Individual factors that influence experiences and perceptions of stigma and discrimination towards people with mental illness in Ghana

A critical review and analysis of the context, current burden, and application of policy to improve cancer equity in Ghana

BACKGROUND

Cancer causes a major disease burden worldwide. This is increasingly being realised in low and middle-income countries, which account disproportionately for preventable cancer deaths. Despite the World Health Organization calling for governments to develop policies to address this and alleviate cancer inequality, numerous challenges in executing effective cancer policies remain, which require consideration of the country-specific context. As this has not yet been considered in Ghana, the aim of this review was to bring together and critique the social-environmental, health policy and system factors to identifying opportunities for future health policies to reduce cancer burden in the Ghanian context. A critical policy-focused review was conducted to bring together and critique the current health systems context relating to cancer in Ghana, considering the unmet policy need, health system and social factors contributing to the burden and policy advances related to cancer.

CONCLUSION

The findings highlight the changing burden of cancer in Ghana and the contextual factors within the socio-ecosystem that contribute to this. Policies around expanding access to and coverage of services, as well as the harmonization with medical pluralism have potential to improve outcomes and increase equity but their implementation and robust data to monitor their impact pose significant barriers.

Attitudes towards persons with mental health conditions and psychosocial disabilities as rights holders in Ghana: a World Health Organization study

BACKGROUND

There are currently major efforts underway in Ghana to address stigma and discrimination, and promote the human rights of those with mental health conditions, within mental health services and the community, working with the World Health Organization's QualityRights initiative. The present study aims to investigate attitudes towards people with lived experience of mental health conditions and psychosocial disabilities as rights holders.

METHODS

Stakeholders within the Ghanaian mental health system and community, including health professionals, policy makers, and persons with lived experience, completed the QualityRights pre-training questionnaire. The items examined attitudes towards coercion, legal capacity, service environment, and community inclusion. Additional analyses explored how far participant factors may link to attitudes.

RESULTS

Overall, attitudes towards the rights of persons with lived experience were not well aligned with a human rights approach to mental health. Most people supported the use of coercive practices and often thought that health practitioners and family members were in the best position to make treatment decisions. Health/mental health professionals were less likely to endorse coercive measures compared to other groups.

CONCLUSION

This was the first in-depth study assessing attitudes towards persons with lived experience as rights holders in Ghana, and frequently attitudes did not comply with human rights standards, demonstrating a need for training initiatives to combat stigma and discrimination and promote human rights.

Cluster randomised controlled trial of a problem-solving, Story-bridge mental health literacy programme for improving Ghanaian community leaders' knowledge of depression

BACKGROUND

Low levels of mental health literacy about depression in the community impact negatively on attitudes towards people with the disorder and their help-seeking.

AIMS

The aim of this study was to assess the effectiveness of a problem-solving, Story-bridge mental health literacy programme, in improving community leaders' knowledge about helpful interventions for, and recognition of, depression.

METHODS

A cluster randomised controlled trial involving 140 assembly members, intervention (n = 70) and control (n = 70) groups. The intervention group received a three-hour mental health literacy programme. The control group received a plain language basic brochure about mental health issues. Data were collected at baseline and 12-week follow-up.

RESULTS

The intervention group demonstrated greater improvement in knowledge about helpful interventions for, and recognition of, depression compared to the control group at follow-up; however, the differences in both measures were small and not statistically significant.

CONCLUSION

The programme has the potential to improve participants' knowledge about helpful interventions for, and recognition of, depression. Positive outcomes have public mental health implications as they might enhance early help-seeking and contribute to better outcomes for individuals with mental health problems.

TRIAL REGISTRATION

ACTRN12617000033347. Date of registration - 9 January 2017.

The professed effect of stigma on community psychiatric nurses in the Greater Accra region of Ghana

BACKGROUND

Stigma is a major factor that inhibits Mental Health Nurses work, especially Community Psychiatric Nurses, in terms of productivity. Even though mental health services have improved drastically, because of decentralization of mental health care, a lot more people still have reservations when it comes to mental health nurses particularly Community Psychiatric Nurses. The purpose of the study was to explore the professed effects of stigma on CPNs in the Southern part of Ghana.

METHODS

The study was carried out in three district hospitals (Ga South, Ga Central and Okaikoi) all in the Accra Metropolis. The aim of the study was to describe how stigma affects Community Psychiatric Nurses. A qualitative descriptive exploratory design was adopted for the study. The purposive sampling technique was used to recruit participants. Data was saturated with 12 participants, aged between 25 and 40 years. The audio-taped interviews were transcribed verbatim and afterwards analyzed using thematic and content analysis.

RESULTS

The findings gathered from participants revealed that Community Psychiatric Nurses experienced various effects of stigma, such as low productivity, depression, and anger. Most of the participants recounted how stigmatization had affected their work both in the hospital setting and in their communities.

CONCLUSION

The study showed that Community Psychiatric Nurses carried out their activities with much difficulty, because of their poor image. They stressed the need for recognition and support from employers, stakeholders and the general community so as to boost confidence and morale with the resultant effect of better healthcare delivery.

Deconstructing institutional racism and the social construction of whiteness: A strategy for professional competence training in culture and migration mental health

The position presented in this article draws on the professional insights of the authors, reflecting on issues of global political importance in culture and migration mental health. As institutional theory perspectives continue to develop, solutions to complex social problems such as racism require embodied knowledge if the lines of authority and basic occupational routines are to be meaningfully renegotiated. Embodied knowledge is socially situated and self-reflexive and reflects cumulative and marginalized experiences that contribute to a better understanding of institutional racism and the social construction of whiteness. The authors foreground the development of critical consciousness and emotional literacy in order to be more professionally competent in institutional contexts of mental health training, education and practice. To this end, elements of due process, transparency, inclusiveness, community engagement and accountability are at the center of a political and intellectual movement towards epistemological justice to promote antiracism and social justice in culture and migration mental health. The authors define decolonial intersectionality as a clear philosophical vision outlining how best to respond to those at risk of experiencing racism and the associated mental health burdens.

The experiences and perceptions of mental health service provision at a primary health centre in the Eastern Cape

Background

Since 1994, the South African healthcare system has undergone several changes to meet the needs of contemporary South Africa. Yet the state of mental healthcare, especially in low-resource areas, remains in a precarious state.

Aim

This study aimed to explore how persons diagnosed with a mental disorder experience and perceive mental health services in a low-resource community in the Eastern Cape, South Africa.

Setting

The study was conducted at a primary care clinic in a low resource community setting in the Eastern Cape, South Africa.

Method

Semi-structured interviews were conducted with eight participants diagnosed with mental illness who had been accessing treatment for at least the past 6 months from a primary health clinic. Thematic analysis was used to analyse and identify pertinent themes.

Results

The following themes emerged from the data: (1) perceptions of mental disorders – role of culture, (2) experiences of having mental disorders – loss of employment, (3) problem of stigma – social rejection and labelling, (4) experience of distress – sadness and frustration and (5) challenges in accessing treatment – transport fee and shortage of staff.

Conclusion

This study yielded several lived experiences and perceptions in relation to participants’ feelings, opinions and interpretations of persons living with mental disorders and accessing mental health treatment in their local context. Future interventions should consider provision of more extensive professional help in the form of counsellors and social workers at the clinics, more efficient service delivery and future interventions regarding stigma should incorporate community members into the learning process.

The psychological distress and mental health disorders from COVID-19 stigmatization in Ghana

The emergence of the COVID-19 global pandemic in Ghana has resulted in various degrees of stigmatization. Previous studies have stressed the need for developing policies to curb the stigma towards COVID-19 survivors and healthcare workers. Some have investigated the knowledge and willingness of people to accept COVID-19 survivors. Others have also explored the experiences of health workers who have been victims of stigma from COVID-19. There is a need for further studies to understand COVID-19 related stigma and related psychological distress. The purpose of this study was to investigate the cases of COVID-19 related stigma and discrimination against healthcare workers, COVID-19 recovered patients, suspected persons of COVID-19, Asians, and persons with travel history from COVID-19 hotspot countries. The study was undertaken using the phenomenology approach to qualitative research. Purposive and snowball sampling techniques were used in recruiting the twenty-eight study participants. Data were garnered using interviews and focus group discussions. Data were analyzed using interpretative phenomenological analysis. The findings revealed that COVID-19 victims have faced various forms of stigma such as stereotyping, social exclusion, mockery, finger-pointing, and insults. The study recommends that the COVID-19 National Response Team in Ghana must put in place a robust psychosocial intervention plan for stigmatized persons to help them cope with the stigma and help in its prevention.

Effectiveness of a Problem-Solving, Story-Bridge Mental Health Literacy Programme in Improving Ghanaian Community Leaders' Attitudes towards People with Mental Illness: A Cluster Randomised Controlled Trial

In Ghana, people with mental disorders commonly experience negative attitudes and discrimination because of deep-rooted public stigma. The aim of the study was to assess the effectiveness of a mental health literacy programme in improving community leaders' attitudes toward people with mental disorders. A cluster randomised controlled trial, comprising an intervention and control group, participated in a 3-hour problem-solving, Story-bridge mental health literacy programme. Data were collected at baseline and 12-week follow-up. The intervention group performed better in most outcome measures at follow-up compared to the control group. There were statistically significant differences between the two groups, in perceived stigma, community mental health ideology (CMHI), and benevolence outcome measures over the two time-points. Overall, the findings suggest that the programme was somewhat effective in improving community leaders' attitudes and who might, subsequently, foster supportive, non-judgemental and empathetic attitudes toward individuals with mental disorders in their communities. There is scope for community psychiatric nurses and other primary health care workers to work with community leaders to increase public awareness of, and favourable attitudes toward, people with mental health problems in the community.

Factors associated with internalized stigma for Indonesian individuals diagnosed with schizophrenia in a community setting

WHAT IS KNOWN ON THE SUBJECT?: Internalized stigma in people diagnosed with mental illness has several negative outcomes; however, it remains unclear in an Indonesian context. The human rights of people diagnosed with mental illness in Indonesia have been routinely violated because of the existing stigma against mental illness and deficiencies in the country's mental healthcare services. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: To the best of our knowledge, this is the first study to examine the level of internalized stigma and related factors among Indonesians diagnosed with schizophrenia. Almost one-third of the subjects had moderate-to-severe levels of internalized stigma, among which discrimination was the strongest type. Specifically, younger and unemployed people with more psychotic symptoms had higher levels of internalized stigma. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The provision of adequate pharmacological and psychosocial treatments to help people manage their psychotic symptoms is extremely important to ameliorate stigma. Vocational rehabilitation and employment support for unemployed people may potentially reduce their internalized stigma and promote recovery. ABSTRACT: Introduction The human rights of people diagnosed with mental illness in Indonesia have been routinely violated because of societal stigma associated with mental illness and deficiencies in the country's mental healthcare services. Knowledge about internalized stigma among people diagnosed with schizophrenia in lower middle-income Muslim countries is also scarce. Aim To identify the level of internalized stigma and related factors among people diagnosed with schizophrenia in Indonesia. Method A cross-sectional survey was conducted with a purposive sample of 300 people diagnosed with schizophrenia from an urban Indonesian psychiatric hospital. Results Almost one-third of the subjects had moderate-to-severe levels of internalized stigma, among which discrimination was the strongest type. Younger age, unemployment status and having psychotic symptoms significantly increased the risk of internalized stigma when analysed in a multivariable ordinal logistic regression. Discussion The present study firstly identified the high levels of internalized stigma among Indonesian individuals diagnosed with schizophrenia. Implications for practice Mental health nurses are suggested to provide early anti-stigma illness management and family psychoeducation interventions to people diagnosed with schizophrenia and their family caregivers, helping them to develop an optimistic understanding about the concept of schizophrenia and mitigating the negative consequences of public and internalized stigma.

Self-Destigmatization Process? Experiences of Persons Living with Bipolar Disorder: A Qualitative Study

This qualitative study investigated subjective experiences of self-stigmatization and self-destigmatization among people living with bipolar disorder (BD). We conducted in-depth interviews focusing on self-stigmatization and self-destigmatization with 22 individuals living with BD. The interview transcripts were thematically analyzed using a mixed inductive and deductive approach. Thirty-six codes were extracted and organized into six themes: language, behaviors, relationships, personal experience, identity, and healthcare. Each theme was characterized by an evolution process, and the codes were distributed in a step-by-step order as landmarks. The process begins with the experience of self-stigmatization, and develops toward self-destigmatization. This study presents a new six-dimension process called the "self-destigmatization process" (SDP), a personal and interrelational process that deconstructs self-stigmatization. Clinicians can use the landmarks of the process for clinical assessment and therapeutic interventions to increase recovery orientation.

Pathways to mental health treatment in Ghana: Challenging biomedical methods from herbal- and faith-healing perspectives

BACKGROUND

The clinical pathways for treating mental illness have received global attention. Several empirical studies have been undertaken on treatment pathways in Ghana. No study, however, has systematically reviewed the literature related to the pathways of mental health treatment in Ghana.

AIM

This article aims to identify the pathways used to treat mental illnesses; examine the evidence about the possibility of collaboration between biomedical, faith and traditional healing pathways; and draw attention to the barriers hindering such collaboration.

METHODS

A search of the published literature was conducted using Medline, Embase, PsycINFO, CINAHL (EBSCO), Web of Science and Scopus databases. The search was limited to the articles that were published in English and released between 2000 and June 2018. The review synthesises both qualitative and quantitative data.

RESULTS

The findings showed that mental illnesses in Ghana are treated using a mixture of biomedical and faith-based and traditional healing services. Faith and traditional healing pathways are typically used as a preliminary source of cultural assessment before seeking biomedical treatment. There is an increasing desire for collaboration between biomedical, faith and traditional healing pathways. However, several individual factors (attitude or stigma, the perceived efficacy of treatment and differences in the treatment process) and health system factors (a lack of policy and regulation, a limited number of biomedical service providers, limited financial support and geographical isolation of services) jointly contribute to barriers precluding establishing such collaboration.

CONCLUSION

This review recommends that policies, regulations, educational support and financial incentives should be developed to facilitate collaboration between biomedical, faith and traditional healing service provision.

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

PURPOSE

To explore factors influencing treatment pathways to mental health services among consumers in Ghana.

DESIGN AND METHODS

Cross-sectional design using quantitative method.

FINDINGS

Treatment pathways for mental illness were general hospitals/clinics, psychiatric hospitals, and faith-based practices. The predisposing (age, household size, primary occupation, ethnicity, marital status, religion, and geographic location, as well as attitudes and beliefs), enabling (affordability), and need factors (severity of mental illness) were significant predictors of treatment pathways.

PRACTICE IMPLICATIONS

Current advocacy and awareness for mental health services in Ghana should consider the predisposing, enabling, and need factors of consumers. Policy initiatives on mental health services should ensure adequate financing mechanisms and further establish collaboration between biomedical and faith-based services.

An integrative review of potential enablers and barriers to accessing mental health services in Ghana

INTRODUCTION

The importance of accessible mental health treatment is a global concern, particularly when one in five people will experience a mental health problem in their lifespan. This is no less important in Ghana; however, no studies have yet attempted to appraise and synthesise the potential enablers and barriers to accessing services in Ghana. The aim of this integrative review is therefore to identify and synthesise existing evidence on the barriers and enablers to accessing mental health services in Ghana.

METHODS

A search of the published literature was conducted using Medline, EMBASE, PsycINFO, CINAHL (EBSCO), Web of Science, and Scopus electronic databases. The search was limited to papers published in English and within 2000-2018. Using pre-defined inclusion and exclusion criteria, two reviewers independently screened the titles and abstracts of the retrieved papers. A data extraction form and a Critical Appraisal Checklist were used to extract and appraise data, respectively. The integrative review incorporates both qualitative and quantitative data into a single synthesis.

RESULTS

Out of 42 papers that met the inclusion criteria, 50% used qualitative methods, 33.3% used mixed methods and 16.7% used quantitative methods alone. The potential barriers in accessing mental health services were attitudinal, knowledge about services, treatment cost, transportation and geographical proximity, as well as perceived efficacy of medication. Similarly, the health systems factors contributing to barriers were low priority, limited funding sources, irregular medicine supply, limited services for marginalised groups and poor state of psychiatric facilities, together with poor management of mental health cadres. The potential enablers for service users involved increased decentralisation and integration, task-shifting and existing support services.

CONCLUSION

The existing evidence on mental health in Ghana is skewed towards weaknesses in the systems and stigma, with rationally little, or no, evidence or emphasis on the effectiveness, or quality of mental health services. These attributes largely neglect the provision of psychiatric services for marginalised mental health service user groups, including children, adolescents, people with disabilities and the elderly.