title: Factors influencing the career choice and retention of community mental health workers in Ghana.
abstract: BACKGROUND
  Whilst there have been several studies exploring retention in health workers, little is known about health workers engaged in the provision of mental health services and the factors that affect their recruitment and retention.
  
  
  OBJECTIVE
  The objective of this research was to examine the views of stakeholders about the factors which influence career choices and retention of community mental health workers (CMHWs) in Ghana.
  
  
  METHODS
  We administered three separate, self-administered, semi-structured questionnaires to 11 psychiatrists, 29 health policy directors and 164 CMHWs across Ghana, including 71 (43.3%) community psychiatric nurses (CPNs), 19 (11.6%) clinical psychiatric officers (CPOs) and 74 (45.1%) community mental health officers (CMHOs).
  
  
  RESULTS
  Overall, 34 (20.7%) of all CMHWs chose to work in mental health because of the job prospects in mental healthcare. Overall, 12 (16.2%) CMHOs, 1 (5.3%) CPO and 20 (28.2%) CPNs reported they had considered leaving the mental health profession because of the stigma, with 4 (36.4%) psychiatrists and 12 (41.4%) health policy coordinators also reporting that they knew some CMHWs who had considered leaving the mental health profession because of stigma. Similarly, 16 (21.6%) CMHOs, 4 (22.1%) CPOs and 38 (53.5%) CPNs said they had considered leaving the mental health profession because of concerns about risk. Furthermore, 6 (54.5%) psychiatrists and 3 (10.3%) health policy directors said they knew some CMHWs who had considered leaving the mental health profession because of concerns about risk. Overall, 61 (37.2%) of CMHWs reported that they have considered leaving the mental health profession for other reasons other than stigma and risk including the following: the lack of support, respect and recognition from healthcare managers, lack of opportunities for professional development and poor conditions of service including low salaries, lack of office and personal accommodation and lack of risk allowance and transportation as well as poor inter-professional relationships.
  
  
  CONCLUSIONS
  Several factors affect the recruitment and retention of CMHWs in Ghana, including the prospects of easy employment, stigma, risk, lack of opportunities for career progression and low salaries.
authors.affiliation: Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. agyapong@ualberta.ca.|Department of Behavioural Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. agyapong@ualberta.ca.|Centre for Global Health, University of Dublin, Trinity College, Dublin, Ireland. agyapong@ualberta.ca.
authors.forename: Vincent I O
authors.initials: VI
authors.lastname: Agyapong
authors.affiliation: Ghana Mental Health Authority and Accra Psychiatric Hospital, Accra, Ghana. akwasiosei2014@gmail.com.
authors.forename: Akwasi
authors.initials: A
authors.lastname: Osei
authors.affiliation: Department of Psychiatry, University of Dublin, Trinity College Dublin, Dublin, Ireland. cfarren@stpatsmail.com.
authors.forename: Conor K
authors.initials: CK
authors.lastname: Farren
authors.affiliation: School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland. eilish.mcauliffe@ucd.ie.
authors.forename: Eilish
authors.initials: E
authors.lastname: McAuliffe
mesh_terms: D001291:Attitude of Health Personnel; D002321:Career Choice; D003153:Community Health Services; D005869:Ghana; D006801:Humans; D007588:Job Satisfaction; D008603:Mental Health; D010560:Personnel Selection; D010563:Personnel Turnover; D011795:Surveys and Questionnaires; D000078329:Workforce