Task shifting of mental health care services in Ghana: Ease of referral, perception and concerns of stakeholders about quality of care

Objectives: 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. Design: A cross-sectional survey. Participants: 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 thatwere echoed by all psychiatrists and over half of all the health policy directors. Conclusion: 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.