In Ghana, psychiatric hospitals express concerns as COVID-19 infections rates remain high

Ghana’s COVID-19 infection rates have significantly decreased in recent times since the country recorded its first two cases on March 12, 2020 after the pandemic hit the world in December 2019.

The country has seen a dramatic decrease in COVID-19 infections. From an average daily case count of about 1,500, Ghana, as of December 16, 2022 had only four active cases and its intensive care units and treatment centers were virtually vacant because there were no severe or critical cases.

However, even as the country observes this ‘milestone’ in-patient mental health facilities in Ghana remain concerned about possible new outbreaks.

Management sources from two of Ghana’s three main psychiatric hospitals, the Accra Psychiatric Hospital (APH) and Pantang Psychiatric Hospital (PPH), say they remain on alert for new COVID-19 outbreaks as admissions continue on a regular basis.

Under the initial phase of Ghana’s National COVID-19 Vaccine Deployment Plan (NVDP), rolled out in March 2021, people with mental health issues were included in the “most at risk’ persons category.

Early on in the pandemic, the first COVID-19 case involving a person with a mental illness was an in-patient at APH on April 27, 2020. By the end of the year, the hospital had recorded 10 more cases among patients on admission.

Fearing the virus spreading, massive vaccination campaigns launched by health authorities’ specifically targeted patients and staff at the country’s three psychiatric hospitals to provide protection among patients against the virus and reduce spread of COVID-19 at the facilities.

At APH, Ghana’s main psychiatric facility, by the end of December 2021, records show that 212 out of 218 in-patients had been vaccinated against COVID-19. At PPH, the number was similar to APH, with management sources indicating that around 70% of its in-patient population had taken at least a single jab of the COVID-19 vaccines.

However, in the past year, the hitherto massive drive targeted at this high risk group had slowed thus increasing risk of an outbreak mainly because of lax adherence to COVID-19 safety protocol and measures by in-patients and the often, unknown, vaccination status of new admissions.

There is also the risk of waned immunity among in-patients inoculated earlier at the onset of vaccine deployment.

While data is not readily available on how many people with mental health disorders in Ghana have received the COVID-19 jab, the Ghana Health Services’ (GHS) Dashboard indicates that as of December 9, 2022, a total of 21.4 million vaccine doses have been administered among the population. Of this number, 12.1 million people have received at least one dose, 9.1 million are fully immunized, and 2.7 million have taken boosters.

The World Health Organization (WHO) estimates that around 10% of Ghana’s population or an estimated 10 out of every 100 people are living with some form of mental disorder or another. Thus, in Ghana, this number would be around 3.1 million people.

These people are categorized in four main groups: Those on the streets, those at the treatment facilities (including psychiatric hospitals and general health facilities), those in the traditional and faith-based healing centers, and those in their homes and with organizations who do not recognize they have a mental illness or who aware they do, but are not doing anything to address it or treat it.

Records at the APH, Ghana’s main psychiatric facility, shows that the hospital receives an average of 80 out-patient-department cases on a daily basis. As of June 2022, it had an in-patient population of 290.

In an interview, Lydia Kuukua Sackey, APH’s Quality Improvement and Assurance Unit Coordinator said that while all patients in the chronic wards were vaccinated against COVID-19 the same could not be said of those at the admission wards.

“Most of the patients come in acutely ill and you cannot verify their vaccination status before admitting them. Patients are admitted and discharged on daily basis and it becomes difficult to vaccinate at all given time”, she said.

According to her, no COVID-19 vaccination exercise was undertaken at the facility after the first round which ended in December 2021, raising fears about the susceptibility of some in-patients contracting the virus and a possible spread to others due to the moving in and out of clients.

“We do not have a sited vaccination centre and aside the two national campaigns, when APH was selected as a vaccination point in 2021, which we took advantage of to vaccinate those within the facility, that has been it,’’ she noted.

Agreeing that continuing access to the COVID-19 vaccines would be much helpful, Ms Sackey admitted that already vaccinated in-patients, who all received a single dose of the vaccines, would also require a booster to enhance their immunity against the virus.

A management member at PPH, who spoke on condition of anonymity, agreed on the need to establish a permanent COVID-19 vaccination centre at the psychiatric hospitals due to the specialty of services they offer to their patients.

In an update on its roadmap for prioritizing use of COVID-19 vaccines, the WHO Strategic Advisory Group of Experts (SAGE) on Immunization, recommends that countries prioritize the distribution of increasingly available vaccines to optimize impact on health and socioeconomic conditions.

It cautions that emerging evidence points to the fact that “higher risk groups” that received COVID-19 vaccines at the early stages of vaccination may have declined immunity over time.

WHO states that “Emerging evidence indicates that vaccine effectiveness against SARS-CoV-2 infection and any symptomatic COVID-19 declines significantly over a period of six months after completion of the primary series, likely resulting from waning protective vaccine-induced immunity, compounded by lower vaccine-induced neutralizing antibody activity including the Delta and Omicron variants.”

Classifying people with mental illnesses as a “high priority-use” group for vaccine coverage, SAGE advises that “in the short-term, a third dose (booster doses) may fully or partially restore vaccine effectiveness” among such individuals.

Ghana’s COVID-19 Emergency Preparedness and Response Project, supported by the World Bank, considers people living with mental disorders as part of vulnerable groups in the distribution of COVID-19 vaccines in line with the WHO mental health and psychosocial support guidelines on the pandemic.

Aligned with Act 846, of Ghana’s Mental Health Act, 2012, the government is expected to make deliberate efforts at investing in mental healthcare to improve access to care and treatment.

In an interview, Dr. Akwasi Osei, Chief Executive Officer of Ghana’s Mental Health Authority (MHA), said in an interview that while all psychiatric hospitals are on high alert with heightened infection prevention control and protocol measures to keep COVID-19 at bay, making vaccines readily accessible was crucial.

“The COVID-19 vaccines are good and safe and we highly recommend them for our patients,” he said, adding, “We are discussing with the Ghana Health Service to get their teams to be on standby at all times at the psychiatric hospitals to improve vaccination.”

Dr. Osei decried the general neglect of mental healthcare in Ghana, especially the non-implementation of the Mental Health Levy to fund care as recommended in the 2012 Mental Health Act.

“Mental illness is a real situation and we are all vulnerable to any situation that may emerge, like COVID-19. There must be a deliberate effort to invest in mental healthcare  to improve access to care and treatment because any one person we fail to treat is a risk to everyone else,” he said.

Dr. Kwame Amponsa-Achiano, the Head of Ghana’s Expanded Programme on Immunisation, under whose purview the NVDP falls, said the government has no intention of leaving behind anyone, including those with mental illnesses, its COVID-19 vaccination agenda  to achieve herd immunity.

He promised that steps would be taken immediately and soon as possible to address the concerns of the psychiatric hospitals.

A study entitled ‘COVID-19 vaccine hesitancy in patients with mental illness: Strategies to overcome barriers’ published in the Journal of the Egyptian Public Health Association in January 2022, stressed the need for countries to build confidence regarding COVID-19 vaccines among people with mental health disorders to attain the goal of fighting the global pandemic.

In  order to ‘leave no one’ behind, Ghana’s health authorities must ensure that COVID-19 vaccines are made available everywhere and it must specifically address the needs of those living with mental health illnesses because, as it has been stated, failure to vaccinate any person is a potential risk to everyone.


Leave a Comment

Your email address will not be published. Required fields are marked *