Improving Ghana's Mental Health Care Through Task Shifting – Psychiatrists and Health Policy Directors Views

Background

Currently, Ghana has only twelfth psychiatrists in active service providing for the mental health needs of a population of nearly 25 million people. Ghana has therefore adopted a system of task-shifting to address the critical shortage of psychiatrists.

Aim

To examine the perception of psychiatrists and health policy directors about the government's policy to expand metal health care delivery in Ghana through a system of task-shifting from psychiatrists to community mental health workers (CMHWs).

Methods

A self-administered semi-structured questionnaire was developed and administered to 11 psychiatrists and 29 health policy directors.

Results

Only one psychiatrist and 3 (10.3%) health policy directors reported they were not aware of task-shifting within Ghana's mental health delivery system. Ten (91.1%) psychiatrists and 23 (79.3%) health policy directors were aware of a policy of the Government of Ghana to improve on the human resource base within mental health through a system task-shifting. Overall, 5 (45.5%) of the psychiatrists and 9 (31%) health policy directors perceived there are some resistance to the implementation of a policy of task shifting including resistance from traditional and spiritual healers, some psychiatrists, some community psychiatric nurses and psychologists. The majority of psychiatrists and health policy directors were of the view that CMHWs should be allowed to assess, diagnose and treat most of the common mental disorders.

Conclusion

Psychiatrists and health policy directors in Ghana support Governments policy to expand on mental health care delivery through a system of task-shifting despite their knowledge of resistance from certain professionals.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

GASP: picking off the pack of lies

GASP is celebrating 25 years tackling Big Tobacco's packs of lies!

Crystal-amorphous polymer interface studied by neutron and x-ray scattering on labeled binary ultralong alkanes

The recently discovered stable semicrystalline phase in binary ultralong alkanes is studied by small-angle neutron and x-ray scattering. Either the shorter or the longer alkane has (CD2)11CD3 ends. It is confirmed that chains are tilted in the crystal layer and found that ca. seven end carbons of the shorter alkane are amorphous. It is also established that the longer chains protrude from the crystal at both ends and that their end groups are preferentially located in the middle of the amorphous layer, suggesting gradual dissipation of orientational order of the chains exiting the crystal.

Naltrexone-induced nausea in patients treated for alcohol dependence: clinical predictors and evidence for opioid-mediated effects

Naltrexone, an opiate antagonist, is well tolerated by most alcoholic patients; however, a subset reports significant nausea that can limit the effectiveness of this therapy. The goal of this study was to identify risk factors for naltrexone-precipitated nausea to assist in the development of management strategies to maximize the overall effectiveness of naltrexone. On the basis of the hypothesis that alterations in the endogenous opioid system occur with repeated stimulation of endogenous opioids by alcohol, the authors predicted that the recency and intensity of alcohol use would be related to the risk of naltrexone-induced nausea. One hundred twenty alcohol-dependent subjects participated in an open-label trial of naltrexone. After 5 to 30 days of abstinence, subjects received an initial naltrexone dose of 25 mg followed by a dose of 50 mg daily thereafter for 10 weeks. New-onset adverse effects were rated mild, moderate, or severe after 1 week of naltrexone. Logistic regression analyses were used to predict moderate to severe nausea during the first week of therapy from pretreatment patient characteristics. Moderate to severe nausea was reported by 18 subjects (15%) and was linked to poorer medication compliance and heavier drinking during treatment. Risk of nausea was significantly predicted by age, gender, intensity of drinking, duration of abstinence, and the interaction of abstinence duration and intensity of drinking. At shorter durations of abstinence, lighter drinkers were more likely to experience nausea than heavier drinkers. However, the risk of nausea declined with longer periods of abstinence, particularly for lighter drinkers. Younger age and female gender were associated with higher rates of nausea. These results support the hypothesis that recency and intensity of alcohol use are related to opiate antagonist-precipitated nausea and suggest that long-term alcohol use may result in alterations in the endogenous opioid system. Potential strategies to minimize the risk of nausea in vulnerable individuals are discussed.

Naturalistic follow-up of drinking behavior following participation in an alcohol administration study

Administration of alcohol to alcohol-dependent individuals for research purposes, while contributing significantly to the fund of knowledge on etiology and treatment of alcohol dependence, has often raised clinical and ethical concerns that such exposure may adversely affect the individual's motivation to reduce drinking or abstain from drinking. In an attempt to evaluate these concerns, we conducted a naturalistic follow-up of subsequent drinking among individuals who participated in an alcohol self-administration study and also received a brief motivational intervention. Twenty-one non-treatment-seeking alcoholics participated in a study examining the effects of naltrexone on alcohol self-administration. Assessment of drinking during the 3 months following the laboratory study indicated that participants had significantly reduced the total number of drinking days and the number of drinks consumed per occasion, as compared to baseline levels. The findings suggest that participation in alcohol administration research does not adversely influence the subsequent drinking of alcohol-dependent individuals. Further, when the alcohol administration research is conducted carefully, with specific attention to the clinical needs of the participants, the risks of adverse effects on participants' drinking behavior is minimal, and, in fact, there is scientific benefit to society and clinical benefit to the participants with regard to their alcoholism.

Effect of LAAM dose on opiate use in opioid-dependent patients. A pilot study

The authors conducted a 16-week study with nine opioid-dependent individuals (six male; four white/two African American/three Hispanic; age 36.8 +/- 2.2 years). Participants were assigned to either a low-dose (165 mg/week; n = 5) or high-dose (330 mg/week; n = 4) Levo-alpha-acetylmethadol (LAAM) condition according to a randomized, double-blind, within-subjects crossover design, such that they were inducted onto one maintenance dose for 4 weeks and then were crossed over to receive the converse for 4 weeks. Subsequently, individuals underwent detoxification from LAAM. Eight of nine participants completed the study protocol. The proportion of urine samples positive for opiates was 0.22 +/- 0.08 and 0.53 +/- 0.12, under the high- and low-dose conditions, respectively (F = 11.8; P = 0.01). These results show that LAAM dose regimen affects the degree of abstinence from opioids.

Naltrexone plus group therapy for the treatment of opiate-abusing health-care professionals

PURPOSE

The success rate of a treatment program tailored to opioid-abusing health-care professionals that included oral naltrexone and group therapy was studied.

METHODS

20 opioid-abusing health professionals were treated over a 5-year-period. Clients received an initial assessment, supervised administration of naltrexone, and weekly attendance at a psychotherapy group for health professionals. Naltrexone was administered for the first several months, then patients continued the program without naltrexone.

RESULTS

18 patients were referred to the program after being caught diverting medication. Two patients came spontaneously. Of the 18 referred patients, 12 had no relapses, and 5 had only one relapse, followed by long-term sobriety. Mean overall duration of naltrexone administration was 8 months, and the mean duration in the program was 1.9 years. 94% of referred clients had long term abstinence, and 66% were working in their profession during the program.

CONCLUSIONS

Naltrexone in the setting of a structured program is helpful in the treatment and professional reinstatement of opioid abusing health professionals.

Smoking cessation programmes targeted at black and minority ethnic communities

Recent research carried out in Britain I amongst four black and minority ethnic groups provides information which can be used to support smoking cessation programmes targeted at these groups. Smoking prevalence rates are generally lower than for the white British population although there are some exceptions. Motivation to quit appears to be high. For example, knowledge of the health risks of smoking is high, as is the desire to quit. However there are fewer attempts to quit and therefore a lower than average smoking cessation rate. This indicates there is potential for targeted campaigns to achieve good results. Based on these findings smoking cessation targeted at black and minority ethnic groups would appear to be very timely. Innovative targeted campaigns with a national coverage are discussed including the Ramadan Project, a resource pack funded by the Department of Health and No Smoking Day. Local activities which target black and minority ethnic smokers in the workplace or cultural centres are also discussed. Recommendations for future smoking cessation strategies are suggested.

A survey of new long-stay hospital patients in an Irish health board area

OBJECTIVES

The aims of this study were to determine the number and rate of accumulation of new long-stay hospital patients in one of Ireland's eight health board areas, to describe their demographic and clinical features, and to assess their needs in relation to possible community placement.

METHODS

Demographic and clinical information was obtained on all patients over age 17 who had been continuously hospitalized in area hospitals for more than one year and less than six years on the census day of March 1, 1992. The Community Placement Questionnaire was used to rate the patients' social functioning, problem behavior, physical disability, social contact, and needs for accommodation and day care.

RESULTS

The survey identified 175 new long-stay patients, mainly middle aged to elderly. Schizophrenia was the most common psychiatric diagnosis. The bed occupancy rate for these patients was 14 per 100,000 population, and the annual accumulation rate was 2.3 per 100,000 population.

CONCLUSIONS

New long-stay patients were chronically ill with significant psychiatric and social disabilities. Involuntary patients were overrepresented in the group. Two-thirds could be placed in the community if facilities were available and had sufficiently high staffing levels.