Towards implementation of context-specific integrated district mental healthcare plans: A situation analysis of mental health services in five districts in Ghana

Background: Access to quality mental health services in Ghana remains poor, yet little is known about the extent of integrated mental health service provision in districts in Ghana. The purpose of the study was to conduct a situation analysis of integrated mental health service provision in five districts, to inform the development and implementation of tailored district mental healthcare plans in Ghana. Methods: A cross-sectional situation analysis was conducted using a standardised tool to collect secondary routine healthcare data supplemented with interviews with key informants across five purposively selected districts in Ghana. The PRIME (Programme for Improving Mental health care) situation analysis tool was adapted to the Ghanaian context and used for data collection. Results: The districts are predominantly rural; more than eight out of ten people in each selected districts live in rural areas. Mental Neurological and Substance use (MNS) conditions were not routinely reported in the top 10 causes of OPD attendance. Across all districts there are severe challenges with the provision of mental health care, primarily because of the slow enforcement of the mental health Act 2012 (Act 846). There are no mental health care plans, supervision of the few mental health professionals is weak and unstructured, access to regular supply of psychotropic medications is a major challenge, and psychological treatments are extremely limited given the lack of trained clinical psychologists. Data on treatment coverage was unavailable but we estimate this to be <0.5% for depression, schizophrenia, and epilepsy across districts. Nonetheless, opportunities for mental health systems strengthening were noted. These included commitment and willingness of leadership, the existence of a district health information management system, well-established network of community volunteers and some collaboration with traditional and faith-based mental health service providers. Conclusion: The baseline data from this situation analysis confirms the widely reported poor mental health infrastructure across Ghana and other Low and Middle-Income Countries. There are opportunities for strengthening mental health systems through interventions at the organisation/policy level, health facility, and community levels. A standardised situation analysis tool is useful to inform district level mental health care planning in low resource settings in Ghana and potentially other sub-Saharan African countries.

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