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Article Abstract

Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 16, Issue 4, 2013. Pages: 151-159
Published Online: 1 December 2013

Copyright © 2013 ICMPE.


 

Household Costs of Mental Health Care in Ghana

Rebecca Addo,1 Justice Nonvignon,2 Moses Aikins3*

1Nurse Educator, Health Concern Ghana, Accra, Ghana
2PhD, Lecturer, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
3PhD, Senior Lecturer and Vice Dean, School of Public Health, College of Health Sciences University of Ghana, Legon, Accra, Ghana
5MSc, Biostatistics, Max Weber Institute

* Correspondence to: Moses Aikins, PhD, Senior Lecturer and Vice Dean, School of Public Health, College of Health Sciences University of Ghana, P.O. Box LG13, Legon, Accra, Ghana.
Tel.: +233-244-433 743
Fax: +233-244-433 743
E-mail: mksaikins@ug.edu.gh

Source of Funding: None declared.

Abstract

There is substantial evidence that the economic burden of mental illness is vast and lifelong. Patients and their household members are the most affected in terms of productivity losses and psychological pain. This study estimated the household cost of mental healthcare to patients attending the Ho Municipal Hospital in southern Ghana. Data collected from 191 patients and their respective household members was used to estimate the direct and indirect costs, and also to describe the intangible cost. The total cost of mental healthcare was estimated as $34,518.27, with direct and indirect costs making up 26% and 74% respectively. The largest component of indirect cost was productivity losses to caregivers, and that of direct cost was cost of drugs. Estimated indirect costs were sensitive to variations in wages. Patients and their households were emotionally affected due to mental illness. Expansion of financial access to mental healthcare for households is greatly needed.

Background: In Ghana, the prevalence of mental illness is about 13% and most patients are seen on out-patient basis. The economic burden of mental health care to patients and their families is, largely, unknown.

Aims: The aim of this study was to estimate the direct and indirect costs of mental illness to patients and their families and also to describe the intangible costs associated with mental illness.

Methods: Cross-sectional study design was used. Data were collected at the Psychiatric Unit of Ho Municipal Hospital, in the city of Ho, Ghana, from patients with mental illnesses and their households. Direct costs were estimated as medical cost and non-medical cost. Indirect costs were estimated for reported lost time/days by patients and their families. Sensitivity analysis was performed by varying uncertain parameters. Intangible costs was described using the Likert scale to measure the effect of mental illness on patients and their households in the areas of functional limitation, fear, emotional suffering, social relationship, stigmatisation/discrimination and leisure time.

Results: The total household cost of mental healthcare for the three month period was estimated as US$34,518.27 (average of US$180.72 per household), with direct and indirect cost making up 26% and 74% respectively. The average monthly household cost was estimated as US$60.24 as compared to the average reported household monthly income of US$184.48. Indirect cost was sensitive to the choice of wage rate used (i.e. local versus national rate). About 64% and 72% of patients and their households respectively were affected emotionally as a result of mental illness.

Discussion: Productivity losses due to caregiving and lost employment were the major contributors to the cost of mental illness to patients and households, constituting more than two-thirds of total costs. Cost of drugs was the highest contributor to the direct cost of mental illness. There is the possibility of over (or under) estimation of the cost due to recall challenges of patients and household. It is important to note that this study presents costs to households whose mentally ill member sought care from the facility -- some patients seek care from outside health facilities.

Implications for Health Care Provisions and Use: Expanding financial access to mental health care for households - through improved coverage under the National Health Insurance Scheme - and improving delivery of mental health care services in Ghana through close-to-client strategies could ease the economic burden of mental health to many households.


Received 20 May 2013; accepted 4 October 2013

Copyright 2013 ICMPE