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.