Household costs of mental health care in Ghana.

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 USD34,518.27 (average of USD180.72 per household), with direct and indirect cost making up 26% and 74% respectively. The average monthly household cost was estimated as USD60.24 as compared to the average reported household monthly income of USD184.48. 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.