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Introduction: Evaluation frameworks are relevant to understanding health service providers’ views regarding existing services and possible improvements, but their application to mental health services is limited, particularly in Low Middle-Income Countries. Aim/Question: To identify program theory for understanding contextual factors and mechanisms that could enhance mental health service outcomes in Ghana. Method A three-phase approach was followed: initial theory and assumption, analysis, and CMO configuration. Systematic reviews were used to develop a middle-range theory and assumptions in phase 1. A purposive sample of 30 mental health professionals was recruited to participate in in-depth interviews in phase 2. Thematic analysis was used to analyze the qualitative data and further configure the CMO in phase 3. Results The analysis identified five CMO configurations: ripple effects and financing source sustainability; unavailability of modern equipment and logistics to support holistic services; promoting inclusivity and geographical proximity of services; information, sensitization, and awareness encourage mental health quality; and monitoring and evaluating improve mental health service quality. Discussion/Implications for Practice: This study concludes that government stakeholders should integrate mental health services into the ongoing insurance policy and provide adequate modern equipment and logistics. Moreover, mechanisms and priorities given to vulnerable consumers should be integrated into policies.

Background Despite growing recognition of essential human rights, people with mental health conditions and psychosocial, intellectual, or cognitive disabilities’ rights are known to be frequently violated in mental healthcare worldwide, with common use of coercive practices and limited recognition of people’s right to exercise their legal capacity and make decisions for themselves on treatment and other issues affecting them. To tackle this issue, Ghana adopted the WHO QualityRights Initiative in 2019. This aims to introduce a right-based, person-centred recovery approach within the mental health care system, protecting and promoting the rights of people with mental health conditions, psychosocial, cognitive, and intellectual disabilities in the healthcare context and community. Methods E-training (capacity-building) was provided in Ghana across a broad array of stakeholder groups including healthcare professionals, carers, and people with lived experience. The training covered legal capacity, coercion, community inclusion, recovery approach, service environment, and the negative attitudes commonly held by stakeholder groups; it was completed by 17,000 people in Ghana as of December 2021. We assessed the impact of the e-training on attitudes through comparing trainees’ pre- and post-questionnaire responses on 17 items, each measured on a 5-point Likert scale (strongly disagree to strongly agree), such that higher scores indicated negative attitudes towards persons with mental health conditions and psychosocial disabilities as rights holders. Analyses were conducted on two main groups: matched pairs (417 pairs of baseline and follow-up questionnaire responses matched to a high degree of certainty), and the unmatched group (4299 individual completed questionnaire responses). Results We assessed the impact of the WHO QualityRights e-training on attitudes: training resulted in highly significant attitude changes towards alignment with human rights, with scores changing by approximately 40% between baseline and follow-up. In particular, attitude changes were seen in items representing treatment choice, legal capacity, and coercion. This change was not affected by age, gender, or background experience. Conclusions The QualityRights e-training programme is effective in changing people’s (especially healthcare professionals’) attitudes towards people with mental health conditions and psychosocial, intellectual, or cognitive disabilities: this is a step towards mental healthcare being more with human rights-based worldwide.

Background Evidence-based clinical practice is an inherent component of mental health professional practice in developed countries. However, little is known about professional perspectives of evidence-based practice in mental in developing countries such as Ghana. This paper describes the processes involved in the delivery of best practice in Ghana. The paper reports on a realistic evaluation of mental health nurses and allied health professionals’ views on the evidence-based therapeutic process in Ghana. Methods A purposive sample of 30 mental health professionals (MHPs) was recruited to participate in semi-structured, in-depth interviews. Thematic analysis was used to analyse the data. A program theory of Context + Mechanism = Outcome (CMO) configuration was developed from the analysis. Results The thematic analysis identified two contexts, mechanism and outcome configurations (themes): 1) technical competency stimulates evidence-based mental health services, and 2) therapeutic relationship building ensures effective interaction. The study demonstrates that contextual factors (technical competencies and therapeutic relationship building) together with mechanisms (intentional and unintentional) help to promote quality in mental health service provision. However, contextual factors such as a lack of sign language interpreters yielded unintended outcomes including barriers to communication with providers for consumers with hearing impairment and those from linguistic minority backgrounds. Conclusion Government stakeholders and policymakers should prioritise policies, periodic monitoring and adequate financial incentives to support the mechanisms that promote technical competence in MHPs and the building of therapeutic relationship.

SummaryPsychiatrists have an essential role to play in promoting human rights in mental healthcare. The World Health Organization's QualityRights initiative, in partnership with different stakeholders, is improving the quality of psychiatric care in different countries.

Nursing is a profession in the health care sector that is pivotal and solely focused on servinghumanity. With having to carry that burden, issues regarding mental health among nurseshave been increasing. Stress is often encountered by nurses in the workplace, whicheventually leads to burnout. Initial evidence suggests that a positive or an increase inpsychosocial well-being increases job satisfaction. The purpose of the study was to examinethe relationship between psychosocial wellbeing and job satisfaction. and examine thesignificant difference in psychological wellbeing and job satisfaction when considering age.Correlational design utilized was used where 100 registered nurses were a purposive samplefrom selected hospitals in the philippines. Psychosocial well-being was measured using CarolRyff’s Psychosocial Well-Being Questionnaire, and job satisfaction was measured using theJob Satisfaction Survey (JSS) by Paul Specter. The statistical treatment used was Pearsoncorrelation, T-Test to address the research questions. The results of the study showed thatthere was a low positive significant relationship between psychosocial wellbeing and jobsatisfaction. There was no significant difference in psychosocial wellbeing and jobsatisfaction when age was considered. The results of the study showed that registered nurseshave high psychosocial wellbeing and which makes them have high job satisfaction at theirwork environment. The study recommends that more studies should be done to identifyfactors influencing psychosocial well-being, job satisfaction, Resilience-oriented training forthe nurses are suggested to enhance resilience and protect the nurses from extensive stressand burnout as well as to benefit the organization with lower turnover rates and higher nursepatient outcome.

The global population is continuously emigrating and progressing due to the increased abilityto travel. This has resulted in upsurge escalation of cultural diversity in every country.Immigration expansion, increasing globalization and the growth of minorities have resulted incultural diversity of students in the nursing education. This, therefore, calls for the need toenhance the teaching strategies of nursing educators to meet the demands of diverse students.This correlational study aims to measure the relationship between the integration ofintercultural competence on the use of innovative pedagogical methodology. Also, it aims tomeasure the significant difference of years of teaching experience on the use of innovativepedagogical methodology. Thirty (30) nurse educators were conveniently sampled from threeuniversities in Trinidad and Tobago. The study adopted and modified Cultural DiversityQuestionnaire for Nurse Educators (CDQN) to assess the intercultural competence of nurseeducators and a self-constructed questionnaire was used for the pedagogical methodology ofnurse educators. The statistical treatment used was Pearson Correlation and ANOVA. Therelationship between intercultural competence and the use of innovative pedagogicalmethodology yielded a moderate significant positive relationship (r=0.387, p=0.008) at a95% confidence interval. In examining the differences between years of teaching experiencethe use of innovative pedagogical methodology, the study showed a non-significantdifference (p=1.35) on equal variance assumed, Therefore, this study concludes that in orderto enhance the quality of nursing education, nurse educators should pose interculturalcompetence in order to provide innovative pedagogical methods that would enhance teachingquality and facilitate cultural diversity in the classrooms. It is therefore critical for continuousprofessional development for nursing educators to include the development of interculturalcompetence and the use of innovative pedagogical methodology. Further research shouldinvestigate using qualitative research design on the challenges that nurse educators face withthe increase of cultural diversity in nursing education.

Self-care management has become a theoretical discussion among health professional andstudents. As a result of its importance, the International Council for Nurses has incorporatedit in their standard of competence. Self-care encourages health and is a fundamental value ofthe scope and standards of practice. Nursing students are advised to have proper self-care. Thisstudy looked into the self-care management practices of nursing students at the AdventistUniversity of the Philippines and how they align with the institutional outcomes. Thisquantitative study conveniently samples 47 nursing students as respondents. The study adoptedthe Circle of Human Potential ' questionnaire by Dossey and Keegan (2009), which assessedself-care management in the areas of physical, relationship, emotional, spiritual, mental, andchoice. The application fo SPSS 23 was used for the descriptive and T’Test analysis asdemanded by the research questions. The results of the study revealed that there is a positiveself-care management attitude among nursing students. The ranked of self-care managementfrom highest to the least in the order of spiritual, mental, emotional, relational, choice, andphysical assessments. It further revealed that there was no significant difference in self-caremanagement when considering the gender of the students. The outcomes of the study were inaccordance with the AUP institutional outcomes of spirituality, critical thinking, professionalexpertise, service, health and wellness, and positive attitude. The study recommends thatnursing students keep up with their positive self-care management.

In the healthcare sector, nurses provide health care services to different clients which can resultin compassion fatigue. The resilience of nurses helps to provide control of compassion fatigue.The purpose of this study is to examine if there is a relationship between resilience andcompassion fatigue and also find a significant difference in resilience and compassion fatiguein terms of sex, age, and clinical experience. Correlational research design was utilized where249 registered nurses were conveniently sampled from Ghana. The study utilized a Resiliencequestionnaire Scale developed by Wagnild and Young (2010) and Professional quality of life(ProQOL) scale developed by Stamm (2010) was adapted and modified for compassion fatigue.The statistical treatments used were and Pearson Correlation, T-Test and ANOVA to addressthe research questions. The study showed that there was a high positive significant relationshipbetween resilience and compassion fatigue. There was a significant difference in age and sexon compassion fatigue however, no significant on clinical experience. Sex and clinicalexperience showed a significant difference in resilience but no significant difference when agewas considered. The results of the study suggest that registered nurses in Ghana experiencehigh compassion fatigue. In preventing the compassion fatigue of the nurse's measures shouldbe instituted to increase the resilience level of the nurses. Healthcare administrators should putin measures to reduce the compassion fatigue of the nurses. Further researchers should exploreother variables in relation to the resilience to help reduce the compassion fatigue of nurses

Throughout hospitalization, patients place emphasis on health professionals to meet theirspiritual and emotional needs. Since 1998, the National Inpatient Priority Index rankedemotional and spiritual needs as the patient's second priority. With evidence that shows theimportance of spirituality in patient’s health, nurses have a pivotal role in providing spiritualcare. The purpose of this study was to examine the perception of nurses of spiritual care practiceamong hospitalized patients. The study used a descriptive research design to examine nurses’perception of spiritual care practices among hospitalized patients. The study was conductedamong registered nurses (RN) working in Ghana. Convenient sampling technique was used toselect 180 registered nurses. The study adopted and modified Nurse Spiritual Care TherapeuticScale developed by Mamier and Taylor (2015). The results showed that the respondent’spractices in terms of spiritual assessment were scaled as sometimes (M=3.12, SD=0.85). Therespondent’s practices in terms of spiritual support were scaled as sometimes (M=2.62,SD=0.88). The respondent’s practices in terms of spiritual communication were scaled as often(M=3.55, SD=0.69). In examining the nurses' overall spiritual care practice, it was noted thatthe respondent’s practices in terms of spiritual care were scaled at sometimes (M=3.12,SD=0.707). It can be concluded that spiritual care in terms of spiritual assessment and spiritualsupport was inadequate. Nurses provided adequate spiritual communication with the patientsby actively listening to the patient’s illness story. A program under the theme “Caring beyondthe Physical” was developed to address the problem of spiritual care among nurses. It isrecommended for administrators and clinical nursing educators to utilize this research andprogram in providing ongoing training for nurses in providing spiritual care. Secondly, furtherstudies are recommended to be done to examine whether the personal profile has a significantdifference in the use of spiritual care.

Continuous Professional Development offers nurses the opportunity to improve theirknowledge, skills and also improve their performance in the healthcare setting. The purpose ofthe study was to examine if there is a relationship between continuous ProfessionalDevelopment and Job Performance and also finds if there is a significant difference of jobperformance when sex, age, and clinical experience. Correlational research design was utilizedwhere 164 registered nurses were conveniently sampled from Ghana. The study utilized selfconstructed survey questionnaire was for continuous professional development and SixDimension Scale of Nursing Performance (SDNS) developed by Schwirian, (1978) wasadopted and modified to measure the job performances of nurses. The statistical treatmentsused were Pearson Correlation, T-Test, and ANOVA to address the research questions. Thestudy showed that there was a moderate positive significant relationship between continuingprofessional development and job. There was no significant difference in job performancewhen age, sex, and clinical experience were considered. Healthcare administrators shouldencourage and advocate for the participation of nurses in continuous learning to improve nursestheir knowledge and skills on nurses. Institution policies should be properly aligned to helpnurses in the participation of professional roles. Further research should explore other variablesin relations to continuous professional development to improve the job performance of nurses.

Background In 2012, Ghana ratified the United Nations Convention on the Rights of Persons with Disabilities and enacted a Mental Health Act to improve the quality of mental health care and stop human rights violations against people with mental health conditions. In line with these objectives, Ghanaian stakeholders collected data on the quality of mental health services and respect for human rights in psychiatric facilities to identify challenges and gather useful information for the development of plans aimed to improve the quality of the services offered. This study aimed to assess psychiatric facilities from different Ghanaian regions and provide evidence on the quality of care and respect of human rights in mental health services. Methods Assessments were conducted by independent visiting committees that collected data through observation, review of documentation, and interviews with service users, staff, and carers, and provided scores using the World Health Organization QualityRights Toolkit methodology. Results This study revealed significant key challenges in the implementation of the United Nations Convention on the Rights of Persons with Disabilities principles in Ghanaian psychiatric services. The rights to an adequate standard of living and enjoyment of the highest attainable standard of health were not fully promoted. Only initial steps had been taken to guarantee the right to exercise legal capacity and the right to personal liberty and security. Significant gaps in the promotion of the right to live independently and be included in the community were identified. Conclusions This study identifies shortcomings and critical areas that the Ghanaian government and facilities need to target for implementing a human rights-based approach in mental health and improve the quality of mental health care throughout the country.

Integrating consumers' experiences into quality mental health service assessment is relevant to improve service outcomes. Despite this, limited studies have attempted to explore consumers' experiences, particularly in developing countries, such as Ghana. This paper aims to explore consumers' subjective experiences of the quality of mental health services. A qualitative method involving in-depth interviews was used to collect data from 21 consumers of mental health services. Thematic analysis was used to analyse the data, which is discussed using a realistic evaluation approach. The study identifies four themes, 33 inductive codes and 594 references. The themes used to interpret the verbatim narratives are the available mental health services, therapeutic interaction with the professionals, competency and skills of the professionals, and the changes experienced in the consumers' lives. The study indicates that the mental health services aim to provide a range of treatments and medications as well as recovery-oriented services, using mechanisms such as ensuring an effective therapeutic relationship and improving technical competency and skills. The contextual factors and the mechanisms have helped to achieve some changes in the lives of consumers (increased satisfaction, reduced symptoms, improved functionality, feeling normal, improved living skills and self-care, work and capabilities, and social inclusion). The study concludes that policymakers and clinicians should integrate evidence-based recovery services, principles and values into the existing mental health services. The mechanisms used to promote quality of mental health services should be strengthened, through periodic monitoring and evaluation, using approaches such as sensor data capturing, to ensure good coordination and continuity.

Purpose Assess factors associated with the quality of mental health services. Design and methods Cross-sectional design, quantitative data, and 510 consumers from three psychiatric facilities. Results The average age of consumers was 34 years and 51.57% males. Consumers reported mixed satisfaction with the quality of mental health services (mean = 3.2; SD = 0.56) but were dissatisfied with the range of interventions (mean = 1.57; SD = 0.77). Predisposing (age, education, and primary occupation), enabling (insurance status), and need factors (mental health status) were significantly associated with quality indicators (range of interventions, efficacy, and overall satisfaction). These factors were significantly associated with consumers' functionality (cognition, mobility, self-care, getting along, life activities, and participation). Practice implications Policymakers and clinicians are encouraged to incorporate the predisposing, enabling, and need factors into mental health planning, monitoring, and advocacy to improve service outcomes.

The World Health Disability Assessment Scale (WHODAS-2.0) has widely been accepted as the standard measure of disability. However, psychometric testing is mostly performed in developed countries. This paper aims to assess the psychometric properties (reliability, validity) of the WHODAS-2.0 among consumers of mental health services in Ghana. Two translators (expert in English language and Akan language) performed forward and backward translation of the WHODAS-2.0 from English language to Ghanaian language (Twi). A total of 510 consumers of mental health services were recruited consecutively to complete the WHODAS-2.0 using RedCAP. Confirmatory factor analysis was used to analyse the data. All domains in the 6-factor solutions had excellent internal consistency (ω = 0.90-0.98), sufficient convergent validity and had satisfactory discriminant validity except for domain on participation. The CFA model confirmed that the data had a good model fit, CFI = 0.97, TLI = 0.96, RMESA = 0.05, RMR = 0.03; NFI = 0.94; χ2 = 1243.8, df = 529, P

Background Evidence-based clinical practice is an inherent component of developed countries mental health professional practice, however, little is known about Ghana mental health professional perspectives on evidence-based practice. This paper outlines the processes involved in the delivery of best practice in Ghana. The paper describes a realistic evaluation of mental health nurses and allied health opinions regarding the evidenced-based therapeutic process in Ghana mental health facilities. Methods A purposive sample of 30 Mental Health Professionals (MHPs) was recruited to participate in semi-structured in-depth interviews. Thematic analysis was used to analyse the data. A programme theory of Context + Mechanism = Outcome (CMO) configuration was developed from the analysis. Results The thematic analysis identified two CMO configurations: 1) technical competency stimulates evidence-based mental health services; and, 2) therapeutic alliance-building ensures effective interaction. The study demonstrated that contextual factors (technical competencies and therapeutic alliance building) together with mechanisms (intentional and unintentional) help to promote the quality of mental health services. However, contextual factor such as the lack of sign language interpreters yielded an unintended outcome such as consumer-provider communication barrier for consumers with hearing impaired and those from linguistically minority background. Conclusion We conclude that government stakeholders and policymakers should prioritize policy documents, periodic monitoring and adequate financial incentives to support the on-going mechanisms that promote mental health professional technical competence and therapeutic alliance building.

The authors assess the impact of Ghanaian diaspora-based psychiatrists’ participation in clinical teaching in Ghana on the attitudes of medical students toward careers in psychiatry. This quantitative cross-sectional study involved fifth- and sixth-year medical students of the four public medical schools in Ghana. Data were analyzed with descriptive and inferential statistics. About half (49.7%) of clinical year medical students in Ghana reported that diaspora-based Ghanaian psychiatrists participated in their teaching during their clinical psychiatry rotation. A significantly higher proportion of medical students who had diaspora-based psychiatrists participate in their clinical training expressed that the depth of clinical teaching (54.4% vs. 45.6%, p = 0.003) and the extent of experience gained during their psychiatric rotations (54.7% vs. 45.3%, p = 0.001) were adequate or somewhat adequate when compared with medical students who did not have diaspora psychiatrists participate in their clinical training. Medical students who had diaspora-based Ghanaian psychiatrists participate in their teaching were significantly more likely to consider careers in psychiatry after their clinical rotation (42.2% versus 25.6%, χ2 = 16.2, p = 0.00). In a low-resource country with few psychiatrists, the involvement of diaspora-based psychiatrists in the teaching of clinical year medical students has the potential to improve the global experience and attitude of the medical students toward psychiatry.

Clinical trials have been conducted almost wholly in high-income countries until recently, yet their results may not always be valid or applicable in middle- and low-income countries. Clinical trials are now, though, increasingly being done in less wealthy countries. While this is welcome, there is a need to ensure the profit motive does not override the benefits. Partnership with local counterparts while adhering to international standards should help to maintain high-quality output from clinical trials.

ObjectivesTo assess the perception of Ghanaian medical students about factors influencing their career interest in psychiatry and to explore gender differences in these perceptions.MethodsThis is a cross-sectional quantitative survey of 5th and 6th year medical students in four public medical schools in Ghana. Data were analyzed with descriptive and inferential statistics using SPSS version 20.ResultsResponses were obtained from 545 medical students (response rate of 52%). Significantly, more male medical students expressed that stigma is an important consideration for them to choose or not to choose a career in psychiatry compared to their female counterparts (42.7%v.29.7%, respectively). Over two-thirds of the medical students perceived that psychiatrists were at risk of being attacked by their patients, with just a little over a third expressing that risk was an important consideration for them to choose a career in psychiatry. There were no gender differences regarding perceptions about risk. Around 3 to 4 out of 10 medical students will consider careers in psychiatry if offered various incentives with no gender differences in responses provided.ConclusionOur study presents important and novel findings in the Ghanaian context, which can assist health policy planners and medical training institutions in Ghana to formulate policies and programs that will increase the number of psychiatry residents and thereby increase the psychiatrist-to-patient ratio in Ghana.

The psychiatrist workforce has been identified as an area in need of development, especially in low- to middle-income countries. The purpose of this project is to assess the perceptions of Ghanaian medical students of a novel mental health inter-medical school speaking competition on career interest in psychiatry and mental health education and advocacy. The study employed quantitative and qualitative methods in a cross-sectional design. A paper-based survey was administered to medical students from four schools in Ghana, and focus groups were conducted. A 52% response rate (545/1041 fifth- and sixth-year medical students from the four public medical schools in Ghana) was achieved. The competition was successful in stimulating interest in psychiatry as a subject (25%) and as a career (14%) and was viewed as serving an important public health and mental health advocacy function (65% and 66% respectively). The competition stimulated interest in students who were undecided or had previously ruled out psychiatry specialization, in both those who had and had not already completed a psychiatry clerkship (23% and 13% before and after completing a clinical rotation in psychiatry, respectively). Overall, 29% of respondents who participated in at least one competition-related activity reported that the competition stimulated their interest in psychiatry, compared to 4% who did not participate in any competition-related activity (Ӽ2 = 80, p = 0.0). Analysis of focus group content echoed these themes and highlighted opportunities for improvement. The innovative public speaking competition was successful in stimulating interest in psychiatry and furthering mental health education and advocacy. Implications are discussed.

There is growing interest in the effectiveness of task shifting as a strategy for addressing expanding health care challenges in settings with shortages of qualified health personnel. The aim of this study is to examine the perception of stakeholders about the adequacy of training, supervision and support offered to community mental health workers (CMHWs) in Ghana. To address this aim we designed and administered self-completed, semi-structured questionnaires adapted to three specific stakeholder groups in Ghana. The questionnaires were administered to 11 psychiatrists, 29 health policy implementers/coordinators and 164 CMHWs, across Ghana, including 71 (43.3%) Community Psychiatric Nurses (CPNs), 19 (11.6%) Clinical Psychiatric Officers (CPOs) and 74 (45.1%) Community Mental Health Officers (CMHOs). Almost all the stakeholders believed CMHWs in Ghana receive adequate training for the role they are expected to play although many identify some gaps in the training of these mental health workers for the expanded roles they actually play. There were statistically significant differences between the different CMHW groups and the types of in-service training they said they had attended, the frequency with which their work was supervised, and the frequency with which they received feedback from supervisors. CPOs were more likely to attend all the different kinds of in-service training than CMHOs and CPNs, while CMHOs were more likely than CPOs and CPNs to report that their work is never supervised or that they rarely or never receive feedback from supervisors. There was disparity between what CMHWs said were their experiences and the perception of policy makers with respect to the types of in-service training that is available to CMHWs. There is a need to review the task shifting arrangements, perhaps with a view to expanding it to include more responsibilities, and therefore review the curriculum of the training institution for CMHWs and also to offer them regular in-service training and formal supervision.

This study compares 20 subjects, in each of three different settings, with serious psychotic disorder (they meet inclusion criteria for schizophrenia) who hear voices, and compares their voice-hearing experience. We find that while there is much that is similar, there are notable differences in the kinds of voices that people seem to experience. In a California sample, people were more likely to describe their voices as intrusive unreal thoughts; in the South Indian sample, they were more likely to describe them as providing useful guidance; and in our West African sample, they were more likely to describe them as morally good and causally powerful. What we think we may be observing is that people who fall ill with serious psychotic disorder pay selective attention to a constant stream of many different auditory and quasi-auditory events because of different "cultural invitations"-variations in ways of thinking about minds, persons, spirits and so forth. Such a process is consistent with processes described in the cognitive psychology and psychiatric anthropology literature, but not yet described or understood with respect to cultural variations in auditory hallucinations. We call this process "social kindling."

Objectives To examine the perceptions of stakeholders about the ease of referral of patients from community mental health workers (CMHWs) to psychiatrists in Ghana and the level of stakeholder concerns about the quality of care provided to these community health cadres. Design A cross-sectional survey. Participants Eleven psychiatrists, 26 health policy directors and 164 community mental health workers, including 71 (43.3%) community psychiatric nurses, 19 (11.6%) clinical psychiatric officers and 74 (45.1%) community mental health officers. Methods We administered three separate, self-administered, semi-structured questionnaires to the study participants. Results Although many respondents including almost all CMHWs perceive that it is easy for them to refer difficult cases to a psychiatrist who will usually see such patients in a timely manner, less than a quarter of these health cadres reported that they always or often refer patients to see a psychiatrist. The majority of CMHWs were of the opinion that patients, psychiatrists and other healthcare workers have concerns about the quality of care they provide, sentiments that were echoed by all psychiatrists and over half of all the health policy directors. Conclusion There is also a need for policy directors to educate CMHWs about their roles and to clarify referral pathways so that cases that are difficult to manage will be appropriately referred to psychiatrists or appropriately trained and incentivized district medical doctors for further management.

Stigma associated with any chronic disease is one of the greatest challenges to the treatment of the disease. Stigma in health is a complex concept, and it causes people with a stigmatizing disease to conceal their disorder. Epilepsy is one such condition with numerous outdated, sometimes inhumane, and sometimes absurd perceptions that tend to fuel its stigma. Health-care workers who participated in an epilepsy training program as part of a World Health Organization/Ghana Health Service collaboration were asked to compile the perceptions associated with epilepsy in their communities. The comments they gathered are presented here.

PurposeThe purpose of this paper is to provide detailed assessments of the mental health laws of Ghana, South Africa, Uganda and Zambia.Design/methodology/approachThe mental health laws of four countries were assessed both by country partners and staff of WHO, Geneva, using the World Health Organization (WHO) Checklist on Mental Health Legislation, which examines the level of coverage of key issues in mental health laws.FindingsThe older laws of Ghana, Uganda and Zambia do not address fundamental human rights of people with mental health conditions. South Africa's more recent Mental Health Care Act (2002) incorporates critical human rights standards, though certain provisions fail to adequately safeguard against potential violations. For mental health legislation to maintain currency with human rights standards it must be regularly reviewed and updated.Originality/valueThe findings highlight the urgent need to revise the mental health laws of Zambia, Uganda and Ghana, and to plan ways to address the gaps identified in the relatively new South African mental health law. The entry into force of the United Nations Convention on the Rights of Persons with Disabilities in 2008 signals a new era in how mental health legislation is to be drafted. The identification of gaps in national laws, as has been undertaken by the four countries, is an important first step towards putting in place legal frameworks to promote the rights of people with mental health conditions in line with current international human rights standards.

Despite radical health transformations in Zambia over the last decade, mental health continues to be marginalized, as reflected in the un-coordinated and under-resourced mental health care system. This paper presents the qualitative results of a situation analysis conducted as part of the first phase of the Mental Health and Poverty Project. The aim of this paper was to explore what a range of stakeholders perceive as the main challenges facing Zambia's mental health system and the primary ways of addressing them. Fifty interviews and six focus group discussions were held with policy makers in and outside of the ministry of health, general and mental health care professionals, users of psychiatric services, teachers, police officers, academics, members of three NGOs and traditional healers. The major challenges identified included: marginalization of mental health; flawed policy development; outdated and harmful legislation; human rights abuses, including stigma; limited mental health services; and inadeq...

Background : Because of the absence of adequate numbers of psychiatrists, the bulk of mental health care at the community level in Ghana is provided by community mental health workers (CMHWs). Objective : To examine the role and scope of practice of CMHWs in Ghana from their own perspectives and to make recommendations to improve the care they provide. Design : We conducted a cross-sectional survey of 164 CMHWs from all the 10 administrative regions of Ghana, comprising 71 (43.3%) community psychiatric nurses (CPNs), 19 (11.6%) clinical psychiatric officers (CPOs), and 74 (45.1%) community mental health officers (CMHOs). Results : Overall, only 39 (23.8%) CMHWs worked closely with psychiatrists, 64 (39%) worked closely with social workers, 46 (28%) worked closely with psychologists and 13 (7.9%) worked closely with occupational therapists. A lower proportion of CMHOs worked closely with psychiatrists, psychologists, and social workers compared with CPOs and CPNs. There was no significant difference in the proportion of the different CMHW types who expressed confidence in their ability to diagnose any of the commonly named mental health conditions except personality disorders. However, a lower proportion of CMHOs than CPOs and CPNs expressed confidence in their ability to treat all the disorders. The CMHWs ranked schizophrenia as the most frequently treated mental health condition and there was no statistically significant difference in the reported frequency with which the three groups of CMHWs treated any of the mental health conditions. Conclusions : Mental health policy makers and coordinators need to thoroughly review the training curriculum and also evaluate the job descriptions of all CMHWs in Ghana to ensure that they are consistent with the demands and health-care needs of patients they care for in their communities. For example, as CMHOs and CPNs prescribe medication even though they are not expected to do so, it may be worth exploring the merits of including the prescription of common psychotropic medication in their training curriculum and job descriptions. Keywords: community mental health workers; role; scope of work; mental health (Published: 9 October 2015) Citation: Glob Health Action 2015, 8 : 28955 - http://dx.doi.org/10.3402/gha.v8.28955 Supplementary materials: To access the supplementary material for this article, please see Supplementary files under ‘Article Tools’

Despite the high rates of depression and anxiety disorders amongst women, the mental health of women is a neglected area, particularly in Africa. This study sought to explore what key stakeholders perceive as the main causes of mental illness in women in Ghana. Using qualitative methods, 81 semi-structured interviews and seven focus group discussions were conducted with 120 key stakeholders drawn from 5 of the 10 regions in Ghana. The analysis was undertaken using a grounded theory approach. Respondents attributed mental illness in women to a number of causes. These included women being the weaker sex, hormones, witchcraft, adultery, abuse and poverty. Explanations could be clustered under three broad categories: women's inherent vulnerability, witchcraft, and gender disadvantage. The way in which women's subordinate position within society may underpin their mental distress needs to be recognized and addressed. The results from this study offer opportunities to identify how policy can better recognize, accommodate and address the mental health needs of women in Ghana and other low-income African countries.

The lack of metrics to assess clamshell formation dredgeability limits the ability of engineers to predict the dredgeability of compact material and increases the risks associated with clamshell selection. Work done and motor energy are possible dredgeability metrics that can be estimated using micro–processor based machine monitoring. The objective of this work was to test the hypotheses that work done by the pistons during dredging, by a hydraulically actuated dredge, is a better predictor of clamshell dredgeability than motor energy. The research hypothesis was tested by comparing the measure of uncertainty surrounding mean estimates and the coefficient of variation. From this work, it can be concluded that work done is a better predictor of formation dredgeability than motor energy.

Background Whilst there have been several studies exploring retention in health workers, little is known about health workers engaged in the provision of mental health services and the factors that affect their recruitment and retention. Aims The objective of this research was to examine the views of stakeholders about the factors which influence career choices and retention of community mental health workers (CMHWs) in Ghana. Methods We administered three separate, self-administered, semi-structured questionnaires to 11 psychiatrists, 29 health policy directors and 164 CMHWs across Ghana, including 71 (43.3%) community psychiatric nurses (CPNs), 19 (11.6%) clinical psychiatric officers (CPOs) and 74 (45.1%) community mental health officers (CMHOs). Results Overall, 34 (20.7%) of all CMHWs chose to work in mental health because of the job prospects in mental healthcare. Overall, 12 (16.2%) CMHOs, 1 (5.3%) CPO and 20 (28.2%) CPNs reported they had considered leaving the mental health profession because of the stigma, with 4 (36.4%) psychiatrists and 12 (41.4%) health policy coordinators also reporting that they knew some CMHWs who had considered leaving the mental health profession because of stigma. Similarly, 16 (21.6%) CMHOs, 4 (22.1%) CPOs and 38 (53.5%) CPNs said they had considered leaving the mental health profession because of concerns about risk. Furthermore, 6 (54.5%) psychiatrists and 3 (10.3%) health policy directors said they knew some CMHWs who had considered leaving the mental health profession because of concerns about risk. Overall, 61 (37.2%) of CMHWs reported that they have considered leaving the mental health profession for other reasons other than stigma and risk including the following: the lack of support, respect and recognition from healthcare managers, lack of opportunities for professional development and poor conditions of service including low salaries, lack of office and personal accommodation and lack of risk allowance and transportation as well as poor inter-professional relationships. Conclusions Several factors affect the recruitment and retention of CMHWs in Ghana, including the prospects of easy employment, stigma, risk, lack of opportunities for career progression and low salaries.