“Making the Mentally Ill Count”, lessons from a Health and Demographic Surveillance System for people with mental and neurological disorders in the Kintampo districts of Ghana

Abstract

BackgroundPersons with mental and neurological disorders (PMNDs) are among the most marginalised groups in developing countries, as they are socially excluded and overlooked in most developmental efforts. Due to high levels of stigma and other operational difficulties, PMNDs are often marginalised in routine enumeration exercises. Health and Demographic Surveillance System is an important public health research platform especially in countries that lacks reliable data systems, as it registers and monitor basic demographic and health events such as births, deaths and migration in a geographically defined population. This information is essential for policy development and resource distribution and service delivery. We aim to document the reasons for not counting PMNDs in our communities and demonstrate the usefulness of the Kintampo Health and Demographic Surveillance Systems (KHDSS) platform in counting PMNDs over time. We also documented strategies in providing vital information that helps in establishing the rights of PMNDs.MethodsAs a longitudinal study, psychiatric case register was established. Both quantitative and qualitative data collection techniques were used to solicit responses from stakeholders regarding the non-consideration of PMNDs as part of household membership in the study area. PMNDs were identified using the KHDSS and followed every 6 months. The “targeted” (actively searching for PMNDs) and “service provision” (providing medical treatment for PMNDs) approaches were adopted to enhance the identification of PMNDs.ResultsStigma was the main reason cited for the non-counting of PMNDs in the area. Following a “targeted” and “service provision” approach, the number of PMNDs enrolled into the psychiatric case register went up to 68% in 2010; as against the previous levels of 49 and 54% in 2005 and 2008 respectively. The study highlights the intrinsic value of such an approach for social inclusion of PMNDs.ConclusionsStigma against PMNDs was report in this study. We provided evidence that the KHDSS platform is useful for identification of PMNDs for service provision. The paper highlights evidence for policy formulation and implementation.

An integrative review of potential enablers and barriers to accessing mental health services in Ghana

“…The integrative review highlighted that there are existing support services that could facilitate access to mental health services for service users [ 29 , 33 , 36 , 39 , 40 , 42 – 45 ]. Generally, the support services were provided through formal and informal sources.…”

“…Generally, the support services were provided through formal and informal sources. Subsequently, the formal support services are provided through self-help groups, which include caregivers, service users, NGOs and professional associations [ 29 , 40 , 42 , 43 ]. For instance, until 2011, there were a total of eight NGOs or consumer associations working on mental health issues in Ghana (Ghana Mental Health Association, Mindfreedom, Alcoholics Anonymous, The Epilepsy Association, Basic Needs, World Vision, Psychomental Health International).…”

“…In addition, another community-based mental health project in the Kintampo district of Ghana supported the formation of self-help groups composed of people with mental illness and caregivers, and subsequently helped them employ a social determinants approach to managing mental illness [ 42 ]. Again, the support services provided by mental health professionals have the potential to facilitate access to mental health services.…”

“…The integrative review showed that the Government of Ghana is currently using a task-shifting policy to increase the number of mental health professionals required to facilitate the delivery of mental health [ 35 , 40 , 42 , 47 , 51 ]. Subsequently, two new programmes, including a Community Medicine and Clinical Psychiatry (CPOs) and Diploma in Community Mental Health (CMHOs), were introduced in 2011 [ 40 , 47 ].…”

“…For instance, a piloted Mental Health Project in the Kintampo District from 2004 to 2010 showed that task-shifting is increasingly effective to improve access to mental health treatment for service users. The piloted intervention trained general health workers and CPNs to conduct periodic community outreach programmes, assess and manage mental illness, and facilitated access to mental health treatment for service users, subsequently facilitating collaboration with traditional healers [ 42 ].…”