Providing Sustainable Mental and Neurological Health Care in Ghana and Kenya Workshop Summary (2016) / Chapter Skim
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3 Ghana
3 Ghana
Pages 33-50
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Asare, chair of the Mental Health Authority Board in Ghana. The treatment gap for mental health disorders in Ghana, said Sammy Ohene, senior lecturer and head of the department of psychiatry at the University of Ghana Medical School, is estimated to be more than 98 percent (WHO, 2007)
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From page 34... ...
Third, the act calls for collaboration with providers of traditional and faith-based medicine and provides for the monitoring of care of people with mental disorders in all facilities, including those operated by traditional and faith healers. The act also established a Mental Health Board, which is given the authority to propose and implement mental health policies in order to carry out the goals of the act.
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Asare projected that under the new Mental Health Act, a number of significant improvements will be made to mental health care in Ghana: • Mental health care will be decentralized and refocused on care in the community; • More inpatient and outpatient facilities will be available for men tal health; • Care will be integrated into primary care, and non–mental health workers will be given specific training in education, case detec tion, support, and referral; • Treatment protocols, including appropriate psychotropic medica tions, will be available for use in primary care; and • Traditional and faith healers will be given clear guidelines for practice and will be trained in regard to their obligations to hu man rights of patients. Overview of Challenges and Opportunities Ebenezer Appiah-Denkyira, director general of the Ghana Health Service, welcomed participants on behalf of the Minister of Health.
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One participant suggested that physically integrating the facilities for mental illness care into general facilities would give patients better access to both physical and mental health care, and it would help to destigmatize mental health. Several participants proposed undertaking a massive public education campaign that includes information about available services so that people know where to turn when faced with a mental health issue.
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BOX 3-1 Sustainable Mental Health Care in Ghana: A Potential Demonstration Project The demonstration project proposed by Julian Eaton, mental health advisor at CBM International, and Sammy Ohene, senior lecturer and head of the department of psychiatry at the University of Ghana Medical School, is based on a task-sharing model, in which greater clinical re sponsibility is given to less senior personnel, with appropriate training, supervision, and support. The project is a minimum 3-year effort, to be implemented in two districts in which district authorities and local part ners are willing to support the effort, there is a track record of success in other projects, and adequate human resources are available.
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The following sections outline the goals and strategies that many participants identified as potential components of demonstration projects.
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Traditional or faith healers are a common first option for those suffering from MNS disorders because the origin of mental health issues is generally seen as spiritual, said 3 This section draws on a commissioned paper, "Providing Sustainable Mental Health Care in Ghana: A Demonstration Project," by Julian Eaton and Sammy Ohene (see Appendix F)
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Goals and Potential Strategies Forward Several workshop participants identified a number of goals in the areas of diagnosis and treatment, and they developed specific strategies to address each of these goals as part of a mental health demonstration project. The suggestions ranged from garnering support and assistance both from the top levels of government and from local community and faith leaders, to improving treatment through enhanced training and use of protocols.
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Improving protocols and guidelines, training and supervision Refining and simplifying the mhGAP protocols to align with the Ghana health system: In order to address the lack of treatment protocols, Eaton suggested adapting WHO's mhGAP guidelines, which are designed for non-specialist health settings and provide protocols for clinical decision making, including psychosocial treatment. He emphasized that the mhGAP protocols required government buy-in to implement.
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Progress could be measured by developing metrics based on tracking trends on the number of faith healers who adhere to protocols; the amount of increased, accurate referrals to health care facilities; the overall number of functioning nonorthodox health care facilities; and observing the proportion of traditional and faith healers to mental health care workers, according to a few participants. Supporting families at home to look after affected relatives once discharged from service: Integrating patients back into their homes is a critical part of recovery, said many participants, and families need support to do this successfully.
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was established by the MoH to develop, manage, and coordinate the national drug policy, said Gyansa-Lutterodt. GNDP has developed an essential medicines list4 and standard treatment guidelines (STGs)
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Goals and Potential Strategies Forward Several workshop participants identified a number of goals in the area of access to medications, and they developed specific strategies to address each of these goals as part of a mental health demonstration project. The discussion focused on improving funding and the procurement process, and on ensuring the safety and quality of drugs once they are on the market.
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Many participants suggested several ways to ensure postmarket quality, including: enabling users to report quality concerns; requiring the Food and Drug Authority to perform postmarket surveillance; encouraging providers to report side effects; and empowering drug and therapeutic committees in the health facilities to monitor drug quality and adverse events. Stigma Stigma is a major barrier to care and treatment of MNS disorders in Ghana, stated many participants.
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Improving information and education surrounding mental health disorders Strengthening professional development training for health care workers and staff: Several participants observed that providers receive little education about mental health, and that some of the most acute stigma against people with mental health disorders is within the health profession. To this end, many participants suggested a comprehensive professional development program for providers that is designed to increase knowledge, improve skills, and boost compassion among health care workers.
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Kwadwo Obeng, psychiatry resident at Accra Psychiatric Hospital, noted that perhaps this suggestion was duplicative, as the government has already pledged to improve psychiatric facilities, but Pringle answered that a fast-moving demonstration project could provide a model for renovation that the government could use. Inadequate Mental Health Information Systems Lily Kpobi, assistant lecturer in the department of psychiatry at the University of Ghana School of Medicine and Dentistry, said that data on mental health needs in Ghana are often inconsistent and sometimes inaccurate, and she noted that this was partly due to outdated and inadequate record keeping and patient management systems.
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Kpobi stated that barriers specific to Ghana include a lack of privacy policies and security of data, poor Internet connectivity or electricity, lack of resources allocated to MHIS, and data that are entered inaccurately, late, or not at all. Goals and Potential Strategies Forward Several workshop participants identified a number of goals to develop and strengthen MHISs, and they developed specific strategies to address each of these goals as part of a mental health demonstration project.
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Several participants suggested that a survey be performed to assess provider knowledge of and attitudes toward MHIS and that knowledge and attitudes could be improved through training, continuing medical education, and involvement of providers in the system development. Developing a system that meets the needs of patients and providers Identifying and using appropriate indicators for mental health planning, monitoring, and evaluation: The indicators included for mental health issues must be appropriate not just for clinical use but also for communityor nationwide planning, monitoring, and evaluation, said several participants.
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