title: Task shifting of mental health care services in Ghana: ease of referral, perception and concerns of stakeholders about quality of care.
abstract: OBJECTIVE
  To examine the perceptions of stakeholders about the ease of referral of patients from community mental health workers (CMHWs) to psychiatrists in Ghana and the level of stakeholder concerns about the quality of care provided to these community health cadres.
  
  
  METHODS
  A cross-sectional survey.
  
  
  METHODS
  Eleven psychiatrists, 26 health policy directors and 164 community mental health workers, including 71 (43.3%) community psychiatric nurses, 19 (11.6%) clinical psychiatric officers and 74 (45.1%) community mental health officers.
  
  
  METHODS
  We administered three separate, self-administered, semi-structured questionnaires to the study participants.
  
  
  RESULTS
  Although many respondents including almost all CMHWs perceive that it is easy for them to refer difficult cases to a psychiatrist who will usually see such patients in a timely manner, less than a quarter of these health cadres reported that they always or often refer patients to see a psychiatrist. The majority of CMHWs were of the opinion that patients, psychiatrists and other healthcare workers have concerns about the quality of care they provide, sentiments that were echoed by all psychiatrists and over half of all the health policy directors.
  
  
  CONCLUSIONS
  There is also a need for policy directors to educate CMHWs about their roles and to clarify referral pathways so that cases that are difficult to manage will be appropriately referred to psychiatrists or appropriately trained and incentivized district medical doctors for further management.
authors.affiliation: Department of Behavioural Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada Centre for Global Health, University of Dublin, Trinity College, Dublin, Ireland.
authors.forename: Vincent I O
authors.initials: VI
authors.lastname: Agyapong
authors.affiliation: Ghana Mental Health Authority and Accra Psychiatric Hospital, Accra, Ghana.
authors.forename: Akwasi
authors.initials: A
authors.lastname: Osei
authors.affiliation: Department of Psychiatry, University of Dublin, Trinity College Dublin, Dublin, Ireland.
authors.forename: Conor K
authors.initials: CK
authors.lastname: Farren
authors.affiliation: School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
authors.forename: Eilish
authors.initials: E
authors.lastname: Mcauliffe
mesh_terms: D001291:Attitude of Health Personnel; D003150:Community Health Workers / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D005869:Ghana; D006297:Health Services Accessibility; D006280:Health Workforce; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D010465:Perception; D011570:Psychiatry / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000458:organization & administration*; D013997:Time Factors
keywords: community mental health workers; concerns; psychiatrists; quality of care