


Magnus: Yes. The narrative of mental illness has been told in a negative fashion. It’s time to change that. We can look at HIV/AIDS as a successful model. The narrative of HIV/AIDS has been shaped by famous and influential advocates like Magic Johnson, because he was living with HIV, or Elizabeth Taylor because of her friendship with Rock Hudson. They were able to advocate in a positive way. Even though the stigma surrounding HIV/AIDS is still there, it’s certainly not like it used to be when it first emerged. Also, with the support of influential people has come large amounts of funding.


As we look throughout history, how many popular artists or musicians are known for living with mental illnesses like Vincent van Gogh, Beethoven and Kurt Cobain? How can we present this to the world? Perhaps by stating the truth, that mental illnesses do not discriminate. It can affect anyone. There are studies out there speaking to the fact that, we are connected to mental illnesses in one way or another, either through people at work, family members or our neighbors. How can we bring more awareness and normalize these illnesses?


Robert: What is the main work you’re doing now?


Magnus: I continue to look at the impact of mental illnesses in Ghana. Right now, I’m exploring it from a religious point-of-view. Often, people feel believing in God precludes them from mental illness and those with the illness need the assistance of a pastor to cast out the evil spirit. They see it as a demonic attack. We would want to educate to understand that the illness could be because of a chemical imbalance and that they need to find other help.


Also, I am working with a colleague researching the impact of climate change on persons with disabilities in Ghana.

 

Attempted suicide decriminalized in Ghana

By GNA

March 30, 2023


Parliament has passed the Criminal Offences (Amendment) Bill, 2021 to decriminalise attempted suicides.

                                                                                                         -News Ghana

 

Robert: Before we go, I wanted to mention suicide. Are churches and schools open to talking about suicide prevention?


Magnus:  Parliament in Ghana recently decriminalized suicide which had been illegal based on the Lunatic Act of 1845. I don’t think much effort has been made to educate the public as yet. I think it’s really necessary to have this type of education. The rate of suicide in Ghana is comparable to other parts of Africa (about 10 per 100,000 people) and in Canada (10 per 100,000) but not as high as the United States (14.5 per 100,000).


Robert: Thank you for helping us better understand mental health care in Ghana and, on behalf of those reading this blog, thank you for the work you're doing, Magnus. For those wanting to talk to someone in Ghana, Canada or the United States, the following methods are available:


In Ghana: 050 991 4046 and 020 681 4666


In Canada and the United States: Dial 988 for the Suicide and Crisis Lifeline or

If you enjoyed this blog, please consider sharing it with a friend. Interested in writing a blog? Contact Robert@thepsychedelicblog.com. 




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