Department of Psychiatry
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Item Adolescent Resilience during the COVID-19 Pandemic: A Review of the Impact of the Pandemic on Developmental Milestones(Behavioral Sciences, 2022) Garagiola, E.R.; Asafo, S.; Lam, Q.; et al.This review explores the literature regarding the ways in which the COVID-19 pandemic has affected the navigation of developmental milestones among adolescents, specifically those in late adolescence, across several domains of their lives. The exploration is contextualized globally. focusing on five key areas: mental health, physical health, education, peer relationships, and family relationships. Implications for practice and interventions are explored in each key area to provide recommendations for those working with adolescents, as well as future research. The changes brought about by the pandemic and the readjustment to what some have referred to as the “new normalcy” will undoubtedly have lasting effects on all areas of life for this cohort of adolescents. who have shown remarkable resilience navigating this new and unfamiliar world. These changes are synthesized, with the aim of highlighting differences and similarities of the shared experiences of the pandemic globally. After exploring the current realities, this chapter goes on to outline the ways in which which the experience of such a significant developmental period of one’s life during the COVID-19 pandemic will have an impact on adolescents for years to come. Although it is still impossible to comprehend the long-term effects, In examining proximal effects, we can postulate distal implications and potential future effects, as well as possible ways to mitigate these implications as we transition back to more of what was experienced pre-pandemic life, from a post-pandemic experience.Item Juggling Art: Making Critical Clinical Decisions without Vital Laboratory Support in Autoimmune Rheumatic Patients in a Resource Poor Setting(Ghana medical journal, 2017) Dey, D.Item Challenges in the use of the mental health information system in a resource-limited setting: Lessons from Ghana(BMC Health Services Research, 2018-02) Kpobi, L.; Swartz, L.; Ofori-Atta, A.L.Background One of the most successful modes of record-keeping and data collection is the use of health management information systems, where patient information and management plans are uniformly entered into a database to streamline the information and for ease of further patient management. For mental healthcare, a Mental Health Information System (MHIS) has been found most successful since a properly established and operational MHIS is helpful for developing equitable and appropriate mental health care systems. Until 2010, the system of keeping patient records and information in the Accra Psychiatric Hospital of Ghana was old and outdated. In light of this and other factors, a complete reforming of the mental health information systems in three psychiatric hospitals in Ghana was undertaken in 2010. Four years after its implementation, we explored user experiences with the new system, and report here the challenges that were identified with use of the new MHIS. Methods Individual semi-structured interviews were conducted with nine clinical and administrative staff of the Accra Psychiatric Hospital to examine their experiences with the new MHIS. Participants in the study were in three categories: clinical staff, administrator, and records clerk. Participants’ knowledge of the system and its use, as well as the challenges they had experienced in its use were explored using an interpretative phenomenological approach. Results The data suggest that optimal use of the current MHIS had faced significant implementation challenges in a number of areas. Central challenges reported by users included increased workload, poor staff involvement and training, and absence of logistic support to keep the system running. Conclusions Setting up a new system does not guarantee its success. As important as it is to have a mental health information system, its usefulness is largely dependent on proper implementation and maintenance. Further, the system can facilitate policy transformation only when the place of mental health in district, regional and national health discourse improves.Item Prevalence and correlates of depression among caregivers of children living with HIV in Ghana: findings from the Sankofa pediatric disclosure study(AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2018-10) Ofori-Atta, A.; Reynolds, N.R.; Antwi, S.; Renner, L.; Nichols, J.S.; Lartey, M.; Amissah, K.; Tettey, J.K.; Alhassan, A.et.al.Prior studies show an association between caregiver depression and child health outcomes. There has been little examination of depression among caregivers of HIV-infected children in sub-Saharan countries where pediatric HIV is concentrated. Using baseline data collected in the pediatric HIV disclosure intervention trial, Sankofa, we examined the prevalence and factors associated with depression among caregivers (N = 446) of children infected with HIV in Ghana. Data were analyzed with descriptive and regression analyses. The mean age of the caregivers was 42.2 ± 10.4 years. Eighty percent of the caregivers were female and 59% were HIV-infected. Twenty-eight percent (n = 126) of the caregivers were found to have mild to severe depression. In the adjusted model, factors significantly associated with caregiver depression included: HIV-positive caregiver status (P = 0.04), low income (P = 0.02), lower social support, (P = 0.01), lower HIV knowledge, (P = 0.01), worse HIV illness perceptions (P≤0.001), and greater perceived HIV stigma (P≤0.001). Although we found a high prevalence of depression among our study participants, several of the risks factors identified are modifiable and amenable to interventions that are locally available and affordable.Item An updated situation analysis of mental health services and legislation in Ghana: Challenges for transformation(Changing Trends in Mental Health Care and Research in Ghana, 2014-01) Ofori-Atta, A.; Read, U.M.; Lund, C.•17• Chapter 4 An Updated Situation Analysis of Mental Health Services and Legislation in Ghana: Challenges for Transformation A. Ofori-Atta, U.M. Read, C. Lund, and the MHaPP Research Programme Consortium1 Introduction Mental health care is often one of the lowest health priorities for low-income countries (World Health Organisation WHO 2001) and Ghana is no exception. In common with many low-income post-colonial countries in Africa, Ghana has not developed the infrastructure and public services, including mental health care, to keep pace with population expansion. The population of Ghana has more than doubled since independence in 1957 and currently stands at approximately 25 million (Ghana Demographic & Health Survey; 2003, 2005) with a consequent growth in the numbers of people suffering from mental disorders. Research has revealed the extent to which mental health care in many low- and middle-income countries is consistently under-resourced.(Jacob, Sharan, Mirza, et al 2007; Kohn, Saxena, Levav, Saraceno, 2004; Saxena, Thornicroft, Knapp & Whiteford, 2007) In the relative absence of community care, institutionalised care remains the norm for many of those with mental health problems in low-income countries (Saxena et al., 2007). Indeed, in countries such as Ghana, many of those in need of treatment do not reach psychiatric services at all, but seek the care of informal community mental health services (WHO, 2003) such as traditional and faith healers as well as family members who offer a varying quality of service and level of efficacy. In addition, there is increasing evidence from developing countries that mental illness is strongly associated with poverty (Patel, 2001; Patel & Kleinman, 2003; Saraceno, Levav & Kohn, 2005). •18• Chapter 4 Despite some significant economic growth in recent years, Ghana is classified as a low-income country with 28.5 percent of the population living in poverty, and 18.2 percent living in extreme poverty, especially in rural areas (Government of Ghana, 2007). Yet there is a growing body of research demonstrating innovative, cost-effective interventions for mental disorders such as schizophrenia and depression in low-income African countries (Wiley-Exley, 2007; Patel, Araya, Chatterjee, et al., 2007; Siskind, Bolton & Kim, 2007). Among these are agricultural rehabilitation villages in Tanzania (Kilonzo and Simmons,1998), family involvement in hospital care in Senegal (Diop & Dores, 1976; Franklin, Sarr, Gueye et al., 1996), group therapy for the treatment of depression in Uganda (Bolton,Bass, Neugebauer, et al., 2003), and collaborations with traditional healers in northern Ghana (Montia, 2008). In Africa therefore, as in other regions of the world, the deficit is not in the evidence for interventions to address mental health problems, but in the resources and political will that can make these interventions available to those who need them. Ghana currently stands in a relatively unique position within the African continent to respond to this challenge. In spite of its low-income status, the country has one of the highest literacy rates (57.9 percent) within West Africa (United Nations Development Programme, 2005), is considered a relatively stable and peaceful democracy, with relatively good standards of governance, and has a strong and diverse civil society. Gaining independence as early as 1957, it was also one of the pioneers of primary health care in the region (Twumasi, 1974) and initiated attempts to develop mental health care in the first years of independence with the establishment of new psychiatric hospitals and later the introduction of clinical psychology, occupational therapy and community psychiatric nursing. Today, despite the shortage of specialist psychiatric personnel, Ghana remains relatively well-resourced for mental health care in comparison to other countries in the region (Jacob, Sharan, Mirza, et al., 2007). There have been several attempts to respond to the call to develop mental health provision in primary care and to provide communitybased mental health services. The training of community psychiatric •19• An Updated Situation Analysis of Mental Health Services and Legislation in Ghana nurses was instituted in 1976 when these nurses were posted to approximately half the districts in the country. Between 1994 and 1998 primary health care and development workers in the Upper West Region of Ghana were trained in mental health care, integrating mental health into primary care (Sefa-Dedeh, Ofori-Atta, Ohene et al., 2006). Similarly, in 1998 the World Health Organisation ( WHO) Nations for Mental Health Project trained health volunteers to provide community support to patients with mental disorders (Asare, 2003; WHO, 2002). Despite these innovations, a comprehensive situation analysis of the mental health system in Ghana has not yet been undertaken...Item A qualitative study of stresses faced by Ghanaian medical students(Changing Trends in Mental Health Care and Research in Ghana, 2014) Ofori-Atta, A.; Okraku, O.; Mork, S.; Sarfo, A.; Ghanney, E.; Sefa-Dedeh, A.; Ohene, S.•212• Chapter 17 A qualitative study of stresses faced by Ghanaian medical students Angela Ofori-Atta, Olive Okraku, Seraphim Mork, Abena Sarfo, E. Ghanney, A. Sefa- Dedeh and Sammy Ohene Introduction Medical students experience much stress throughout their period of study. The stressors include but are not limited to difficulties of clinical years, stressors associated with continuous assessments, economic constraints,relationshipproblems,personalityproblems,mentalhealth problems, substance abuse training and inadequate social support (Sani M, Mahfouz MS, Bani I et al., 2012; Sreeramareddy, Shankar, Binu et al., 2007; Chandrashekhar, Sreeramareddy, Suri et al.,2010; Super, 1998). Although these stresses may be considered as part of the daily hassles which all students face, the stresses faced by medical students seem to be magnified by the large amount of academic workload they face, the limited amount of time they have and the excellence expected of them. The prevalence of depressive symptoms among medical students was 12.9%, significantly higher than in the general population according to a study conducted in Sweden by Dahlin, Joneborg & Runeson (2005), and in Saudi Arabia, the sense of belittlement felt by students from both students and peers contributed significantly to stress (Shoukat, Anis, Kella et al., 2010). According to a study conducted in Nigeria, medical students cited as stressors overcrowded accommodation, congested classrooms, prolonged and frequent strikes and lack of holidays (Omigbodun, Odukogbe, Omigbodun et al., 2006). Gunderson (2001) quotes from a director of medical humanities and medical research at Dalhousie University in Halifax: “We want people who are driven, who are competitive, who can excel at everything that they do.” This is a tall order indeed because this high expectation comes at a price; most medical students are so concerned with dealing with •213• A qualitative study of stresses faced by Ghanaian medical students the workload at school that they forget to take care of their physical, emotional, social and spiritual needs and this leads them to experience stress. “Self-care is not a part of the physician’s professional training and typically is low on a physician’s list of priorities” according to Gunderson (also Tait, Shanafelt, Bradley, et al., 2002); Dyrbye, Thomas, and Massie (2008). In addition to neglecting their own health, Werner and Korsch (1976) report L.L. Stephen’s words; “the encounter with morbidity and mortality heightens the student’s feelings of vulnerability. If he over-identifies with patients, he may suffer more and be unable to provide rational medical care. If he protects himself by dehumanizing patients, humane treatment suffers.” Clearly, the medical student is caught between a rock and a hard place. In spite of this, a study from Norway concluded that the mental health of medical students in Norway did not differ significantly from that of the general public. However, the students recorded lower levels of general self-esteem than those of the general public. Additionally, male students reported less general self-esteem and more nervous symptoms than female students (Bramness, Fixdal, & Vaglum; 1991). In Ghana, practical steps are yet to be taken to identify the stresses that are experienced by Ghanaian medical students and the methods that can be used to prevent and alleviate them in order to prevent students from dropping-out. Participants and methods Selection of participants After seeking permission from the University’s administration, the class lists for medical students in Level 200, Level 300, the first clinical year and second clinical year were obtained. Every tenth student on the class list was selected to ensure random sampling from each class, after which the class presidents were added. They then participated in focus group discussions. •214• Chapter 17 Procedure The selected students were invited to the Department of Psychiatry at a time that was convenient for both the students and the staff at the department. Before focus group discussions began, the students were informed of the aims of the focus group discussion and their consent was sought. The students were assured confidentiality. A facilitator initiated the discussions by posing open-ended questions inquiring about stressors typically faced by medical students. This led to further discussions on topics including academic workload, food, accommodation and hostel facilities, relationship problems, financial problems, entertainment, religion and social support. Participants proposed possible solutions. These discussions were recorded with student permission by a simple digital voice recorder. Analysis of data The recordings of the focus group discussions were transcribed and emerging common themes on various stresses were identified. Similarly, solutions suggested by participants were noted...Item SANKOFA: a multisite collaboration on paediatric HIV disclosure in Ghana(AIDS, 2015-06) Reynolds, N.R.; Ofori-Atta, A.; Lartey, M.; Renner, L.; Antwi, S.; Enimil, A.; Catlin, A.C.; Fernando, S.; Kyriakides, T.C.; Paintsil, E.With the scale-up of effective antiretroviral therapy in resource-limited settings, many HIV-infected children are now able to survive into adulthood. To achieve this potential, children must navigate normative developmental processes and challenges while living with an unusually complex, stigmatizing, potentially fatal chronic illness and meeting the demands of treatment. Yet many of these children, especially preadolescents, do not know they are HIV-infected. Despite compelling evidence supporting the merits of informing children of their HIV status, there has been little emphasis on equipping the child’s caregiver with information and skills to promote disclosure, particularly, when the caregiver faces a variety of sociocultural barriers and is reluctant to do so. In this study, we present the background, process and methods for a first of its kind collaboration that is examining the efficacy of an intervention developed to facilitate the engagement of caregivers in the process of disclosure in a manner suitable to the sociocultural context and developmental age and needs of the child in Ghana. We also report preliminary data that supported the design of the intervention approach and currently available domains of the data system. Finally, we discuss challenges and implications for future research.Item Prayer camps and biomedical care in Ghana: Is collaboration in mental health care possible?(Public Library of Science, 2016) Arias, D.; Taylor, L.; Ofori-Atta, A.; Bradley, E.H.Background Experts have suggested that intersectoral partnerships between prayer camps and biomedical care providers may be an effective strategy to address the overwhelming shortage of mental health care workers in Africa and other low-income settings. Nevertheless, previous studies have not explored whether the prayer camp and biomedical staff beliefs and practices provide sufficient common ground to enable cooperative relationships. Therefore, we sought to examine the beliefs and practices of prayer camp staff and the perspective of biomedical care providers, with the goal of characterizing interest in-and potential for-intersectoral partnership between prayer camp staff and biomedical care providers. Methods We conducted 50 open-ended, semi-structured interviews with prophets and staff at nine Christian prayer camps in Ghana, and with staff within Ghana's three public psychiatric hospitals. We used the purposive sampling method to recruit participants and the constant comparative method for qualitative data analysis. Results Prayer camp staff expressed interest in collaboration with biomedical mental health care providers, particularly if partnerships could provide technical support introducing medications in the prayer camp and address key shortcomings in their infrastructure and hygienic conditions. Nevertheless, challenges for collaboration were apparent as prayer camp staff expressed strong beliefs in a spiritual rather than biomedical explanatory model for mental illness, frequently used fasting and chained restraints in the course of treatment, and endorsed only short-termuse of medication to treat mental illness-expressing concerns that long-term medication regimens masked underlying spiritual causes of illness. Biomedical providers were skeptical about the spiritual interpretations of mental illness held by faith healers, and were concerned by the use of chains, fasting, and the lack of adequate living facilities for patients in prayer camps; many, however, expressed interest in engaging with prayer camps to expand access to clinical care for patients residing in the camps. Conclusions The findings demonstrate that biomedical care providers are interested in engaging with prayer camps. Key areas where partnerships may best improve conditions for patients at prayer camps include collaborating on creating safe and secure physical spaces and delivering medication for mental illness to patients living in prayer camps. However, while prayer camp staff are willing to engage biomedical knowledge, deeply held beliefs and routine practices of faith and biomedical healers are difficult to reconcile Additional discussion is needed to find the common ground on which the scarce resources for mental health care in Ghana can collaborate most effectively.Item 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)(2014-05-04) Roberts, M.; Mogan, C.; Asare, J.B.Abstract Background 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.Item An assessment of mental health policy in Ghana, South Africa, Uganda and Zambia(2011-04-08) Faydi, Edwige; Funk, Michelle; Kleintjes, Sharon; Ofori-Atta, Angela; Ssbunnya, Joshua; Mwanza, Jason; Kim, Caroline; Flisher, AlanAbstract Background Approximately half of the countries in the African Region had a mental health policy by 2005, but little is known about quality of mental health policies in Africa and globally. This paper reports the results of an assessment of the mental health policies of Ghana, South Africa, Uganda and Zambia. Methods The WHO Mental Health Policy Checklist was used to evaluate the most current mental health policy in each country. Assessments were completed and reviewed by a specially constituted national committee as well as an independent WHO team. Results of each country evaluation were discussed until consensus was reached. Results All four policies received a high level mandate. Each policy addressed community-based services, the integration of mental health into general health care, promotion of mental health and rehabilitation. Prevention was addressed in the South African and Ugandan policies only. Use of evidence for policy development varied considerably. Consultations were mainly held with the mental health sector. Only the Zambian policy presented a clear vision, while three of four countries spelt out values and principles, the need to establish a coordinating body for mental health, and to protect the human rights of people with mental health problems. None included all the basic elements of a policy, nor specified sources and levels of funding for implementation. Deinstitutionalisation and the provision of essential psychotropic medicines were insufficiently addressed. Advocacy, empowerment of users and families and intersectoral collaboration were inadequately addressed. Only Uganda sufficiently outlined a mental health information system, research and evaluation, while only Ghana comprehensively addressed human resources and training requirements. No country had an accompanying strategic mental health plan to allow the development and implementation of concrete strategies and activities. Conclusions Six gaps which could impact on the policies' effect on countries' mental health systems were: lack of internal consistency of structure and content of policies, superficiality of key international concepts, lack of evidence on which to base policy directions, inadequate political support, poor integration of mental health policies within the overall national policy and legislative framework, and lack of financial specificity. Three strategies to address these concerns emerged, namely strengthening capacity of key stakeholders in public (mental) health and policy development, creation of a culture of inclusive and dynamic policy development, and coordinated action to optimize use of available resources.