- Title
- Implementation of the Mental Health Act in Ghana: a study of barriers and enablers using a mixed-method approach
- Creator
- Ae-Ngibise, Kenneth Ayuurebobi
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2022
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- The introduction of the Mental Health Act (MHA) 846 in 2012 to promote and improve mental health service provision has been recognised locally and internationally as an excellent step for transforming mental healthcare in Ghana. Despite some achievements resulting from implementing the MHA, there has been a weak implementation of the policy provisions similar to previous policies such as the 1888 Lunatic Asylum Act and the 1972 Mental Health Decree that were loosely implemented. Little is known about the main contextual issues that would facilitate or impede the implementation of the present MHA. The aim of this Thesis was to investigate the barriers and enablers to implementing the current MHA. Methods: A mixed-method approach including a survey, focus group, interviews, and field observations were used to investigate the barriers and enablers to implementing the MHA. The study participants included senior civil servants, health professionals, law enforcement officers, parliamentarians, carers, community opinion leaders, mental health service users and traditional and faith-based practitioners. For the quantitative study, the World Health Organisation Disability Assessment Schedule (WHODAS-12, version 2.0) was used for data collection to measure level of functional disability among people with mental disorders. A study-specific survey was conducted to assess both participants’ access to support from the available mental health stakeholders in Ghana and their knowledge of the MHA. For the qualitative study, in-depth interviews and focus group discussions were conducted with district, regional, and national key stakeholders. The qualitative data collected through interviews and focus groups were digitally recorded, transcribed verbatim and exported into NVivo 11 for analysis. Quantitative data were analysed using descriptive statistics, while thematic analysis utilising the 5-step Framework approach was used for analysing the qualitative data. Results: This Thesis reports significant achievements in mental health service provision attributable to the influence of the MHA. Some of these notable achievements include: establishing the Ghana Mental Health Authority (GMHA); expansion of the mental health workforce through the appointment of regional mental health coordinators (RMHC) entrusted with the mandate to coordinate mental health services in the various administrative regions; and the provision of other mental health personnel that invariably increased access to mental health services. Participants also reported that there had been a systematic reduction in the use of chains and flogging of people with mental illness to drive out evil spirits. Thematic analysis identified five main barriers impeding the implementation of the MHA. These include: underfunding mental health due to a lack of political commitment; policy failure and delay in passing the Legislative Instrument (LI); insufficient resources and mental health workforce; poor mental health literacy and limited knowledge of the MHA and a lack of mental health data for planning. Participants reported that the insufficient allocation of resources for mental healthcare results in poor mental health service provision, which directly affects the implementation of the statutory provisions of the MHA. Some of the identified enablers for implementing the MHA include advocacy, central Government intervention through increased funding, and effective collaboration with Traditional and Faith-Based Healers (TFHs) through guidance and regulation to minimise human rights abuse. Findings from this study showed that key stakeholders play a central role in facilitating the MHA implementation, yet no broader consultation and collaboration among stakeholders currently exist in efforts to implement the MHA. Stakeholders and key institutions such as the GMHA, Ministry of Health (MoH), Ghana Health Service (GHS), TFHs, National Health Insurance Authority (Igbinomwanhia et al.), District Assembly, Social Welfare, NGOs, health service providers, legal services including Ghana Police Service, Prison Services and Commission for Human Rights and Administrative Justice, community opinion leaders, service users and carers were identified as playing critical roles to ensure the MHA is implemented. The quantitative study reports higher disability (66%) among participants with mental illness, indicating an inability to function well due to the mental disorder. Also, there was a general lack of a support network for people with mental disorders in the area, with only a third of the participants having access to any form of support or social protection services. Conclusion: Key stakeholders' commitment to mental healthcare in Ghana is lacking, evidenced by the limited implementation of the provisions of the MHA. Integrating mental health in primary healthcare and collaboration between various healthcare providers could be an excellent strategy in harnessing and maximising the limited human and material resources and, more significantly, destigmatising mental illness. Government commitment and investment in mental healthcare will be significant in facilitating the implementation of the MHA provisions to ensure the desired improvement of Ghana's mental healthcare delivery.
- Subject
- Mental Health Act (MHA); policy implementation; mental illness; barriers; enablers; mental healthcare; mixed-methods; Ghana
- Identifier
- http://hdl.handle.net/1959.13/1501710
- Identifier
- uon:55166
- Rights
- Copyright 2022 Kenneth Ayuurebobi Ae-Ngibise
- Language
- eng
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