Department of Psychiatry
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Item Attitudes of primary health care providers towards people with mental illness: Evidence from two districts in Zambia(African Journal of Psychiatry (South Africa), 2011-09) Kapungwe, A.; Cooper, S.; Mayeya, J.; Mwanza, J.; Mwape, L.; Sikwese, A.; Lund, C.; Flisher, A.J.; Agossou, T.et.al.Objective: The aim of this study was to explore health care providers' attitudes towards people with mental illness within two districts in Zambia. It sought to document types of attitudes of primary health care providers towards people suffering from mental illness and possible predictors of such attitudes. This study offers insights into how health care providers regard people with mental illness that may be helpful in designing appropriate training or re-training programs in Zambia and other low-income African countries. Method: Using a pilot tested structured questionnaire, data were collected from a total of 111 respondents from health facilities in the two purposively selected districts in Zambia that the Ministry of Health has earmarked as pilot districts for integrating mental health into primary health care. Results: There are widespread stigmatizing and discriminatory attitudes among primary health care providers toward mental illness and those who suffer from it. These findings confirm and add weight to the results from the few other studies which have been conducted in Africa that have challenged the notion that stigma and discrimination of mental illness is less severe in African countries. Conclusion: There is an urgent need to start developing more effective awareness-raising, training and education programmes amongst health care providers. This will only be possible if there is increased consensus, commitment and political will within government to place mental health on the national agenda and secure funding for the sector. These steps are essential if the country is improve the recognition, diagnosis and treatment of mental disorders, and realize the ideals enshrined in the progressive health reforms undertaken over the last decade.Item Breaking bad news(Changing Trends in Mental Health Care and Research in Ghana, 2014) Asafo, S.Item Changing trends in mental health care and research in Ghana(Changing Trends in Mental Health Care and Research in Ghana, 2014) Ofori-Atta, A.; Ohene, S.This Reader is about the changing trends in mental health care and research in Ghana. The book includes a brief history of the department and Mental Health Care in Ghana through the eyes of professionals who have lived this history. There is also a revised situation analysis of mental health services and legislation from 2005. These are followed by three main sections on Conceptualization of Mental Illness (depression, religion and illness, autism, substance use disorders and schizophrenia), Mental Health Practice in a teaching hospital setting (referrals to Korle-Bu, how psychiatric illnesses manifest, how people's lives are affected and what skill sets and resources are available for dealing with them) and finally the Department's focus on research includes the Mental Health Information System, Sickle Cell Disease, Medical Ethics, and Liaison Psychiatry. In the concluding paragraph, read about the way forward in mental health care and research. © University of Ghana, 2014. All Right Reserved.Item Co-Designing M-Healer: Supporting Lay Practitioner Mental Health Workers in Ghana(Springer, 2021) Albright, L.; Le, H.; Meller, S.; Atta, A.O.; Attah, D.A.; Asafo, S.M.; Collins, P.Y.; Zeev, D.B.; Snyder, J.. Mental health is a vast problem around the globe and is one of the key population health issues in the world today. At any given time, up to 6.8% of the world’s population suffers from a serious mental illness (SMI) such as schizophrenia or bipolar disorder. The impacts of SMI on a population are especially challenging in low and middle-income countries (LMIC). Mobile healthcare application research is a growing area of research aiming to ameliorate these challenging impacts. In Ghana, a LMIC in West Africa, mental healthcare systems are severely under resourced and people with SMI often receive care from lay practitioners such as traditional and faith healers rather than trained mental health clinicians. These challenges exist alongside developed wireless infrastructure. In these contexts, mobile applications can substantially increase access to health information. This is the basis for our work developing a mobile health (mHealth) application to support mental health lay practitioners in Ghana. We describe the ways that our principled design research practice is intersecting with local faith-based practices, vernacular expertise and values, and the practicalities of technology adoption in Ghana.Item Common understandings of women's mental illness in Ghana: Results from a qualitative study(International Review of Psychiatry, 2010-12) Ofori-Atta, A.; Cooper, S.; Akpalu, B.; Osei, A.; Doku, V.; Lund, C.; Flisher, A.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. © 2010 Informa UK Ltd All rights reserved.Item A Digital Toolkit (M-Healer) to Improve Care and Reduce Human Rights Abuses Against People With Mental Illness in West Africa: User-Centered Design, Development, and Usability Study(JMIR, 2021) Ben-Zeev, D.; Meller, S.; Snyder, J.; Attah, D.A.; Albright, L.; Le, H.; Asafo, S.M.; Collins, P.Y.; Ofori-Atta, A.The resources of West African mental health care systems are severely constrained, which contributes to significant unmet mental health needs. Consequently, people with psychiatric conditions often receive care from traditional and faith healers. Healers may use practices that constitute human rights violations, such as flogging, caging, forced fasting, and chaining. The aim of this study is to partner with healers in Ghana to develop a smartphone toolkit designed to support the dissemination of evidence-based psychosocial interventions and the strengthening of human rights awareness in the healer community. Methods: We conducted on-site observations and qualitative interviews with healers, a group co-design session, content development and prototype system build-out, and usability testing. A total of 18 healers completed individual interviews. Participants reported on their understanding of the causes and treatments of mental illnesses. They identified situations in which they elect to use mechanical restraints and other coercive practices. Participants described an openness to using a smartphone-based app to help introduce them to alternative practices. A total of 12 healers participated in the co-design session. Of the 12 participants, 8 (67%) reported having a smartphone. Participants reported that they preferred spiritual guidance but that it was acceptable that M-Healer would provide mostly nonspiritual content. They provided suggestions for who should be depicted as the toolkit protagonist and ranked their preferred content delivery modality in the following order: live-action video, animated video, comic strip, and still images with text. Participants viewed mood board prototypes and rated their preferred visual design in the following order: religious theme, nature motif, community or medical, and Ghanaian culture. The content was organized into modules, including an introduction to the system, brief mental health interventions, verbal de-escalation strategies, guided relaxation techniques, and human rights training. Each module contained several scripted digital animation videos, with audio narration in English or Twi The module menu was represented by touchscreen icons and a single word or phrase to maximize accessibility to users with limited literacy. In total, 12 participants completed the M-Healer usability testing. Participants commented that they liked the look and functionality of the app and understood the content. The participants reported that the information and displays were clear. They successfully navigated the app but identified several areas where usability could be enhanced. Posttesting usability measures indicated that participants found M-Healer to be feasible, acceptable, and usable.The module menu was represented by touchscreen icons and a single word or phrase to maximize accessibility to users with limited literacy. In total, 12 participants completed the M-Healer usability testing. Participants commented that they liked the look and functionality of the app and understood the content. The participants reported that the information and displays were clear. They successfully navigated the app but identified several areas where usability could be enhanced. Posttesting usability measures indicated that participants found M-Healer to be feasible, acceptable, and usable.Item Dilemmas of healthcare professionals in Ghana(Changing Trends in Mental Health Care and Research in Ghana, 2014-01) Ofori-Atta, A.; Jack, H.Item Empowerment and use of antenatal care among women in Ghana: A cross-sectional study(BMC Pregnancy and Childbirth, 2014-11) Sipsma, H.; Ofori-Atta, A.; Canavan, M.; Udry, C.; Bradley, E.Background: Empowerment among women in the context of a romantic relationship may affect the use of reproductive healthcare services; however, current literature examining this association is limited and inconsistent. We therefore aimed to examine the relationship between several measures of empowerment and use of inadequate antenatal care among women in Ghana. Methods: We conducted a cross-sectional study using data from a nationally representative cohort of women in Ghana. Our analytic sample was limited to non-pregnant women who had been pregnant and involved in a relationship within the last 12 months. We used multivariable logistic regression to assess the associations between empowerment and inadequate use of antenatal care and interaction terms to assess moderation by education. Results: Approximately 26% of women received inadequate antenatal care. Multivariable analysis indicated that having experienced physical abuse in the past year was directly associated with inadequate use of antenatal care (OR = 5.12; 95% CI = 1.35, 19.43) after adjusting for socio-demographic characteristics. This effect was particularly pronounced among women with no formal education and was non-significant among women with at least some formal education (P-value for interaction <0.001). Conclusions: Results suggest that improving use of reproductive health care services will require reducing partner abuse and enhancing empowerment among women in Ghana and other low-income countries, particularly among those with no formal education. Furthermore, the involvement of male partners will be critical for improving reproductive health outcomes, and increasing education among girls in these settings is likely a strong approach for improving reproductive health and buffering effects of low empowerment among women. © Sipsma et al.Item Evaluating the Impact of an Innovative Public Speaking Competition to Promote Psychiatry as a Career Option for Ghanaian Medical Students(Academic Psychiatry, 2019-04) Agyapong, V.I.O.; Hrabok, M.; Agyapong-Opoku, G.; Khinda, H.; Owusu-Antwi, R.; Osei, A.; Ohene, S.; Ulzen, T.; Gilligan, P.OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: The innovative public speaking competition was successful in stimulating interest in psychiatry and furthering mental health education and advocacy. Implications are discussed.Item Experience of strengthening the mental health information system in Ghana's three psychiatric hospitals(Changing Trends in Mental Health Care and Research in Ghana, 2014) Ofori-Atta, A.; Mirzoev, T.; Mensah-Kufuor, A.; Osei, A.; Dzadey, A.; Armah-Aloo, K.; Atweam, D.•255• Chapter 20 Experience of Strengthening the Mental Health Information System in Ghana’s Three Psychiatric Hospitals A.Ofori-Atta, T. Mirzoev, A. Mensah-Kufuor, A. Osei, A. Dzadey, K. Armah-Aloo, K.D.Atweam Introduction The World Health Organization defines a Mental Health Information System (MHIS) as ‘a system for collecting, processing, analysing, disseminating and using information about a mental health service and the mental health needs of the population it serves (WHO, (2005). Developing MHIS may be considered a costly intervention, and yet the ultimate aim in establishing MHIS in low-income countries is for a more equitable distribution of resources in the context of scarcity (Husein, Adeyi, Bryant et al., 1993) . This is particularly pertinent for mental health care in Ghana, where there is inequitable distribution of mental health services (Doku, Ofori-Atta, Akpalu, et al., 2008). A situation analysis of mental health policy implementation in Ghana was conducted as the first phase of the Mental Health and Poverty Project (MHAPP). The MHAPP was a 5-year (research consortium project funded by the Department for International Development of the United Kingdom (DfID) and it ended in December 2010. The situation analysis revealed numerous challenges faced by the existing Mental Health Information System (MHIS) in Ghana (Doku et al., 2008). There was limited information on mental health collected routinely at the three psychiatric hospitals, and the district and regional hospitals. The information also focused on four disease categories only (psychotic disorders, epilepsy, substance use disorders and neurosis). The definitions of the categories were not standardized across the different data-gathering institutions, results were poorly analysed, rarely disseminated and the output was not useful to policy makers or for mental health advocacy. In response to the above •256• Chapter 20 challenges, an intervention to strengthen the MHIS in Ghana was implemented with support from the MHAPP and in collaboration with the Ghana Health Service. MHIS is owned by the Ministry of Health and the Ghana Health Service (GHS). This intervention was therefore a collaboration between the Ghana Health Service and the Mental Health and Poverty Project (MHAPP). A basic understanding to work conjointly towards the strengthening of the MHIS was agreed upon, with the MHAPP acting as collaborator and catalyst, and the Ministry of Health and its institutions as the implementers. The GHS provided the human resources, with the MHAPP contributing specialist and financial resources. The objective of this paper is to report on the design and implementation of the MHIS, and to deliberate on the factors which influenced these processes and the key intervention effects. General principles on health management information systems which were considered in the design of the MHIS Our design for the development of the MHIS was informed by general principles deduced from literature. The literature showed that challenges when developing health information systems generally in developing countries include insufficient training for staff responsible for implementation, lack of understanding of the changes introduced, inadequate supervision for staff involved, and lack of the skills and abilities necessary to undertake additional responsibilities required by the HMIS (Gladwin, Dixon, and Wilson, 2003) . Furthermore, systems must be ‘user friendly’ (WHO 2005) in order to have the best chance of consistent and accurate collection of data by health care workers (Husein et al., 1993). There is the need to focus on a broad spectrum of mental disorders, not only those for which treatment is available in order to illustrate unmet need so as to lobby for greater resources. One must also decide whether data collected should be population or facility-based depending on how comprehensive the data need to be ( Kustner, Varo, and Gonzales, 2002). An MHIS that collects data only from mental health services is likely to exclude many cases. Finally, process issues such as consultation with stake-holders, and the need •257• Experience of Strengthening the Mental Health Information System for monitoring and evaluation, are worth planning for (OdhiamboOtieno , 2005a; Odhiambo-Otieno, 2005b). Intervention design and implementation Intervention design. The intervention was aimed to strengthen and expand MHIS at the psychiatric hospitals, focusing on the functions of collection, processing, analysis, and use of information. The MHIS was designed to include a combination of paper-based and computerized elements. Patients were given a registration form on each visit, which was filled in as they contacted professionals in each department of the hospital. On exit, the form was retained and sent to the records department, where it was entered into the database. Sites: The intervention was...Item Female genital cutting: Current practices and beliefs in western Africa(Bulletin of the World Health Organization, 2012-02) Sipsma, H.L.; Chen, P.G.; Ofori-Atta, A.; Ilozumba, U.O.; Karfo, K.; Bradley, E.H.Objective To conduct a cross-national comparative study of the prevalence and correlates of female genital cutting (FGC) practices and beliefs in western Africa. Methods Data from women who responded to the Multiple Indicator Cluster Surveys between 2005 and 2007 were used to estimate the frequencies of ever having been circumcised, having had a daughter circumcised, and believing that FGC practices should continue. Weighted logistic regression using data for each country was performed to determine the independent correlates of each outcome. Findings The prevalence of FGC was high overall but varied substantially across countries in western Africa. In Sierra Leone, Gambia, Burkina Faso and Mauritania, the prevalence of FGC was 94%, 79%, 74% and 72%, respectively, whereas in Ghana, Niger and Togo prevalence was less than 6%. Older age and being Muslim were generally associated with increased odds of FGC, and higher education was associated with lower odds of FGC. The association between FGC and wealth varied considerably. Burkina Faso was the only country in our study that experienced a dramatic reduction in FGC prevalence from women (74%) to their daughters (25%); only 14.2% of the women surveyed in that country said that they believe the practice should continue. Conclusion The prevalence of FGC in western Africa remains high overall but varies substantially across countries. Given the broad range of experiences, successful strategies from countries where FGC is declining may provide useful examples for high-prevalence countries seeking to reduce their own FGC practices.Item From mental health policy development in Ghana to implementation: What are the barriers?(African Journal of Psychiatry (South Africa), 2010-07) Awenva, A.D.; Read, U.M.; Ofori-Attah, A.L.; Doku, V.C.K.; Akpalu, B.; Osei, A.O.; Flisher, A.J.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.Item The Ghanaian non-medical conceptualization of mood disorders(Changing Trends in Mental Health Care and Research in Ghana, 2014) Ohene, S.; Addom, S.•47• Chapter 5 The Ghanaian Non-Medical Conceptualization of Mood Disorders Sammy Ohene and Selassie Addom Depressive disorders constitute a great proportion of mental disorders that affect human beings worldwide. Unipolar and bipolar depression are responsible for a significant amount of morbidity and distress. Sadness as a state of feeling or mood has always been recognized as part of human emotions. Prolonged grief from loss or adversity, akin to descriptions of the depressive state can be found in ancient texts such as the book of Job in the Holy Bible. Whilst depression as a disease entity gained recognition in psychiatric literature, early Western psychiatrists doubted the occurrence of depression among Africans. Carothers (1947) categorically stated that depression did not exist among Africans. This view was seriously challenged by Fields (1955) who suggested that most of the women she studied in the then Gold Coast (now Ghana), who confessed to witchcraft, were exhibiting the self-accusatory symptoms often seen in depressed British women. Her belief was confirmed by Osei (2001) who found all 17 women in three shrines who had confessed to witchcraft, suffered from depression according to ICD-10 criteria. Fields, in fact, declared depression to be the commonest mental disorder among rural Akan women (Fields, 1960). Majodina and Johnson (1983) demonstrated that depression could be diagnosed among Ghanaians utilizing the same instruments as in Western cultures. Using the Schedule of Affective and Depressive Disorders (SADD), they found in a small study of 50 patients, 40 reported somatic symptoms like headaches, body heat and general bodily pains. Many respondents in the study also reported anxiety, tension, guilt, loss of interest, inability to enjoy themselves and sadness. In another study, Turkson and Dua (1997) utilized the MontgomeryAsberg Depressive Rating Scale (M-ADRS) with 131 depressed female patients at the Accra Psychiatric Hospital. They found a high level of •48• Chapter 5 somatic complaints like headaches (77.9 percent) and sleeplessness (68.7 percent), but relatively low incidence of psychological symptoms like sadness(13 percent) and pessimistic thoughts (20.6 percent), with 7.3 percent of the depressed women admitting to suicidal ideas. Perez and Junot (1998) stated that depression in Africans presented in a mode specific to African culture involving the individual and his relationship to others. In their view, the Western model of depression was irrelevant to Africa, but predicted that with increasing modernization , features of the disorder would tend to look more like, and have outcomes similar to those seen in Western countries. Depression is characterized by the presence of symptoms like sadness, loss of interest, loss of self-confidence, inappropriate guilt feelings as well as thoughts of death and suicide. Invariably, depressed individuals have disturbances of sleep, appetite and impaired concentration . Additionally in many populations including among Ghanaians, depressed individuals present with multiple bodily complaints. In fact, the somatic symptoms may be so overwhelming they may appear to obscure the core depressive symptoms. Whilst many of these symptoms may sometimes occur after adverse life events, a diagnosis of clinical depression is made only after persistence of the symptoms over a minimum of two weeks. (American Psychiatric Association, 2006; World Health Organization, 1992). Depression may be mild, moderate or severe in intensity and often runs a recurrent course. However, up to 20% of patients have depression that is chronic and non-remitting, (Thornicroft & Sartorious, 1993). To understand the effects of depression on the human being, it is helpful to think of depression as a disease that affects the brain and disrupts all cerebral functions. Depressed patients often have slowed heart rate and blood pressure leading to dizziness. Digestive secretions reduce causing constipation. Frequent complaints of various types of pain and irritability occur due to reduced pain and noise threshold. Slowed motor activity and muscle fatigue is often seen. Sleep and hormonal functions are disrupted leading to menstrual abnormalities in women for example. Higher cognitive functions such as memory, attention and reasoning capacity are all compromised. (Moussaoui, 2012). •49• The Ghanaian Non-Medical Conceptualization of Mood Disorders Depression occurs all over the world. Analysis of the Global burden of disease 2000 study, estimates the point prevalence of depression worldwide to be 1.9 percent in men and 3.2 percent in women. Over a twelve- month period, 5.8 percent of men and 9.5 percent of women would be expected to experience depression. Unipolar depression is the fourth leading cause of burden among all diseases. It is responsible for a huge proportion of working time...Item Introduction(Changing Trends in Mental Health Care and Research in Ghana, 2014) Ofori-Atta, A.Item Is the concept of learning disabilities applicable to Ghana?(Changing Trends in Mental Health Care and Research in Ghana, 2014) Attah, D.; Mate-Kole, C.C.Item Liaison psychiatry in korle bu teaching hospital(Changing Trends in Mental Health Care and Research in Ghana, 2014) Boateng, P; Ofori-Atta, A; Ohene, SItem Mental health policy in South Africa: Development process and content(Health Policy and Planning, 2009-06) Draper, C.E.; Lund, C.; Kleintjes, S.; Funk, M.; Omar, M.; Flisher, A.J.; Agossou, T.et.al.Introduction: Mental health is increasingly acknowledged as a crucial public health issue in South Africa (SA). However, it is not given the priority it deserves on policy agendas in this and many other low- and middle-income countries. The aim of this analysis is to describe the content of mental health policy and the process of its development in SA. Methods: Quantitative data regarding SA's mental health system were gathered using the World Health Organization (WHO) Assessment Instrument for Mental Health Systems. The WHO Checklist for Mental Health Policy and Plans was completed for SA's 1997 mental health policy guidelines. Semi-structured interviews provided understanding of processes, underlying issues and interactions between key stakeholders in mental health policy development. Results: There is uncertainty at provincial level regarding whether the 1997 policy guidelines should be considered national policy. At national level the guidelines are not recognized as policy, and a new policy is currently being developed. Although the guidelines were developed through wide consultation and had approval through national policy development processes, difficulties were encountered with dissemination and implementation at provincial level. The principles of these policy guidelines conform to international recommendations for mental health care and services but lack clear objectives. Discussion: The process of mental health policy implementation has been hindered by the low priority given to mental health, varying levels of seniority of provincial mental health coordinators, limited staff for policy and planning, varying technical capacity at provincial and national levels, and reluctance by some provincial authorities to accept responsibility for driving implementation. Conclusion: These findings highlight the importance of national leadership in the development of new mental health policy, communication between national and provincial levels, the need for provincial structures to take responsibility for implementation, and capacity building to enable policy makers and planners to develop, monitor and implement policy. © The Author 2009; all rights reserved.Item Neuropsychological functioning of adult sickle cell disease patients in Ghana(Changing Trends in Mental Health Care and Research in Ghana, 2014) Ampomah, M.; Mate-Kole, C.C; Ofori-Atta, A; Anum, A; Ohene, S.; Ekem, I.; Acquaye, J.K; Ankra-Badu, G.A; Sey, F.; Sefa-Dedeh, AItem An overview of Ghana's mental health system: Results from an assessment using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS)(International Journal of Mental Health Systems, 2014) Roberts, M.; Mogan, C.; Asare, J.B.This survey provides data on the Mental Health System in Ghana for the year 2011. It supplies essential planning information for the implementation of Ghana's new Mental Health Act 846 of 2012, a renewal of the Ghana 5 year plan for mental health and it contributes to international knowledge base on mental health. It provides a baseline from which to measure future progress in Ghana and comparison data for use in other countries. In addition to reporting our findings we describe and analyse deficiencies and strengths of the Ghana mental health system.Methods: We used the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS) to collect, analyse, and report data on the mental health system and services for all districts of the ten regions of Ghana. Data was collected in 2012, based on the year 2011.Results: In 2011, Ghana was a lower middle income country with a population of approximately 25 million. A mental health policy, plan and legislation were in place. Mental health legislation was outdated and no longer in line with best practice standards. Services were significantly underfunded with only 1.4% of the health expenditure going to mental health, and spending very much skewed towards urban areas. There were 123 mental health outpatient facilities, 3 psychiatric hospitals, 7 community based psychiatric inpatient units, 4 community residential facilities and 1 day treatment centre, which is well below what would be expected for Ghana's economic status. The majority of patients were treated in outpatient facilities and psychiatric hospitals and most of the inpatient beds were provided by the latter. There were an estimated 2.4 million people with mental health problems of which 67,780 (ie 2.8%) received treatment in 2011. The were 18 psychiatrists, 1,068 Registered Mental Nurses, 19 psychologists, 72 Community Mental Health Officers and 21 social workers working in mental health which is unbalanced with an unbalanced emphasis on nurses compared to what would be expected.Conclusions: The main strength of the mental health system was the presence of a long established service with staff working across the country in outpatients departments and hospitals. The main weakness was that government spending on mental health was very low and the bulk of services, albeit very sparse, were centred around the capital city leaving much of the rest of the country with almost no provision. Service provision was dominated by nurses with few other professions groups present. © 2014 Roberts et al.; licensee BioMed Central Ltd.Item Overview of mental health care in Ghana(Changing Trends in Mental Health Care and Research in Ghana, 2014) Kpobi, L.; Osei, A.; Sefa-Dedeh, A.