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Role and Responsibilities of health

workers in the Mental Health Law

RGN 3, Wa NTC,
David Dobara
27 July, 2018

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Integration of mental health in general health
• Provision: Full integration of mental health into general
health care at all levels: CHPS, Sub-District, District,
Regional, Teaching Hospitals (Articles 2.d, 3.b-e, 11, 17)
• Implication:
– All doctors, nurses and other health personnel are expected to be
knowledgeable about mental health issues, to administer primary
mental health treatment.
– All health workers should be able to recognize and manage mental
illness, and when necessary refer to specialty services
– Health workers will be retrained in basic mental health care

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Obligation on health managers for
integration

 Provision: Health directors are obliged by law


to include mental health care in their services
(Articles 2.d, 3.b-e, 11, 17)
 Implication:
 It is no longer a matter of personal discretion.
 Any Regional, District, Medical Director who
says mental health is not his/her priority has
violated the law and is subject to sanction

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Integration in health management structures

• Mutual incorporation of mental health and


Ghana Health Service management structures at
regional and district levels
• Mental Health Coordinators will be members of
their respective Regional or District Health
Management Team, and will collaborate closely
with the Regional or District Health Director
(18.1.c., 18.2., 20-23)

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Regional and district directors to be part of
mental health coordinating committees
• Mental Health Sub-Committees will be
established within the Regional and District
Health Management Teams, and will advise the
Mental Health Coordinators and collaborate
with the Regional and District Health
Management Teams (18-22)
• Regional and District Health Directors, or their
representatives, will be members of Mental
Health Sub-committees
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Health Workers’ responsibility to respect rights of
mental health care users

 It is unlawful to discriminate against or


stigmatize the mentally ill
 PWMD (persons with mental Disorders) are
entitled to the same fundamental rights as a
fellow citizen, and therefore shall not be
subjected to discrimination (54)

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Respect and provide highest standard
of care to the mentally ill

 A person with mental disorder is entitled to the


same standard of care as a person with physical
health problems, and shall be treated on an
equitable basis including quality of in-patient
food, bedding, sanitation, buildings, levels and
qualifications of staff, medical and related
services, and access to essential medicines (57)

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No torture or any inhuman
treatment
 A person with mental disorder is entitled to
humane and dignified treatment, and shall not be
subjected to torture, cruelty, forced labour, or
any other inhumane act (Art. 57.3)
 Mental health care is free, and mental health
patients are entitled to insurance for treatment of
physical health problems under the National
Health Insurance Scheme (88)

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Access to information

 A patient shall have free and full access to


information about the mental disorder and the
treatment plan for the patient (62)
 A person shall be entitled to psycho-social
rehabilitation and aftercare services, including
supervision, rehabilitation, and vocational
training (72)

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Non-discrimination against the
vulnerable

 Women, children, and the aged shall not be


discriminated against with respect to admission,
treatment, or community care, and will be given
separate accommodations upon admission (64-
66)

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Rights violations will be prosecuted

 Anybody who breaches the rights of a person


with mental disorder as defined by the Act
commits an offence and is liable on summary
conviction to a fine of not more than five
thousand penalty units, or to a term of
imprisonment of not more than ten years, or to
both the fine and imprisonment (96)

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 One penalty unit equal to GHS12.00

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Specific provisions for mental health
workers
 Voluntary treatment (39-41)
 Consent of a voluntary patient must be obtained
before treatment is given, and the patient
reserves the right to refuse treatment.
 A voluntary patient may request to be discharged
from the facility, and the request must be granted
within 24 hours unless at that time the patient
meets the requirements for involuntary
admission.
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Involuntary treatment (Art. 42-53)

 Involuntary means involuntary, includes a patient being


tied and brought to the hospital by a relative
 Involuntary admission and treatment can only be
authorized by a court order, where the application must
be supported by recommendations from a medical
practitioner and from a mental health, or by Certificate
of Urgency.
 Prolonged treatment requires the recommendation of
the psychiatrist or head of the facility, and must be
approved by the Mental Health Review Tribunal.

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Emergency cases
 In emergency cases, a medical practitioner may
approve admission and treatment without a court
order, but after completing Certificate of
Urgency, and the person may not be detained for
more than 72 hours.
 On the expiry of the period specified by the
court, the involuntary patient shall be discharged,
unless by court prolongation.

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No Seclusion and restraint ‘by heart’
• Seclusion or restraint may only be practiced under
strict institutional guidelines (57-58):
• A person may be placed in involuntary seclusion or
minimal mechanical restraints only when there is
imminent danger to the patient or others
• The seclusion or restraint must be authorized by the
head of the facility or the senior nurse in charge of
the ward
• The documentation of the seclusion or restraint shall
be placed immediately in the clinical notes of the
16 patient
Mental retardation is no reason for
admission
 A person shall not be admitted to a mental health
facility merely for mental retardation, unless
there is evidence of gross misbehavior or
perceptual disturbances (67)
 Informed consent must be obtained for any
intrusive or irreversible procedure (29)
 Electroconvulsive therapy without anaesthesia is
discouraged

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The role of doctors in a court order for
involuntary admission/treatment
• Anybody can make an application to the court for the
temporary involuntary admission and treatment of a
person with mental disorder where there is a substantial
risk that the disorder will deteriorate seriously (Article
42)
• The application will need to be supported by the
recommendation of a medical officer and that of a
mental health practitioner
• The recommendation should detail reasons (history,
mental state exam and diagnosis)

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Emergencies and certificate of urgency
• In an emergency, anybody (relative, friend,
police, employer, colleague, on-looker, etc) can
send a patient straight to a mental health facility
or any health facility for a Certificate of Urgency
(Art 48)
• At the health facility any medical officer, after
satisfying himself that the patient requires
emergency care, will fill a Certificate of Urgency
to enable him admit the patient
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• A Certificate of Urgency is a form specially
designed by the MHA to authorize admission as
an emergency case
• All health facilities will have copies of the
Certificate of Urgency
• Admission on Certificate of Urgency shall be for
72 hours after which the patient shall be released
or else application to the Mental Health Review
Tribunal can authorise an extension
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 “Certificate of Urgency" means a certificate
issued by a medical practitioner for involuntary
admission initiated by the police
or any other person for an urgent or emergency
case (Art. 97)

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 Emergency or urgent case is a case in which a
person's mental disorder requires to be quickly
addressed when there is a high risk or imminent
danger of the condition seriously
deteriorating or of the person causing harm to
self, others or personal property (Art. 97)

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Implications to health workers
• All health workers should now be conscious of
human and legal rights of persons with mental illness
• Should understand that one could easily be dragged
to the Mental Health Tribunal for any breach of the
rights of the mentally ill
• Should be guided by common sense and a high sense
of responsibility, human feeling, respect for the
patient
• Documentation is the name of the new game

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• Reprisal (retaliatory) assault on a patient,
whether physical or verbal, shall not be
entertained
• Abandoning of patient or failure to supervise
after delegation of responsibility shall not be
excusable
• Every facility shall have a Human Rights Officer
whose full time responsibility shall be to go
round the hospital to identify who is mal-
handling patients

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Sanctions against non-compliance

 Proven discrimination, through an act of omission or


commission, may attract penalty of five thousand
penalty units, or to a term of imprisonment of not
more than ten years, or to both the fine and
imprisonment (96)
 Negligence may be sanctioned by internal policy,
Medical and Dental Council, Nurses and Midwives
Council or the appropriate Regulatory Body, and/or
the Law Courts depending on the gravity
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Thank you
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