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Andres Barkil-Oteo, MD, MSc, Assistant Professor of Psychiatry,
Yale School of Medicine
I was invited to visit Ghana by GHLI to discuss the incorporation of a mental health component, known as the “Psych Corps,” into Ghana’s National Health Service. Ghana graduates 300 psychology students per year who serve one required year posted to clinics across the country.
This is the second year of the program and we see many issues that still need to be addressed, but largely the feedback was positive and Psych Corps members look forward to expanding the program. Why were my team and I involved? Although none of us had ever been to Ghana, and its culture and customs were foreign to us, somehow the setting felt familiar.
For the last two years, our group has overseen a student run clinic in New Haven, CT offering behavioral health services to a large, undocumented Latino population in a low income neighborhood. The problems of lack of access, stigma, and lack of professional staff in Ghana’s clinics mirrored many of the problems we face in the U.S. We shared our model with our Ghanaian counterparts, and sought feedback from a group of enthusiastic nurses and psychology graduates on how this could be adapted to their current situation. We, in turn, learned from them how to go about performing outreach and home visits, things we currently lack in our complex, hospital-focused system.
Our travel to Ghana further illustrated to us that problems of access are universal, as are problems of under utilizing evidence-based therapies, and problems of marginalization and stigma. We need to change our mental perspective to one that assumes that we all deal with similar problems, with differences in intensity, but not in kind. Students wishing to work in the area of global health would be well advised to find a similarly local under-resourced setting, where they could learn skills and practices not taught inside large hospital settings; only then could they approach global initiatives with a mentality of solidarity rather than a mentality of difference. After spending a full day with Psych Corps, exchanging ideas, I came back optimistic about this collaboration, and look forward to continuing the shared learning experience.
Recently, I traveled with a team from Yale’s Global Health Leadership Initiative and witnessed the treatment and lack thereof, of those dealing with mental health issues in the country of Ghana. GHLI has partnered with senior health practitioners, policymakers, and health care officials for several years to assist their efforts in treating those with mental health disorders. Our team spent a majority of the time in Accra where we visited Accra Psychiatric Hospital, and met with the Ghana GHLI delegation to discuss progress made to improve mental health care.
My most memorable experience of this trip was visiting the small city of Koforidua to better understand how the mental health care system works outside of Accra. During our day there, the community psychiatric nurse scheduled many activities. We first met with the regional health director and the director of the regional hospital. We then went on home visits where we followed community outreach workers who remind patients to return to the hospital for follow up treatment including medication. We also a visited a clinic focused on child mortality, and a prayer camp. The prayer camp housed mostly mentally ill patients who were there to pray their sickness away, but they were also given medicine by the local hospital through outreach by a community psychiatric nurse.
The day was overwhelming, but also inspiring as I witnessed the passion that the mental health staff had for their work. With no additional government funding beyond their basic mandate, the staff at the regional hospital managed to find funds to create a new psychiatric ward with eighteen beds because they knew it was important. I also saw dedication of one psychiatric nurse, Akosua, who took it upon herself to start “Project Dignity,” an initiative where staff rehabilitates homeless persons with mental illness.
Discussing the challenges of improving mental health care in Ghana for the first half of the week, I could see there was a long way to go. After meeting the frontline people who were making this happen, I had a lot more hope that Ghana could achieve their goal of improving mental health care.
|Photo by Peter Hvizdak / New Haven Register|
When the body’s circulatory, nervous, musculoskeletal and immune systems all work together, it wards of multiple infections every day. When these systems do not work in coordination, the body can be overcome by an infection, as happens with untreated HIV infection leading to AIDS. Medical treatments and social determinants affect the success of the compliance and treatment among AIDS patients. By linking complex systems to fight insurgencies in a nation and infections in a vulnerable human body, we can fight off constant threats and rebuild health. To read a news article about this event, click here.
Elizabeth Bradley, Ph.D.
Faculty Director, GHLI/GHI
Master, Branford College
I was warned about the long train ride from Zurich and the icy walks in Davos, but nothing truly prepared me for the World Economic Forum. As a professor accustomed to more limited signs of power, I had never seen so many prime ministers, CEOs of mega-corporations, and global influencers in one place as last week nestled in the Alps.
By Helen Jack,
Together, we designed a study of Ghana’s mental health workforce, aimed at exploring how staff in psychiatric hospitals can be recruited and retained. I spent summer 2011 at Ghana’s three psychiatric hospitals, interviewing staff members.
“One thing that motivates us to work is our colleagues,” said a psychiatric nurse. “Sometimes you are tired, but your colleague says, ‘my friend, let’s get up and do the work.’” Almost universally, positive interpersonal relationships and constructive feedback motivated staff. On the other hand, workers were regularly attacked by patients and not compensated for injuries, they felt that the stigma of mental health disorders extended to those who treated them, and they were frustrated with the poor hospital infrastructure, low salaries, and lack of professional development opportunities.
Following data collection, the members of the Ghanaian delegation helped me get my research findings to decision-makers in Ghana, providing them with information that could inspire and inform changes. Some of the data, for example, went to the Vice President, helping advocate for the passage of a new Mental Health Law, which would increase focus on workforce welfare. The opportunity to conduct research in global health comes with the responsibility of ensuring that information gets back to where it can be most useful.
Alice Bradley, GHLI volunteer
Recently, I had the great opportunity to serve as a research assistant with the GHLI during a trip to Ghana to observe the state of mental health in that country. So many aspects about my trip with GHLI to Ghana were memorable, but it was the tour of Mt. Horeb Prayer Camp that I remember most vividly.
These religious communities (varying denominations) offer treatment to people with mental illness. They are a popular alternative to psychiatric hospitals, with 70 prayer camps just in Greater Accra. The camp leaders view mental disorders as demons inside a person and do not use psychiatric medication, but rather a regimen of fasting, prayer, and beatings to expel the demons.
Beginning our tour, I expected to be immediately outraged, but instead I was caught off guard with the natural beauty of the jungle setting and the camp’s feeling of community. There was a market, people laughing, flowers, goats, and colorful buildings. Our guide had a big grandfatherly smile. I could almost imagine the appeal of this peaceful community.
Unfortunately, the peaceful feeling came to an end as we approached the “sanitorium.”