Scaling up community-based services and improving quality of care in the state psychiatric hospitals: the way forward for Ghana

Objective: This paper aims to explore the options available for developing community-based care and improving the quality of care in psychiatric hospitals in Ghana. Method: Semi-structured interviews (SSIs) and focus group discussions (FGDs) were conducted with a cross-section of stakeholders including health professionals; researchers; policy makers; politicians; users and carers. The SSIs and FGDs were recorded digitally and transcribed verbatim. Apriori and emergent themes were coded and analysed with NVivo version 7.0; using a framework analysis. Results: Psychiatric hospitals in Ghana have a mean bed occupancy rate of 155. Most respondents were of the view that the state psychiatric hospitals were very congested; substantially compromising quality of care. They also noted that the community psychiatric system was lacking human and material resources. Suggestions for addressing these difficulties included committing adequate resources to community psychiatric services; using psychiatric hospitals only as referral facilities; relapse prevention programmes; strengthening psychosocial services; adopting more precise diagnoses and the development of a policy on long-stay patients. Conclusion: There is an urgent need to build a credible system of community-based care and improve the quality of care in psychiatric hospitals in Ghana

Pratique de la psychothérapie institutionnelle en Côte d'Ivoire : exemple du Centre de Santé Victor Houali de Trinle-Diapleu

La pratique de la Psychotherapie Institutionnelle au centre de sante Victor Houali de Trinle-Diapleu est une experience complexe qui tente d'articuler depuis vingt-deux ans environ; les soins de sante mentale et les soins de sante primaire dans une structure villageoise. Cette experience tres originale s'appuie sur une demarche de recherche action integrant psychotherapie institutionnelle; chimiotherapie et contexte socioculturel africain. Elle peut d'ailleurs servir de reference au developpement de la psychiatrie communautaire et a la necessaire decentralisation des soins psychiatriques en Cote d'Ivoire