Towards Implementation of Context-specific Integrated District Mental Health Care Plans: A Situation Analysis of Mental Health Services in Five Districts in Ghana

Background: Access to quality mental health services in Ghana remains poor, yet little is known about the extent of integrated mental health service provision in districts in Ghana. The purpose of the study was to conduct a situation analysis of integrated mental health service provision in five districts, to inform the development and implementation of tailored district mental healthcare plans in Ghana. Methods: A cross-sectional situation analysis was conducted using a standardised tool to collect secondary routine healthcare data supplemented with interviews with key informants across five purposively selected districts in Ghana. The PRIME (Programme for Improving Mental health care) situation analysis tool was adapted to the Ghanaian context and used for data collection. Results: The districts are predominantly rural; more than eight out of ten people in each selected districts live in rural areas. Mental Neurological and Substance use (MNS) conditions were not routinely reported in the top 10 causes of OPD attendance. Across all districts there are severe challenges with the provision of mental health care, primarily because of the slow enforcement of the mental health Act 2012 (Act 846). There are no mental health care plans, supervision of the few mental health professionals is weak and unstructured, access to regular supply of psychotropic medications is a major challenge, and psychological treatments are extremely limited given the lack of trained clinical psychologists. Data on treatment coverage was unavailable but we estimate this to be <0.5% for depression, schizophrenia, and epilepsy across districts. Nonetheless, opportunities for mental health systems strengthening were noted. These included commitment and willingness of leadership, the existence of a district health information management system, well-established network of community volunteers and some collaboration with traditional and faith-based mental health service providers. Conclusion: The baseline data from this situation analysis confirms the widely reported poor mental health infrastructure across Ghana and other Low and Middle-Income Countries. There are opportunities for strengthening mental health systems through interventions at the organisation/policy level, health facility, and community levels. A standardised situation analysis tool is useful to inform district level mental health care planning in low resource settings in Ghana and potentially other sub-Saharan African countries.

FORENSIC MENTAL HEALTH IN EUROPE: SHARED LEGAL HERITAGE AND CONTEMPORARY LANDSCAPE

This paper provides an overview of some of the key features of forensic mental health systems around Europe. Forensic mental health systems share in common the aim to assist in the rehabilitation of people diagnosed with a mental disorder and reduce reoffending or risk of harm. How these aims are pursued varies across the continent. We suggest that best practices can be learnt from observing different countries’ approaches. This paper has six foci: legal traditions in Europe, the concept of criminal responsibility, patient pathways through forensic systems, epidemiological studies of forensic patients, training programmes in forensic mental health, and recent developments in the field across Europe. Readers should reflect on these topics in the context of their own country and how these diverge/converge from the countries described in this paper.

Barriers and facilitators to the integration of digital technologies in mental health systems: A protocol for a qualitative systematic review

Introduction Digital technology has the potential to improve health outcomes and health system performance in fragmented and under-funded mental health systems. Despite this potential, the integration of digital technology tools into mental health systems has been relatively poor. This is a protocol for a synthesis of qualitative evidence that will aim to determine the barriers and facilitators to integrating digital technologies in mental health systems and classify them in contextual domains at individual, organisational and system levels. Methods and analysis The methodological framework for systematic review of qualitative evidence described in Lockwood et al. will be applied to this review. A draft search strategy was developed in collaboration with an experienced senior health research librarian. A systematic search of Medline, Embase, Scopus, PsycInfo, Web of Science and Google Scholar, as well as hand searching of reference lists and reviews will identify relevant studies for inclusion. Study selection will be carried out independently by two authors, with discrepancies resolved by consensus. The quality of selected studies will be assessed using JBI Critical Appraisal Checklist for Qualitative Research. Data will be charted using JBI QUARI Data Extraction Tool for Qualitative Research. Findings will be defined and classified both deductively in a priori conceptual framework and inductively by a thematic analysis. Results will be reported based on the Enhancing transparency in reporting the synthesis of qualitative research. The level of confidence of the findings will be assessed using GRADE-CERQual. Ethics and dissemination This study does not require ethics approval. The systematic review will inform policy and practices around improving the integration of digital technologies into mental health care systems.

LGBTQIA+ rights, mental health systems, and curative violence in India

This commentary examines the space-attitude-administrative complex of mainstream mental health systems with regard to its responses to decriminalisation of non-heteronormative sexual identities. Even though the Supreme Court, in its 2018 order, instructed governments to disseminate its judgment widely, there has been no such attempt till date. None of the government-run mental health institutions has initiated an LGBTQIA+ rights-based awareness campaign on the judgment, considering that lack of awareness about sexualities in itself remains a critical factor for a non-inclusive environment that forces queer individuals to end their lives. That the State did not come up with any awareness campaign as mandated in the landmark judgment reflects an attitude of queerphobia in the State. Drawing on the concept of “biocommunicability”, analysing the public interfaces of state-run mental health institutions, and the responses of mental health systems to the death by suicide of a queer student, I illustrate how mental health institutions function to further anti-LGBTQIA+ sentiments of the state by churning out customer-patients out of structural violence and systemic inequalities, benefitting the mental health economy at the cost of queer citizens on whom curative violence is practised.

Reimagining Community Mental Health Care Services: Case Study of a Need Based Biopsychosocial Response Initiated During Pandemic

Community mental health systems worldwide have undergone transformation in order to accommodate enormous demands of the pandemic and its mitigation efforts. The pandemic created unprecedented challenges that required Mehac Foundation (further referred as Mehac), a not for profit organization based in Kerala, to reassess our care delivery model. The aim of this report is to present a flexible, need-based biopsychosocial response; a case study effectuated by the Non-Governmental Organization (NGO) with a focus on minimizing the impact of COVID 19 on vulnerable communities, while adhering to timely regulations issued by the government. The key aspect of our biopsychosocial response was implementation of a phased approach that was rooted in real time need identification. The strategies will be described under broad headings of (i) adaptations for maintaining continuity of care, (ii) identifying vulnerable subgroups and need based psychological response, (iii) exploring social dimensions of the pandemic and implementing strategies to address them, (iv) ensuring team well-being and enhancing skills to effectively respond to the challenges.

The Realities Of Schizophrenia For Black African Families Navigating Greater Toronto's Mental Health Services

This is a qualitative phenomenological (Padgett, 2017) study of how Black African families with relatives diagnosed with schizophrenia navigate and experience mental health systems in the Greater Toronto Area. Data was collected through individual face-to-face interviews with 3 participants who are self-identified adult African family members or relatives of a person diagnosed with schizophrenia. The research draws on the theoretical approaches of Anti-Black Racism (Kumsa et al, 2014) and Anti-Black Sanism (Abdillahi, Meerai & Poole, 2014; Meerai, Abdillahi & Poole, 2016). Participants had an outlet to share their experiences, and a space to share ideas on program development and coping strategies. The findings of this study suggest that Black families need a space where Black and/or African individuals with mental health challenges can safely navigate and share their stories through storytelling, poetry and music, to name a few methods. There is a need for Black and/or African navigating resource services for Black and/or African immigrants diagnosed with mental health challenges and their families. We can conclude that there are a number of areas of research which require more exploration, including the social construction of Black and/or African immigrant families faced with mental health challenges pre- and post-diagnosis and how they navigate mental health systems. It is critical to promote the voices of Black and/or African individuals with mental health challenges and their families in research and practice because “you cannot know about us without us” (Morrow &Malcoe, 2017, p.132).

The Realities Of Schizophrenia For Black African Families Navigating Greater Toronto's Mental Health Services

This is a qualitative phenomenological (Padgett, 2017) study of how Black African families with relatives diagnosed with schizophrenia navigate and experience mental health systems in the Greater Toronto Area. Data was collected through individual face-to-face interviews with 3 participants who are self-identified adult African family members or relatives of a person diagnosed with schizophrenia. The research draws on the theoretical approaches of Anti-Black Racism (Kumsa et al, 2014) and Anti-Black Sanism (Abdillahi, Meerai & Poole, 2014; Meerai, Abdillahi & Poole, 2016). Participants had an outlet to share their experiences, and a space to share ideas on program development and coping strategies. The findings of this study suggest that Black families need a space where Black and/or African individuals with mental health challenges can safely navigate and share their stories through storytelling, poetry and music, to name a few methods. There is a need for Black and/or African navigating resource services for Black and/or African immigrants diagnosed with mental health challenges and their families. We can conclude that there are a number of areas of research which require more exploration, including the social construction of Black and/or African immigrant families faced with mental health challenges pre- and post-diagnosis and how they navigate mental health systems. It is critical to promote the voices of Black and/or African individuals with mental health challenges and their families in research and practice because “you cannot know about us without us” (Morrow &Malcoe, 2017, p.132).

Mental Health and Well-Being during COVID-19 in the developing world: A Review of Sub-Saharan Africa and Asia

In view of the latest COVID-19 pandemic's unprecedented major global health crisis, it is extremely vital to consider the mental effect of this rising and formidable threat on the life of humanity, which has significant morbidity and mortality worldwide. Previous research indicates that people affected by COVID-19 can have a high burden of issues with mental health, including depression, anxiety disorders, stress, sleep disorders, emotional illness, signs of post-traumatic stress, and suicidal behavior. In the background of the COVID-19 pandemic, as the outbreak entails a large-scale change in behavior and further, creates major psychological burdens on individuals, there is a growing concern to resolve the mental health issues of the general population. This review article attempts to highlight different mental health challenges faced during COVID-19 by multiple individuals. In certain settings, virtual mental health systems should be set up, and social media should be used to provide education and networking tools for mental health. Psychopathological issues in various communities should be emphasized in future epidemiological research