Task shifting – Ghana's community mental health workers’ experiences and perceptions of their roles and scope of practice

Abstract

BackgroundBecause 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).ObjectiveTo 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.DesignWe 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).ResultsOverall, 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.ConclusionsMental 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.

The predictors of treatment pathways to mental health services among consumers in Ghana

“…were engaged in semi-skilled employment (jobs that require more skills than unskilled employment) and 20.52% skilled employment (jobs that require specialized training or skills). However, 35.37% were unemployed. The highest education was at the tertiary level, but 32.10% were educated up to the basic level (primary and junior high school), while 18.27% had no education.…”

“…22,28 Conversely, the mental health systems in Ghana is challenged with limited and poor management of mental health workforce. 22,[33][34][35][36] This challenge is attributed to the perceived low status of mental health professionals, lack of adequate training as well as misconceptions around mental illness. 22 In addition, the mental health systems are challenged with an irregular supply of medications for mental health services.…”

“…The few existing mental health services were disproportionately distributed in favor of the urban and southern sector of the country . Conversely, the mental health systems in Ghana is challenged with limited and poor management of mental health workforce . This challenge is attributed to the perceived low status of mental health professionals, lack of adequate training as well as misconceptions around mental illness .…”

Barriers and facilitators to implementing a mobile intervention with task shifting in the treatment of depressive symptoms in people with diabetes and / or hypertension in Brazil: A study protocol using the CFIR.

“…Currently, there is an increasing global demand for mental health care and a lack of specialized human resources to meet this need in LMICs, especially within primary and secondary care. Evaluation of task-shifting in mental health settings has shown task exchange or delegation to be an effective strategy to cope with this demand (Agyapong et al 2015). Active service user participation and the use of trained non-specialists could be essential tools to increase access to mental health care (Patel et al 2010).…”

“…Task-shifting is a strategy to delegate tasks usually performed by professionals with higher qualifications to people with a lower level of formal education or training (Verdeli 2016;Joshi et al 2014). It creates a new workforce with specific training for particular tasks and offers a pragmatic response to health worker shortages (Joshi et al 2014;Agyapong et al 2015). If the CONEMO intervention is shown to be effective, it could be an essential tool in reducing the mental health treatment gap.…”