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.

Vincent Israel Opoku Agyapong,Conor Farren,Eilish McAuliffe

doi:10.1186/s12992-016-0199-z

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.

Highlights

The scarcity of mental health professionals places specialist psychiatric care out of the reach of most people in low and middle income countries
The bulk of modern mental health care at the community level in Ghana is currently provided by Community Mental Health Officers (CMHOs), Clinical Psychiatric Officers (CPOs) and Clinical Psychiatric Nurses (CPNs)
Results of the qualitative analysis Scope of work for the Community mental health worker (CMHW) The following themes and subthemes were identified in relation to psychiatrists and health policy directors’ perceptions about the role and scope of practice of CMHWs in Ghana: range of roles, task shifting value, and task shifting challenges

Summary

Introduction

The 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). There is the suggestion that there are some institutional and professional resistances to the introduction of task shifting models of care [25] Given this backdrop, our study aims to examine the perception of psychiatrists and health policy directors about the government’s policy of expanding mental health care delivery in Ghana through a system of task shifting and the role community mental health workers play as part of these task shifting arrangements. The research questions included: 1. Do psychiatrists and health policy directors in Ghana acknowledge that task shifting exists within the mental health delivery system and is the Government of Ghana committed to expanding mental health services care through task shifting?

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