Mobile Health for Mental Health in West Africa: The Case for Ghana

I recently returned from Ghana, a country of approximately 27 million residents in sub-Saharan Africa. Like much of the region, Ghana faces enormous mental health challenges, including lack of mental health professionals and clinical infrastructure, poor or inconsistent access to medication, and pervasive societal stigma around mental illness (1). As a consequence, thousands of Ghanaians have mental illness that goes undiagnosed and untreated, and many are abused—chained and confined for weeks, months, or years at a time. [A photograph is available as an online supplement.] This situation cannot persist.

Although underdeveloped in mental health care, Ghana is remarkably advanced in telecommunications. It was one of the first countries in Africa to have access to the Internet and a mobile cellular network. This infrastructure has grown dramatically over the years and is quite robust today. It is exactly the type of context where innovative mobile health (mHealth) approaches could help to address significant unmet public mental health needs (2).

To assess the viability of mHealth for mental health in Ghana, I met with psychiatrists, psychologists, nurses, health care trainees, patients with mental illness and their family members, telecommunication company officials, and Ghana’s Minster of Health. In the south I visited with the University of Ghana’s School of Medicine and toured one of the country’s three psychiatric hospitals. In the north I spent time with a nongovernmental organization that provides outreach and mental health services in the community (BasicNeeds) and with a Christian charitable organization that provides education and health services to the predominantly Muslim population in the neighboring villages (King’s Village). In the city of Tamale, I toured the Shekinah Clinic, which provides basic medical care services to the most impaired and indigent residents, many of whom have psychiatric conditions. I met with the community’s traditional healers, pastors, and prophets and visited a large Pentecostal prayer camp where people with mental illness and developmental disabilities were shackled to concrete slabs and forced to live in crowded and extremely unhygienic conditions—an environment that eclipsed anything I have seen in the most austere psychiatric inpatient or criminal justice settings in the United States. Hundreds of similar prayer camps exist in the region (3). The conversations, observations, and experiences I had in Ghana left me with several strong impressions.