Assessment of mental distress among prison inmates in Ghana’s correctional system
RESEARCH Open Access
Assessment of mental distress among prison inmates in Ghana’s correctional system: a cross-sectional study using the Kessler Psychological Distress Scale Abdallah Ibrahim1*, Reuben K Esena1, Moses Aikins1, Anne Marie O’Keefe2 and Mary M McKay3
Abstract
Background: Applying global estimates of the prevalence of mental disorders suggests that about 2.4 million Ghanaians have some form of psychiatric distress. Despite the facts that relatively little community-based treatment is available (only 18 psychiatrists are known to actively practice in Ghana), and that mental disorders are more concentrated among the incarcerated, there is no known research on mental disorders in Ghana prisons, and no forensic mental health services available to those who suffer from them. This study sought to determine the rate of mental distress among prisoners in Ghana.
Methods: This cross-sectional research used the Kessler Psychological Distress Scale to estimate the rates and severity of non-specific psychological distress among a stratified probability sample of 89 male and 11 female prisoners in one of the oldest correctional facilities in the country. Fisher’s exact test was used to determine the rates of psychological distress within the study population.
Results: According to the Kessler Scale, more than half of all respondents had moderate to severe mental distress in the four weeks preceding their interviews. Nearly 70% of inmates with only a primary education had moderate to severe mental distress. Though this was higher than the rates among inmates with more education, it exceeded the rates for those with no education.
Conclusions: The high rate of moderate to severe mental distress among the inmates in this exploratory study should serve as baseline for further studies into mental disorders among the incarcerated persons in Ghana. Future research should use larger samples, include more prison facilities, and incorporate tools that can identify specific mental disorders.
Keywords: Mental health, Ghana prisons, Northern Ghana, Kessler Psychological Distress Scale
Background Every year millions of people worldwide are diagnosed with one or more disabling mental disorders. Unfortunately, mental disorders, which are responsible for increasing medical care costs and lost productivity every year, do not get the same attention that physical illnesses do. It is esti- mated that globally, mental disorders account for 12% of the burden of diseases, and this is expected to increase
to 15% by 2020 [1]. However, among the adult popula- tion alone in Ghana, mental disorders account for 13% of the nation’s burden of disease [2]. The World Health Organization (WHO) also estimates that worldwide, about 25% of a country’s population will suffer from a mental disorder at some point in their lives. At any point in time, an estimated 10% of people suffer from a psychiatric con- dition, including an estimated one percent who have a se- vere form of mental disorder [2,3]. Applying the WHO global estimates to Ghana’s most recent population census suggests that about 2.4 million Ghanaians may have some form of psychiatric condition [2]. More recently, the
* Correspondence: aibrahim@ug.edu.gh 1School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana Full list of author information is available at the end of the article
© 2015 Ibrahim et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Ibrahim et al. International Journal of Mental Health Systems (2015) 9:17 DOI 10.1186/s13033-015-0011-0
mailto:aibrahim@ug.edu.gh
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World Health Organization has estimated that about 650,000 Ghanaians (or 3% of the population) have a severe form of mental disorder [2]. With only 18 psychiatrists known to be actively prac-
ticing in Ghana and an estimated 2.4 million Ghanaians suffering from at least one mental disorder, there is a significant gap between need and the availability of mental health services in the country [2-4]. Despite the incredible unmet need for mental health care, little emphasis has been put on this evolving crisis in Ghana’s public mental health system. On average, more than 6,300 individuals are admitted
annually to the state psychiatric facilities that exist in Ghana, all of them located in the urban parts of the country [2,3]. The primary psychiatric diagnoses for these admissions are schizophrenia, depression, and sub- stance use disorder [3]. Many other individuals who are believed to be experiencing a form of mental disorder are sent or referred to non-traditional healing or treat- ment facilities known as “prayer camps”, or to other al- ternative African traditional healing centers. Because of the limited number of public psychiatric facilities and the large number of people who need treatment, the non-traditional treatment centers see the majority of pa- tients who need care in Ghana. In addition to the people in mental health institutions
and those accessing the prayer camps for mental health care, there are a growing number of people in Ghana in the criminal justice system who are believed to be suffer- ing from many forms of mental disorders [4]. Since there is little or no pressure to address this problem among the general Ghanaian population, those with mental distress who are incarcerated have little recourse. Research has estimated that between 16% and 64% of
individuals who are incarcerated or have a history of in- volvement in the criminal justice system suffer from mental disorders [5-7]. Although there is no known re- search on the number of incarcerated Ghanaians with mental disorders, the true prevalence may be similar to what has been found in other African countries includ- ing South Africa, Zambia, and Nigeria [7-9]. Having a mental disorder by itself is not a crime. How-
ever, mental illness may influence a person to commit a crime and therefore lead to incarceration. The colonial legacy approach in Ghana reveals how little is understood about treatments that could enable individuals with men- tal disabilities to live normal, integrated, and productive lives in their communities. Forensic mental health ser- vices, i.e., the interface between mental disorders and the criminal justice system, have not been studied and are not addressed by the new Mental Health Act (MHA) enacted by Ghana’s Parliament in 2012 [1]. The MHA of 2012 replaced the archaic Mental Health Decree of 1972 that had emphasized institutionalizing individuals with
mental disorders [3]. The MHA seeks to reorient the country’s response to mental disorders toward non- institutional treatment. Although the new mental health law is an important
step to adequately addressing the country’s mental health needs, little has been done to implement it. In fact, very little is known about the true prevalence of mental disor- ders within the general population, let alone among those in Ghana’s correctional system. The few studies of mental disorders in prison or jail populations that have been done in Africa were conducted in South Africa, Zambia, Nigeria, and a few other African countries [7-10]. To address the gaps in our knowledge, this exploratory
study sought to determine the rates of mental distress among those involved in the correctional system in Ghana using a validated screening tool.
Methods This cross-sectional research study used the Kessler Psychological Distress Scale (K10) (interviewer admin- istered version) developed for use in the United States’ National Health Interview Survey to estimate the preva- lence of mental distress [11]. The interviewer adminis- tered version was used because of the high rates of illiteracy in Northern Ghana and among the population studied. Scores on the K10 range from 10 to 50, corre- sponding to the severity of a respondent’s mental distress. If an individual scores under 20 on the Kessler tool, it re- flects relatively good mental health; scores of 20–24 reflect a mild mental disorder; individuals with scores of 25–29 are likely to have a moderate mental disorder; and individ- uals who score 30 to 50 are likely to have a severe mental disorder [11]. The Kessler instrument has been used in several coun-
tries including South Africa and Nigeria, where the valid- ity of the instrument was established for Africa [12]. The tool has also been used in Australia to assess the level of psychological distress among prisoners in the Australian National Prisoner Health Census [13]. The K10 tool is a brief, client-friendly screener. It is
much easier to administer than more extensive screen- ing tools such as the World Mental Health Composite International Diagnostic Interview (WMH-CIDI) that re- quires interviewers to undergo mandatory training available only at WHO-authorized Training and Reference Centers. The K10 is also more appropriate for this research than the patient health questionnaire (PHQ-9) and mood dis- order questionnaire (MDQ) that are tailored for specific mental disorders.
Study setting The participants interviewed for this study were serving time at the Tamale central correctional facility in the Northern Region of Ghana, the largest of Ghana’s ten
Ibrahim et al. International Journal of Mental Health Systems (2015) 9:17 Page 2 of 6
administrative regions. This facility was chosen because it is one of the oldest prison facilities in Ghana’s correc- tional system. The interview process included a demo-…
