By Natalie Schuck, LL.M., PhD student, N.S.Schuck@rug.nl 

Traditional health care, including herbal and faith-based healing, is practised in many countries across the world. In Ghana, it has played a key role in providing health care over the past centuries and is still widely used as an alternative to allopathic medicine. It is speculated that around 80% of Ghanaians first turn to traditional health providers before making use of allopathic clinics.[1] However, in regard to regulating traditional practice or the collaboration with the allopathic sector to ensure quality mental health care, little legislation exists, hindering the capacity of many in their ability to fully access their right to mental health.

Mental illness is said to be healed in traditional health centres because of the belief of it being caused by evils spirits, which seeks for spiritual healing. Additionally, with the strong stigma and discrimination surrounding mental illness, patients would refrain from going to designated psychiatric wards or hospitals and rather blend in in the traditional centres where there are physical illnesses as well. Furthermore, WHO estimates that around 650,000 Ghanaians suffer from severe mental illness,[2]but as of now, there are only three psychiatric hospitals in Ghana (all located in the south), 11 practising psychiatrist and around 20 practising psychologists.[3] This big treatment gap and the aggravated access to the hospitals is a third reason for patients reaching out to traditional practitioners.

Ever since stories of human rights violations, such as chaining and forced fasting (especially in the traditional setting) were published by Human Rights Watch,[4]there has been a push for policy development and a betterment of the situation – a challenge that has been ongoing for years. Through the influence of international organizations and the urge to meet international standards, the Ghanaian mental health law has developed faster than the required attitudinal change of the people, leaving a big gap between the provision under the law and the knowledge, attitude and practice of mental health care, which is the cause of the ongoing human rights violations.

Already in 2000, Ghana passed the Traditional Medicine Practice Act to regulate the practice carried out by traditional healers to guarantee certain standards. The law is seen as a basis for the traditional health care regulation and also established the Traditional Medicine Practice Council (TMPC) as a regulatory body, mandated to register practitioners, license their practice and oversee their centres.[5] However, since the law targets a rather informal system with new and small-scale centres continuously being opened, overseeing all centres is impossible.

Additionally, the Act is lacking specific regulations that practitioners have to follow in regard to their health care service, and mental health is not explicitly mentioned. Both of these improved, in a way, with the passing of the Mental Health Act of 2012.

Act 846 pushed an important change in the mental health practice. It is detailed in its provisions and offers specific regulations for the allopathic and traditional health care setting. Although the law includes the deeply rooted traditional practices when striving towards expanding mental health care and raising the quality thereof, it portrays traditional health care rather as a necessary evil and only as a first point of contact instead of valuing it for the important role it plays for Ghanaians. When considering emergency cases, for example, an involuntary patient can be received in a traditional health centre if the admission to a mental health facility is impracticable, but only for a maximum of 48 hours before the patient has to be transferred to a mental health facility.[6] In an allopathic clinic, such patient can be admitted for 72 hours and even longer if a Court Order allows.[7]

In addition, despite the prescribed collaboration between the allopathic and traditional mental health care providers,[8] research on the ground in Ghana shows that instead of collaboration, the Mental Health Authority rather provides guidelines and policies that the traditional practitioners must follow, without consulting the TMPC or equivalent representatives in the drafting process.

The TMPC has been carrying out nationwide sensitizing programs for traditional practitioners, making them aware of the provisions in the Mental Health Act. As a result, many practitioners established collaboration with psychiatric hospitals (in the south) or with district hospitals that hire community psychiatric nurses (in all parts of Ghana).[9] Some NGOs have taken initiative to create awareness for mental health care and urge traditional practitioners to collaborate with allopathic hospitals.[10] More actions like that, where the power of traditional medicine practice is considered, can help raise the quality of mental health care. Nevertheless, it seems there is a need to set out legal regulation for a working collaboration between the two sectors on the side of the executive power. While some stakeholders hope such provisions will be found in the Legislative Instrument that is not yet published, others believe that collaboration can be achieved by drafting a specific policy.

 Questions for further discussion

• How can international human rights law be implemented in domestic legislation without neglecting traditional beliefs on the one hand, and without infringing on the human right on the other hand?
• Is there a need for specific legal provisions within the domestic law that allow traditional mental health care (including herbal and spiritual healing) as it is practised today because of the role it plays for Ghanaians, or should the law – as it does – set its focus on internationally recognized mental health care?
• In what way can the Mental Health Authority, which (according to the Mental Health Act) is in charge of raising the quality of mental health care, cooperate with the TMPC and not fall into the role of controlling it?

[1] Interview with the General Secretary of the Ghana Association of Faith Healers, April 2018.

[2] WHO (2007), The Country Summary Series: Ghana, October 2007.

[3] Interview with a psychologist from Korle Bu Teaching Hospital, April 2018.

[4] Human Rights Watch (2012) “Like a Death Sentence”, Abuses against Persons with Mental Disabilities in Ghana, 2 October 2012.

[5] Republic of Ghana, Traditional Medicine Practice Act, 2000 (Act 575), sections 1-2.

[6] Republic of Ghana, Mental Health Act, 2000 (Act 875), article 48(3).

[7] Republic of Ghana, Mental Health Act, 2000 (Act 875), article 49(1).

[8] “[T]he [Mental Health] Authority shall collaborate with the Traditional and Alternative Medicine Council and other providers of unorthodox mental health care to ensure the best interest of persons with mental disorder”, Republic of Ghana, Mental Health Act, 2000 (Act 875), article 3(m).

[9] Interviews with the General Secretary of the Ghana Association of Faith Healers, April 2018 and with a training officer of the Traditional Medicine Practice Council, May 2018; and additional field trips to traditional health centres.

[10] Interviews with the project manager of BasicNeeds Ghana, April 2018, and with the Executive Director of MindFreedom Ghana, May 2018.