title: Improving Ghana's mental healthcare through task-shifting- psychiatrists and health policy directors perceptions about government's commitment and the role of community mental health workers.
abstract: The scarcity of mental health professionals places specialist psychiatric care out of the reach of most people in low and middle income countries. There is growing interest in the effectiveness of task shifting as a strategy for targeting expanding health care demands in settings with shortages of qualified health personnel. Given this background, the aim of our study was to examine the perceptions of psychiatrists and health policy directors about the policy to expand mental health care delivery in Ghana through a system of task-shifting from psychiatrists to community mental health workers (CMHWs).
  
  
  
  A self-administered semi-structured questionnaire was developed and administered to 11 psychiatrists and 29 health policy directors. Key informant interviews were also held with five psychiatrists and four health policy directors. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed thematically.
  
  
  
  Almost all the psychiatrists and 23 (79.3 %) health policy directors were aware of the policy of the Government of Ghana to improve on the human resource base within mental health through a system of task-shifting. Overall, about half of the psychiatrists and 9 (31 %) health policy directors perceived there is some professional resistance to the implementation of the policy of task shifting. The majority of respondents were of the view that CMHWs should be allowed to assess, diagnose and treat most of the common mental disorders. The respondents identified that CMHWs usually perform two sets of roles, namely; officially assigned roles for which they have the requisite training and assumed roles for which they usually do not have the requisite training. The stakeholders identified multiple challenges associated with current task shifting arrangements within Ghana's mental health delivery system, including inadequate training and supervision, poor awareness of the scope of their expertise on the part of the CMHWs.
  
  
  
  Psychiatrists and health policy directors support the policy to expand mental health service coverage in Ghana through a system of task-shifting, despite their awareness of resistance from some professionals. It is important that the Government of Ghana upholds its commitment of expanding mental healthcare by maintaining and prioritizing its policy on task shifting and also providing the necessary resources to ensure its success.
authors.affiliation: Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 WMC 8440 112 St NW, Edmonton, AB, T6G 2B7, 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 Israel Opoku
authors.initials: VI
authors.lastname: Agyapong
authors.affiliation: Department of Psychiatry, University of Dublin, Trinity College, Dublin, Ireland.
authors.forename: Conor
authors.initials: C
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: D000288:Administrative Personnel / Q000523:psychology*; D001291:Attitude of Health Personnel; D005869:Ghana; D006076:Government; D006291:Health Policy / Q000639:trends; D006801:Humans; D001523:Mental Disorders / Q000628:therapy; D008605:Mental Health Services / Q000592:standards*; D010465:Perception; D011570:Psychiatry; D036301:Qualitative Research; D000078329:Workforce
keywords: Community mental health workers; Health policy directors; Psychiatrists; Task-shifting