Aggression in mental health settings: a case study in Ghana

Perspectives Stigma towards people living with mental health problems is often the result of deep-rooted fears about irrational behaviour or loss of control. 1 When we conducted a study of recruitment and retention factors for staff in Ghanaian psychiatric hospitals, we found that the stigma was directed towards mental health professionals too. Some of our respondents linked the pervasive stigma of mental health to perceptions that patients with mental disorders could be aggressive or violent. We used a semi-structured discussion guide with follow-up prompts in face-to-face interviews with 28 mental health workers of all levels. Inclusion criteria were employment in one of Ghana's three psychiatric hospitals and ability to speak English. We selected respondents using the chain referral method of sampling 2 to theoretical saturation, 3 seeking diversity in roles within the hospital, gender, age and length of time working in mental health services. We asked respondents about daily job activities and reasons why they started and stayed working at a psychiatric hospital. For data analysis, we used the qualitative constant comparative method, 4 adapted for health services research. 5 We have described the findings relevant to worker recruitment and retention elsewhere. 6 Although we asked no questions specifically about stigma or the behaviour of people with mental health problems, many respondents revealed that one of the greatest challenges they encountered at work was fear of and injury from aggression. Aggressive behaviours of people attending psychiatric hospitals 7 and primary care settings 8 have previously been documented. Our work on Ghana's mental health system suggests that aggression and stigma are central challenges for mental health workers. Appropriate support for mental health professionals could play a key role in reducing stigma, increasing health worker recruitment and retention and improving mental health care. These efforts must be central, not secondary, in global efforts to scale-up access to mental health care. In low-and middle-income countries , less than 25% of people with the most severe mental disorders receive any conventional treatment. Treatment rates are far lower for people with moderate or mild disorders. 9 Mental health care, perhaps even more than other areas of medical treatment, relies on trained workers. If the mental health treatment gap is to be addressed, a global effort to strengthen human resources for mental health will be required. There are currently fewer than 1.7 mental health workers of any kind per 100 000 population in in Africa and …