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The Mental Health System in Ghana

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The mental health system in Ghana Full Report Based on a survey conducted in 2012 using the World Health Organisation Assessment Instrument for Mental Health Systems (WHO-AIMS) for the year 2011. Published on behalf of The Ghana Ministry of Health by the Kintampo Project. Authors Dr Mark Roberts Professor Joseph B Asare Caroline Mogan Dr Emmanuel T Adjase Dr Akwasi Osei Published: June 2013 Authors Dr Mark Roberts Professor Joseph B Asare Dr Caroline Mogan Dr Emmanual T Adjase Dr Akwasi Osei Published: Spring 2013 www.moh-ghana.org www.thekintampoproject.org Full report from the survey conducted The mental health using the World Health Organisation Assessment Instrument for Mental Health Systems (WHO-AIMS) during system in Ghana 2011. Published in June 2013. All contents © The Kintampo Project 2013, all rights reserved. Note: data in this report will be subject to academic publication by the authors. THE MENTAL HEALTH SYSTEM IN GHANA | 2011 / 2012 Contents Foreword 6 Legal status of admissions to mental health services 25 Acknowledgments 7 Equity of distribution of inpatient beds 25 Number of patients treated 26 Executive Summary 8 Mental Health Services: Summary charts and tables 27 Introduction 13 3: Mental health in primary health care 34 Training in mental health care for primary care staff 34 Results 15 Mental health service provision in primary health care 35 Informal primary health care (faith-based 1: Policy, legislative framework, and traditional practitioners) 35 financing and human rights 16 Prescription in primary health care 36 Policy and plans 16 Legislation 17 4: Human resources 37 Financing of mental health services 17 Staff working in mental health services 37 Non-governmental funding for mental health in Ghana 17 Training mental health practitioners 43 Public funding for mental health in Ghana 18 Consumer associations, family associations, NGOs and other mental health projects / programmes 43 Monitoring of human rights 18 Access to psychotropic medicines 19 5: Public education and links Social insurance schemes 19 with other sectors 46 Legislative and financial provisions for persons Public education and awareness campaigns with mental disorders 19 on mental health 46 Links with other sectors 46 2: Mental health services 20 Preface 20 6: Monitoring and research 47 Organisation of Mental health data set 47 mental health services 20 Research 47 Outpatient services 21 Day treatment services 21 7: Strengths and weaknesses of the mental health system 48 General hospital / clinic-based psychiatric inpatient units 22 Strengths of the mental health system 48 Long stay residential services 24 Weaknesses of the mental health system 49 Mental hospitals 24 Other residential services 25 8: Comparison of Ghana with other low and middle income countries 52 4 / 5 www.thekintampoproject.org About the Kintampo Project Formed in 2007, the Kintampo Project is a partnership between the College of Health, Kintampo (Ghana) and Southern Health NHS Foundation Trust in Hampshire (UK). The Project is increasing the community mental health workforce in Ghana by training new health professionals, and ensuring sustainability by supporting graduates with professional development. In 2013, the health workers trained by the Kintampo Project accounted for 17% of the overall trained mental health workforce in Ghana. The Kintampo Project also lobbies the Ghanaian Government on mental health issues and works to better understand mental health provision in Ghana. www.thekintampoproject.org Presence of a mental health policy or plan 53 Abbreviations Spending on mental health 54 Outpatient treatment rates 54 CHAG Christian Health Association of Ghana Patients treated in psychiatric day services 55 Psychiatric beds in hospitals and clinics 55 CHRAJ Commission on Human Rights and Administrative Justice Admissions to psychiatric beds in hospitals and clinics 56 The balance of nursing to non-nursing staff in CMHO Community Mental Health hospital and clinic inpatient units 57 Officer Beds in mental hospitals 58 CoHK College of Health and Wellbeing, The balance of nursing to non-nursing staff in Kintampo mental hospitals and the ratios of staff to beds 59 CPN Community Psychiatric Nurse Long stay (‘residential’) facilities 60 CPO Clinical Psychiatric Officer Beds in other residential services 60 GDP Gross Domestic Product The cost of medication 61 The total number of mental health workers 61 GHS Ghana Health Service The number of psychiatrists needed for LAMICs Low- and middle-income 24.2 million people 62 countries The number of other staff needed for LICs Low income countries 24.2 million people 62 Refresher training 64 LMICs Low-middle income countries Patients treated 64 mhGAP Mental Health Gap Action Programme 9: Next steps in strengthening MICs Middle income countries the mental health system 65 PHC Primary Health Care Top level priorities 65 Detailed next steps 66 USD United States Dollars VSO Voluntary Service Overseas WHO-AIMS World Health Organisation References 69 Assessment Instrument for Mental Health Systems Appendix A: About the WHO-AIMS 70 WTE Whole time equivalent Appendix B: Glossary of terms and definitions 71 Appendix C: Regional data collectors 74 THE MENTAL HEALTH SYSTEM IN GHANA | 2011 / 2012 Foreword or the first time we have a comprehensive assessment and evaluation of mental health Fservices in Ghana based on a national survey using a standard instrument. WHO-AIMS was the instrument for this comprehensive survey. This instrument had earlier been used here but it was limited in scope and the findings generalised. This current survey is particularly important as it has been done at a time when a new mental health act has been enacted and the country is preparing towards its implementation. It is therefore important to have a baseline survey to enable us measure our progress after some time of implementation. For another reason a new cadre of mental health personnel has been produced, Clinical Psychiatric Officers (Physician Assistants in Psychiatry) and Community Mental Health Officers, to bolster the staff strength and fill gaps in our staffing situation. This survey will enable measurement of our success and contribution to care as a result of the introduction of these programmes. This current survey is This work is deeply appreciated and is further evidence of fruitfulness in collaboration with particularly important Southern Health NHS Foundation Trust in the UK, spearheaded by Dr Mark Roberts and the Kintampo as it has been done Project. at a time when a new May this survey mark the turn around of mental health care for the better in the country.” mental health act has been enacted...” Dr Akwasi Osei Chief Psychiatrist Mental Health Authority 6 / 7 www.thekintampoproject.org Acknowledgments his report is produced from a survey of the Joseph Nuertey (Regional Director, Ghana Health mental health system of Ghana conducted Service, Volta Region), Dr Angela Ofori Atta (Clinical Tin 2012 using the World Health Organisation Psychologist, University of Ghana Medical School), Assessment Instrument for Mental Health Systems Dr Sammy Ohene (Senior Lecturer in Psychiatry, (WHO-AIMS). The survey was coordinated by University of Ghana Medical School) and Mr Peter Professor. JB Asare (WHO-AIMS in-country Focal Yaro (Executive Director, BasicNeeds Ghana). Point), Caroline Mogan (WHO-AIMS Project Manager We thank the Community Mental Health Officers and Lead Researcher), Abena Anokyewaa Sarfo and mental health preceptors who assisted in the (WHO-AIMS Research Assistant), Dr Mark Roberts data collection, a full list of those involved can be (UK Lead, The Kintampo Project), Dr ET Adjase seen in Appendix C. (Director, Kintampo College of Health) and Dr Akwasi Osei (Chief Psychiatrist of Ghana Health Specific thanks are extended to the College of Service). Health and Wellbeing, Kintampo without which the survey would not have been possible. The The WHO-AIMS survey would not have been College provided administrative support throughout, possible without the generous financial support of conducted training for data collectors, arranged the Ghana Ministry of Health and the UK Health meetings, conferences, travel and much more Partnership Scheme. The Health Partnership Scheme is funded by the UK Department for The document was designed by Tom Westbury, International Development (DFID) and managed by Kintampo Project Communications Manager. the Tropical Health & Education Trust (THET). We The World Health Organisation Assessment are grateful for the continuous collaboration of the Instrument for Mental Health Systems (WHO- Ministry of Health, Ghana Health Service, mental AIMS), the primary data collection method for this health practitioners throughout Ghana, Ministry of assessment, was developed by the Mental Health Education, Ghana Police Service and Ghana Prisons Evidence and Research team of the Department of Service. We thank all Regional Directors of Ghana Mental Health and Substance Abuse, World Health Health Service, The Chief Director of The Ministry of Organisation (WHO), Geneva, in collaboration with Health and the Honourable R Mettle-Nunoo Deputy colleagues inside and outside of the WHO. For full Minister for Health. information on the WHO-AIMS instrument please We thank senior stakeholders who reviewed the see Appendix A, or refer to the following website: report: Dr Armah Arloo (Director, Ankaful Psychiatric www.who.int/mental_health/evidence/WHO-AIMS Hospital), Dr Koku Awoonor-Williams (Regional Director, Ghana Health Service,
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