Improving Ghana’s mental healthcare through task-shifting- psychiatrists and health policy directors perceptions about government’s commitment and the role of community mental health workers

Abstract

BackgroundThe scarcity of mental health professionals places specialist psychiatric care out of the reach of most people in low and middle income countries. There is growing interest in the effectiveness of task shifting as a strategy for targeting expanding health care demands in settings with shortages of qualified health personnel.Given this background, the aim of our study was to examine the perceptions of psychiatrists and health policy directors about the policy to expand mental health care delivery in Ghana through a system of task-shifting from psychiatrists to community mental health workers (CMHWs).MethodsA self-administered semi-structured questionnaire was developed and administered to 11 psychiatrists and 29 health policy directors. Key informant interviews were also held with five psychiatrists and four health policy directors. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed thematically.ResultsAlmost all the psychiatrists and 23 (79.3 %) health policy directors were aware of the policy of the Government of Ghana to improve on the human resource base within mental health through a system of task-shifting. Overall, about half of the psychiatrists and 9 (31 %) health policy directors perceived there is some professional resistance to the implementation of the policy of task shifting. The majority of respondents were of the view that CMHWs should be allowed to assess, diagnose and treat most of the common mental disorders. The respondents identified that CMHWs usually perform two sets of roles, namely; officially assigned roles for which they have the requisite training and assumed roles for which they usually do not have the requisite training. The stakeholders identified multiple challenges associated with current task shifting arrangements within Ghana’s mental health delivery system, including inadequate training and supervision, poor awareness of the scope of their expertise on the part of the CMHWs.ConclusionPsychiatrists and health policy directors support the policy to expand mental health service coverage in Ghana through a system of task-shifting, despite their awareness of resistance from some professionals. It is important that the Government of Ghana upholds its commitment of expanding mental healthcare by maintaining and prioritizing its policy on task shifting and also providing the necessary resources to ensure its success.

The predictors of treatment pathways to mental health services among consumers in Ghana

“…22,28 Conversely, the mental health systems in Ghana is challenged with limited and poor management of mental health workforce. 22,[33][34][35][36] This challenge is attributed to the perceived low status of mental health professionals, lack of adequate training as well as misconceptions around mental illness. 22 In addition, the mental health systems are challenged with an irregular supply of medications for mental health services.…”

“…The few existing mental health services were disproportionately distributed in favor of the urban and southern sector of the country . Conversely, the mental health systems in Ghana is challenged with limited and poor management of mental health workforce . This challenge is attributed to the perceived low status of mental health professionals, lack of adequate training as well as misconceptions around mental illness .…”

Dementia research needs in Ghana: a perspective

“…In Ghana, health care delivery approaches have adopted the task shifting or task sharing approach at the primary care level as in other countries. 23,24 Task shifting is a rational distribution of tasks from physicians to non-physician health workers. 25 This approach is useful in delivering healthcare to the doorstep of individuals at the community level.…”

Leveraging intrinsic resources for the protection of health information assets

“…Additionally, rural healthcare suffers a critical shortage of skilled staff in public institutions which can largely be attributed to the push-pull factors affecting rural to urban migration of skilled workers (Strümpfer, 1995). A consequence of the lack of skilled labour is the prevalence of task shifting which can be described as the redistribution of medical and health service responsibilities from qualified health professionals to health workers with less training and qualifications (Agyapong, Farren, & McAuliffe, 2016;Clarke et al, 2012;Heunis, Wouters, Kigozi, Rensburg, & Jacobs, 2016). This problem is particularly severe in Sub-Saharan Africa (Gupta & Dal Poz, 2009) and has been compounded by the persistent migration of skilled health care workers.…”