Publications (5) View all
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Article: 'Whether you like it or not people with mental problems are going to go to them': a qualitative exploration into the widespread use of traditional and faith healers in the provision of mental health care in Ghana.
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ABSTRACT: Limited research has been conducted to explore the factors that support or obstruct collaboration between traditional healers and public sector mental health services. The first aim of this study was to explore the reasons underpinning the widespread appeal of traditional/faith healers in Ghana. This formed a backdrop for the second objective, to identify what barriers or enabling factors may exist for forming bi-sectoral partnerships. Eighty-one semi-structured interviews and seven focus group discussions were conducted with 120 key stakeholders drawn from five of the ten regions in Ghana. The results were analysed through a framework approach. Respondents indicated many reasons for the appeal of traditional and faith healers, including cultural perceptions of mental disorders, the psychosocial support afforded by such healers, as well as their availability, accessibility and affordability. A number of barriers hindering collaboration, including human rights and safety concerns, scepticism around the effectiveness of 'conventional' treatments, and traditional healer solidarity were identified. Mutual respect and bi-directional conversations surfaced as the key ingredients for successful partnerships. Collaboration is not as easy as commonly assumed, given paradigmatic disjunctures and widespread scepticism between different treatment modalities. Promoting greater understanding, rather than maintaining indifferent distances may lead to more successful co-operation in future.International Review of Psychiatry 01/2010; 22(6):558-67. · 1.80 Impact Factor -
Article: Common understandings of women's mental illness in Ghana: results from a qualitative study.
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ABSTRACT: 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.International Review of Psychiatry 01/2010; 22(6):589-98. · 1.80 Impact Factor -
Article: From mental health policy development in Ghana to implementation: What are the barriers?
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ABSTRACT: Objective: This paper identifies the key barriers to mental health policy implementation in Ghana and suggests ways of overcoming them. Method: The study used both quantitative and qualitative methods. Quantitatively, the WHO Mental Health Policy and Plan Checklist and the WHO Mental Health Legislation Checklist were employed to analyse the content of mental health policy, plans and legislation in Ghana. Qualitative data was gathered using in-depth interviews and focus group discussions with key stakeholders in mental health at the macro, meso and micro levels. These were used to identify barriers to the implementation of mental health policy, and steps to overcoming these. Results: Barriers to mental health policy implementation identified by participants include: low priority and lack of political commitment to mental health; limited human and financial resources: lack of intersectoral collaboration and consultation; inadequate policy dissemination; and an absence of research-based evidence to inform mental health policy. Suggested steps to overcoming the barriers include: revision of mental health policy and legislation; training and capacity development and wider consultation. Conclusion: These results call for well-articulated plans to address the barriers to the implementation of mental health policy in Ghana to reduce the burden associated with mental disorders.07/2010; 13(3):184-91. · 1.07 Impact Factor -
Article: Scaling up community-based services and improving quality of care in the state psychiatric hospitals: the way forward for Ghana.
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ABSTRACT: Objective: This paper aims to explore the options available for developing community-based care and improving the quality of care in psychiatric hospitals in Ghana. Method: Semi-structured interviews (SSIs) and focus group discussions (FGDs) were conducted with a cross-section of stakeholders including health professionals, researchers, policy makers, politicians, users and carers. The SSIs and FGDs were recorded digitally and transcribed verbatim. Apriori and emergent themes were coded and analysed with NVivo version 7.0, using a framework analysis. Results: Psychiatric hospitals in Ghana have a mean bed occupancy rate of 155%. Most respondents were of the view that the state psychiatric hospitals were very congested, substantially compromising quality of care. They also noted that the community psychiatric system was lacking human and material resources. Suggestions for addressing these difficulties included committing adequate resources to community psychiatric services, using psychiatric hospitals only as referral facilities, relapse prevention programmes, strengthening psychosocial services, adopting more precise diagnoses and the development of a policy on long-stay patients. Conclusion: There is an urgent need to build a credible system of community-based care and improve the quality of care in psychiatric hospitals in Ghana.05/2010; 13(2):109-15. · 1.07 Impact Factor -
Article: The comparative validity of screening scales for postnatal common mental disorder in Kintampo, Ghana.
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ABSTRACT: There have been few attempts formally to validate screening measures for postnatal common mental disorder in low income country settings. We have investigated the comparative validity of three different screening approaches in a community-based study in Kintampo, Ghana. 160 women aged 15-45 years, and 5-11 weeks postpartum were first screened using the Self-Report Questionnaire (SRQ-20), with oversampling of higher scorers. The other test assessments were the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9). Criterion validity was measured against the Comprehensive Psychopathological Rating Scale (CPRS), and concurrent validity against the WHO Disability Assessment Schedule. A sub-sample (n=40) was re-interviewed 2 weeks later for test-retest reliability. Internal consistency (Cronbach's Alpha) was equivalent across all three test scales; EPDS (0.79), SRQ-20 (0.78) and PHQ-9 (0.79). Test-retest reliability was better for PHQ-9 (ICC 0.75) than for the EPDS (0.51). For criterion validity the PHQ-9 (AUROC 0.90 (0.81-0.98)), was superior to the SRQ-20 (0.74 (0.62-0.86)) and the EPDS ((0.84 (0.76-0.92). Youden's Index was also superior for PHQ-9. Item analysis revealed that a mixture of somatic and cognitive symptoms best discriminated between cases and non-cases for all three scales. Inability to ascertain inter-rater reliability, order effects and possible loss of technical equivalence due to item modifications. The evidence for the validity, reliability, and superiority of the PHQ-9 over other screening assessments has been extended. The PHQ-9 is short, easy to administer and acceptable to a largely illiterate population of Ghanaian women, 5 to 11 weeks post partum.Journal of Affective Disorders 08/2008; 113(1-2):109-17. · 3.52 Impact Factor
