The ambiguities of social inclusion in mental health: learning from lived experience of serious mental illness in Ghana and the occupied Palestinian territory.

PURPOSE: Social inclusion of people living with serious mental illness is widely promoted. However, only limited consideration has been given to the meanings of social inclusion within different settings and the ways in which it is envisioned, negotiated, and practised. In this paper, we explore meanings and practises of social inclusion from the perspectives of people living with serious mental illness and their families in Ghana and Palestine and how this is shaped by differing political and socio-cultural contexts. METHODS: This paper draws on comparative ethnographic research including participant observation and interviews with people living with mental illness and family members in Ghana and the occupied Palestinian territory. Data were triangulated and analysed using thematic analysis. RESULTS: Participants described experiences of social inclusion and participation within communities, home and family life, friendships and social life, and work and livelihoods. This revealed how such experiences were variously shaped by differing political contexts and socio-cultural norms and expectations within the two settings. These in turn intersected with aspects such as gender roles, age, and socio-economic status. Aspirations for inclusion included greater awareness and understanding within society, accompanied by opportunities and support for meaningful inclusion at the political as well as community level. CONCLUSION: Findings point to the value of a contextual understanding of social inclusion, taking account of the impact of the wider socio-cultural, political, and economic environment. They also point to the need for an intersectoral approach, beyond communities and mental health services, to provide meaningful opportunities and support for social inclusion.

Psychosocial impacts of caring for a child with a genetic disorder in Accra, Ghana.

Caregivers caring for a child with a genetic condition may experience psychosocial distress, which may be compounded by the context in which the caring takes place. Few studies have examined psychosocial distress and support among caregivers caring for a child with a genetic disorder in low-middle-income countries such as Ghana. The purpose of the current study was to investigate the psychosocial impacts of caring for a child with a genetic disorder in an urban setting in Ghana's capital, Accra. We conducted individual interviews among 17 caregivers who were taking care of children with various genetic disorders including, albinism, Edward's syndrome, osteogenesis imperfecta, sickle cell disease, and spondyloepiphyseal dysplasia congenita. Thematic analysis of the data revealed three main themes on the psychosocial impacts, including: (1) self-blame, guilt, and shame; (2) sleep and mood disturbances; and (3) discrimination and stigmatization. We observed three themes about support: (1) psychological support; (2) family and community support; and (3) institutional support. Participants reported limited support from professionals such as psychologists. Discussion focuses on the supportive care needs of caregivers and implications for genetic counselling awareness, advocacy, and training.

Implications of COVID-19 Innovations for Social Interaction: Provisional Insights From a Qualitative Study of Ghanaian Christian Leaders.

Responses to the COVID-19 pandemic prompted people and institutions to turn to online virtual environments for a wide variety of social gatherings. In this perspectives article, we draw upon our previous work and interviews with Ghanaian Christian leaders to consider implications of this shift. Specifically, we propose that the shift from physical to virtual interactions mimics and amplifies the neoliberal individualist experience of abstraction from place associated with Eurocentric modernity. On the positive side, the shift from physical to virtual environments liberates people to selectively pursue the most fulfilling interactions, free from constraints of physical distance. On the negative side, the move from physical to virtual space necessitates a shift from material care and tangible engagement with the local community to the psychologization of care and pursuit of emotional intimacy in relations of one's choosing-a dynamic that further marginalizes people who are already on the margins. The disruptions of the pandemic provide an opportunity to re-set social relations, to design ways of being that better promote sustainable collective well-being rather than fleeting personal fulfillment.

Ban of Religious Gatherings during the COVID-19 Pandemic: Impact on Christian Church Leaders' Well-Being in Ghana.

This study was conducted during a period of lockdown and ban on social gatherings, including religious gatherings, in Ghana. The restrictions were instituted in response to the COVID-19 pandemic. The purpose of the study was to understand how the well-being of Christian church leaders was impacted during the prohibition in terms of aspects of their vocation and religious practices. Fourteen Christian church leaders located in urban and rural settings in Ghana, with 5 to 32 years of experience, discussed how they and their families were impacted by the ban on religious gatherings in Ghana. Findings revealed negative impacts of the COVID-19 restrictions, including spiritual slacking, loss of fellowship, disruption of normal routine, pandemic anxiety, and financial stress. Positive impacts included increased faith, relief/reduced stress, and increased family time. These findings are discussed from psychological trauma and disaster response perspectives.

The Impact of COVID-19 and Religious Restrictions on the Well-Being of Ghanaian Christians: The Perspectives of Religious Leaders.

In response to the COVID-19 pandemic, the Ghana government instituted a ban on social gatherings, including religious gatherings. To understand how the unanticipated restrictions and interruption in normal church routines affected the well-being of congregants in Ghana, we interviewed 14 religious leaders. Thematic analysis revealed psychospiritual impacts including decline in spiritual life, loss of fellowship and community, financial difficulties, challenges with childcare, as well as fear of infection. Religious leaders intervened by delivering sermons on hope, faith, and repentance. Some religious leaders sensitized their members on health hygiene and COVID-19-related stigma. The study sheds light on the perceived impacts of COVID-19 and restrictions of religious gatherings on congregants in Ghana.

Competence in professional psychology practice in Ghana: Qualitative insights from practicing clinical health psychologists.

Issues concerning competence of practicing psychologists have not been critically investigated in Ghana. This study used the three-dimensional cube model of core competencies as a framework to explore competencies of professional psychologists in active clinical health practice in Ghana. Sixteen clinical psychologists with 1 to 20 years of practicing experience were interviewed on adequacy of their graduate training for practice as well as maintaining post-training competence. The results suggested that training equipped the practitioners mainly for research and teaching but less so for clinical practice. Reflective practice was underdeveloped leading to critical challenges in emotional and cultural competencies. Structural support for continuous professional development was limited. Implications for professional psychology training, research and practice are discussed. This study is the first to explore competence issues in professional psychology practice in Ghana, and it contributes to the global discourse on continuous competence in psychology.

Spirituality and subjective well-being among Ghanaian older adults: optimism and meaning in life as mediators.

OBJECTIVE: This cross-sectional study investigated the relationship between spirituality and subjective well-being (positive affect, negative affect, and life satisfaction), and whether this relationship is mediated by optimism and meaning in life. METHOD: Participants were 235 older adults (≥60 years) conveniently sampled from Ghanaian communities. Structural equation modeling (SEM) was used to test the direct and indirect relationships. Sobel test was also used to test specific mediating effects of optimism and meaning in life. RESULTS: Spirituality was positively related with positive affect and life satisfaction, but negatively related with negative affect. The SEM results revealed that the relationship between spirituality and subjective well-being was indirect. Sobel test showed that the mediating effect of optimism was only statistically significant for negative affect but not positive affect and life satisfaction. In contrast, the mediating effect of meaning in life was statistically significant for the three components of subjective well-being. CONCLUSION: The study has demonstrated that spirituality indirectly influences subjective well-being through optimism and meaning in life. It also showed the relative importance of meaning in life over optimism as a mediator. Theoretical and practical implications of these findings have been discussed.

Self-Forgiveness Among Incarcerated Individuals in Ghana: Relations With Shame- and Guilt-Proneness.

Research on the forgiveness of self has largely focused on less severe, more common types of offenses among samples within developed westernized nations. In this brief report of a study within a developing nation in Africa, applications of self-forgiveness are extended to incarcerated people. The sample comprised N = 310 males (83.87%) and females (16.13%) who were incarcerated in a medium-security Ghanaian prison (Mage = 39.35, SDage = 13.28). Participants completed measures of self-forgiveness, shame-proneness, and guilt-proneness. Prison records were examined for criminal history details. We hypothesized that self-forgiveness would correlate negatively with shame-proneness and positively with guilt-proneness. We tentatively hypothesized that this association would be moderated by offense type. Self-forgiveness correlated with both shame- and guilt-proneness in the hypothesized direction. However, neither association was moderated by type of offense. The findings offer further evidence on the salience of self-conscious emotions in forgiving oneself, particularly among incarcerated offender populations. We discuss the implications of the findings for enhancing offender rehabilitation initiatives.

Dilemma Tales as African Knowledge Practice: An Example From Research on Obligations of Support.

This contribution to the Frontiers research topic collection on African Cultural Models considers dilemma tales: an African knowledge practice in which narrators present listeners with a difficult choice that usually has ethical or moral implications. We adapted the dilemma tale format to create research tasks. We then used these research tasks to investigate conceptions of care, support, and relationality among participants in Ghanaian, African American, and European American settings that vary in affordances for embedded interdependence vs. modern individualism. Results revealed hypothesized patterns, such that judgments about the inappropriateness of institutionalized eldercare (vs. home elder care) and prioritization of material support to parent (over spouse) were greater among Ghanaian participants than European American participants. Responses of African American participants were more ambiguous, resembling European American acceptance of institutionalized eldercare relative to Ghanaian participants, but resembling Ghanaian tendencies to prioritize support to parent (over spouse) relative to European American participants. Results illuminate that standard patterns of hegemonic psychological science (e.g., tendencies to prioritize obligations to spouse over mother) are the particular product of WEIRD cultural ecologies rather than context-general characteristics.

Premarital Counseling Practices among Christian and Muslim Lay Counselors in Ghana.

We examined premarital counseling services offered by Christian and Muslim lay counselors in Ghana. Participants including clergy, Islamic clerics, and laity practicing in four urban centers were interviewed. Thematic analysis showed that common issues covered include medical screening, beliefs and values, expectations, partner knowledge, roles and duties, sex, parenthood, financial management, communication, and conflicts. The findings offer important insight into religious premarital counseling in Ghana and contribute to the global literature on premarital counseling.

Cultural Models of Well-Being Implicit in Four Ghanaian Languages.

This contribution to the collection of articles on "African Cultural Models" considers the topic of well-being. Reflecting modern individualist selfways of North American and European worlds, normative conceptions of well-being in hegemonic psychological science tend to valorize self-acceptance, personal growth, and autonomy. In contrast, given the embedded interdependence of everyday life in many West African worlds, one can hypothesize that cultural models of well-being in many Ghanaian settings will place greater emphasis on sustainability-oriented themes of material sufficiency and successful navigation of normative obligations. To explore this hypothesis, we interviewed local cultural experts who function as custodians of religion and an important source of support for well-being in many Ghanaian settings. We asked participants to identify and explain models of well-being implicit in four Ghanaian languages (Akan, Dagbani, Ewe, and Ga). Participants were 19 men and 15 women (age range 32-92 years; Mean = 59.83; SD: 14.01). Results reveal some features of local models, including good health and positive affective states, that appear to resonate with standard understandings of well-being in hegemonic psychological science. However, results also provide evidence for other features of local models - specifically, good living (including moral living, material success, and proper relationality) and peace of mind - associated with a sustainability or maintenance orientation to well-being.

Emotion Norms, Display Rules, and Regulation in the Akan Society of Ghana: An Exploration Using Proverbs.

Proverbs are widely used by the Akan of West Africa. The current study thematically analyzed an Akan proverb compendium for proverbs containing emotion references. Of the identified proverbs, a focus on negative emotions was most typical. Emotion-focused proverbs highlighted four emotion regulation strategies: change in cognition, response modulation, situation modification, and situation selection. A subset of proverbs addressed emotion display rules restricting the expression of emotions such as pride, and emotional contagion associated with emotions such as shame. Additional themes including: social context influences on the expression and experience of emotion; expectations of emotion limits; as well as the nature of emotions were present in the proverb collection. In general, Akan emotion-related proverbs stress individual-level responsibility for affect regulation in interpersonal interactions and societal contexts.

'My Own House, Car, My Husband, and Children': meanings of success among Ghanaians.

The purpose of the study was to explore the extent to which contemporary social, economic, and religious developments inform social constructions of success in Ghana. Participants, consisting of 21 females and 39 males, aged between 20 and 70, from different educational and occupational backgrounds were interviewed about what they consider as success. Participants belonged to either Traditionally Western Mission Churches or Charismatic Christian denominations and were selected from three regions of Ghana. Thematic analysis revealed four dimensions of success: (1) Social (including marriage, children, social recognition, and social contribution to society); (2) Material (comprising meeting basic needs; economic independence; material wealth); (3) Educational; and (4) Religious (e.g., God's work, relationship with God). Three pathways to success were also observed in the data: (a) Divine blessings; (b) Adaptability; and (c) Striving. Discussion focuses on social, policy, counselling, and research implications.