Care delivery in the context of district mental healthcare plans in Ghana: a qualitative study exploring experiences of primary healthcare workers and service users

Objective: To explore the perceptions and experiences of mental health service users and healthcare workers regarding the implementation of district mental healthcare plans (DMHPs) in three district demonstration sites in Ghana.

Design: The study employed a qualitative design using reflexive thematic analysis. Interview data were analysed by combining inductive and deductive approaches.

Setting: The study was conducted in three DMHP districts in Ghana: Anloga (Volta), Asunafo North (Ahafo) and Bongo (Upper East). The districts were selected via national stakeholder consultations, using a DMHP framework. Data were collected between January 2023 and June 2023.

Participants: In-depth interviews were conducted with 28 primary healthcare workers who played key roles in the delivery of care in the demonstration districts. Thirty-two service users who are 18 years and above and have been receiving healthcare for the past year in the demonstration districts were also interviewed. Participants were purposively sampled.

Findings: Three main themes were identified: (1) factors supporting DMHP implementation, including capacity building, collaboration, awareness creation and acceptability; (2) challenges affecting DMHP implementation, such as inadequate resources and medication shortages and (3) perceived outcomes of the DMHPs, including improved well-being and daily functioning as well as changing attitudes towards mental health. Some district-level variations were noted in the intensity of challenges and outcomes.

Conclusion: The DMHPs have shown promise in improving mental healthcare in primary care settings in Ghana. However, addressing resource constraints and medication shortages and sustaining capacity building and awareness creation efforts will be crucial for successful scale-up. The perspectives of service users and healthcare providers offer valuable insights for policymakers and practitioners aiming to enhance integrated mental healthcare.