Mental Health Competence in two Urban Poor Communities in Accra, Ghana: A Social Psychology of Participation Approach

Abstract

Poor communities in Africa are disproportionately affected by mental disorders globally. Current research proposes that improving mental health in poor communities requires building their mental health competence. There are however limited community mental health competency studies in African context, to inform diagnosis of social realities of mental health in such communities and guide intervention planning. Integrating the social psychology of participation and community mental health competency models into a conceptual framework, this thesis conducted a critical social psychological analysis of the social realities of mental health probkems in Jamestown and Usshertown - two urban poor communities in Accra, Ghana. The conceptual framework explored three social psychological features of community mental health competency; i) symbolic competency – social representations which provides insight into lay mental health knowledge in the communities, ii) material competency – access to concrete material conditions such as money food, shelter and mental healthcare which structure mental illness experience in community context, and iii) relational competency – access to bonding, bridging and linking social capital which provides material and symbolic resources for addressing mental health problems. Mixed-method data were gathered, combining survey, focus group discussion, key informant interviews and situated conversations. Data was gathered from 384 survey respondents and 77 qualitative participants. The qualitative data was analysed using theoretically-driven thematic analysis. The survey data was analysed using chi square, multiple regression and structural equation modelling. Three key insights emerged, in line with the conceptual framework. First, the communities exhibited relatively high symbolic mental health competency, compared to their material and relational competencies. There was general awareness that the prevalent mental health disorders in the communities were depression, anxiety, ‘madness’, epilepsy, substance

addiction, suicide, psychosocial stress, excessive anger, worry and frustration. There was also high awareness of the multilevel factors that expose them to these mental health disorders. Mental illness stigma and empathy co-existed simultaneously. Representations of the mental illness were cognitive-emotional, which informed legitimization and illegitimization of some mental health disorders depending on severity of conditions and identity of the sufferers. Second, the communities were extremely low on material mental health competency. Structural poverty and joblessness exposed healthy community members to recurring psychosocial struggles, and also undermined quality of care for individuals and families affected by mental health disorders. Finally, relational mental health competency of the communities was also low. While their bonding social capital was relatively high, there are limited existing bridging and linking social capital targeted at addressing mental health problems within the communities. Nevertheless, there are existing partnerships that offer opportunities for strategic alliances in transforming mental health within the communities. The implications of the insights in the development of participatory mental health interventions to build mental health competency in the research communities are discussed.