title: Task shifting--Ghana's community mental health workers' experiences and perceptions of their roles and scope of practice.
abstract: BACKGROUND
  Because of the absence of adequate numbers of psychiatrists, the bulk of mental health care at the community level in Ghana is provided by community mental health workers (CMHWs).
  
  
  OBJECTIVE
  To examine the role and scope of practice of CMHWs in Ghana from their own perspectives and to make recommendations to improve the care they provide.
  
  
  METHODS
  We conducted a cross-sectional survey of 164 CMHWs from all the 10 administrative regions of Ghana, comprising 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, only 39 (23.8%) CMHWs worked closely with psychiatrists, 64 (39%) worked closely with social workers, 46 (28%) worked closely with psychologists and 13 (7.9%) worked closely with occupational therapists. A lower proportion of CMHOs worked closely with psychiatrists, psychologists, and social workers compared with CPOs and CPNs. There was no significant difference in the proportion of the different CMHW types who expressed confidence in their ability to diagnose any of the commonly named mental health conditions except personality disorders. However, a lower proportion of CMHOs than CPOs and CPNs expressed confidence in their ability to treat all the disorders. The CMHWs ranked schizophrenia as the most frequently treated mental health condition and there was no statistically significant difference in the reported frequency with which the three groups of CMHWs treated any of the mental health conditions.
  
  
  CONCLUSIONS
  Mental health policy makers and coordinators need to thoroughly review the training curriculum and also evaluate the job descriptions of all CMHWs in Ghana to ensure that they are consistent with the demands and health-care needs of patients they care for in their communities. For example, as CMHOs and CPNs prescribe medication even though they are not expected to do so, it may be worth exploring the merits of including the prescription of common psychotropic medication in their training curriculum and job descriptions.
authors.affiliation: Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.|Department of Behavioural Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.|Centre for Global Health, Trinity College Dublin, University of Dublin, Dublin, Ireland; agyapong@ualberta.ca.
authors.forename: Vincent I O
authors.initials: VI
authors.lastname: Agyapong
authors.affiliation: Ghana Mental Health Authority, Accra, Ghana.|Accra Psychiatric Hospital, Accra, Ghana.
authors.forename: Akwasi
authors.initials: A
authors.lastname: Osei
authors.affiliation: Department of Psychiatry, Trinity College Dublin, University of 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: D000488:Allied Health Personnel; D001291:Attitude of Health Personnel; D003156:Community Mental Health Services; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000451:nursing; D005869:Ghana; D014943:Global Health; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy*; D011361:Professional Competence; D000078329:Workforce
keywords: community mental health workers; mental health; role; scope of work