The challenges
Mental health care is under-resourced at national level in Ghana and is often poorly
understood at the community level. Lack of education and awareness, resource
constraints and dispersed communities result in limited access to mental health
services. Research in Ghana has found that 85-98% of people experiencing mental
health conditions in Ghana cannot access the treatment they need due to the lack of
service provision, lack of trained mental health professionals, inaccessible services
and the stigma surrounding mental health. Identifying mental health conditions,
developing support systems, signposting to services, tackling stigma, and standing
up for rights cannot be done solely by primary care services, the government or
any single stakeholder alone.
The solution
Volunteers are a critical part of mental health interventions. Volunteers can perform
several tasks including: playing a role linking marginalised people and the community
through self-help groups; supporting trained healthcare workers; advocating for rights;
and championing positive behaviours.
Working with volunteers can engage communities more as it provides a sense of
ownership. Volunteering also ensures sharing and retention of knowledge and skills.
What did we do?
We offered a variety of support for three types of volunteers:
- Community Health Volunteers: these volunteers are managed by the Ghana
Health Service and we trained them as part of helping deliver on District Mental
Healthcare Plans. - Community Volunteers: volunteers organised and trained by our partner,
BasicNeeds-Ghana, to provide mental health and psychosocial support to
people in the community. - Inclusion Ambassadors and Disability Champions: our grantees selected
and appointed community members to take up roles supporting stigma
reduction, education, advocacy and influencing, as well as reporting abuse.
Community health volunteers delivering health services support
As part of our work on establishing District Mental Health Care Plans, we trained 87
Community Health Volunteers to help increase access to mental health services
in communities. Community Health Volunteers were integrated into the district plans
and trained by us to identify and report cases to professional mental health workers.
Community Health Volunteers, under the supervision of Ghana Health Service, now
provide psychosocial services door-to-door and will continue supporting people with
mental health conditions, in their respective communities, beyond the lifetime of this
project by detecting and referring possible cases to mental healthcare services.
Community volunteers supporting self-help groups
In 2020, in the midst of the pandemic, a training programme was prepared with our
partner, BasicNeeds-Ghana, to train community volunteers to support self-help
groups across 28 districts, in five regions. Training focused on COVID-19 safety
and hygiene protocols, supporting access to Mental Health and Psychosocial Support
for persons with mental health conditions, quality data collection, safeguarding, and
providing essential working tools. These fundamental competencies equip community
volunteers to ensure the self-help groups they support are sustainable, scalable and
efficient.
Community volunteers actively supported programme activities to reorganise and
facilitate resumption of operations of 272 self-help groups after the pandemic
restrictions were lifted.
Inclusion Ambassadors championing disability rights
Through grantees, volunteers received training as inclusion champions, to support a
range of advocacy and social and behaviour change activities outlined in a coordinated
behaviour change strategy. Inclusion Ambassadors or Disability Champions were
carefully selected from the community to advocate for, and engage in, design and
deliver activities, and were paid a small stipend for their expenses.
Community Health Volunteers successfully identified and referred 144 individuals
with probable mental health issues to mental health professionals working at local
healthcare facilities. Evaluations also demonstrated an increase in the knowledge of
relevant mental health topics.
How we made a difference
- In four years, we trained 60 community volunteers, who went on to reach
27,735 people through self-help groups and home visits. - Community volunteers supported by our partner facilitated numerous interface
meetings between policy makers and self-health groups and benefited an
additional 20,356 people directly through their activities
Increased reach of health services
Community Health Volunteers successfully identified and referred 144 individuals
with probable mental health issues to mental health professionals working at local
healthcare facilities. Evaluations also demonstrated an increase in the knowledge of
relevant mental health topics.
Informed attitudes on mental health
Evaluations of people who carried out roles as Inclusion Ambassadors were positive
about their participation in stigma reduction activities, and cited increased knowledge
and confidence.
Community Volunteers played an active role in advocating for the establishment of
the Mental Health Review Tribunal and Mental Health Regional Visiting Committees.
They have also served as key representatives during meetings between policy makers
and self-help groups. As a result of these meetings, metropolitan, municipal and
district assemblies have become more aware of the rights of people with mental health
conditions and have been more inclusive in their social intervention programmes
Sustainable volunteering
In 2023, 60 community volunteers attended a two-day review meeting facilitated
by our partner BasicNeeds-Ghana. Participants reflected on their learnings,
collective achievements and challenges in supporting self-help groups and enabling
engagement with District Assemblies and other stakeholders. Plans for community
volunteers in 2024 were also developed.
Our evaluations of Inclusion Ambassadors show that they are known, respected and
supported by their communities. This has positively changed community attitudes,
increased participation and inclusion and reduced stigma
Gender focus
Evidence showed that inclusion ambassadors, disability champions and community
volunteer positions were dominated by men (86%). Opportunities were provided for
women to be trained as volunteers, but feedback demonstrated there was lower selfesteem and lower levels of confidence. Social expectations around doing household
chores and caregiving responsibilities meant women had less capacity to take on
additional volunteering. Cultural issues also played a part; a woman seen moving from
one household to another for household visits was sometimes accused of promiscuity.
We advocated for increased women’s representation and participation in programme
activities from our self-help groups. We encouraged the groups to identify female
volunteers. As a result, ten women were added to the pool of community
volunteers. These women were then able to support other women with disabilities
and mental health conditions. We also conducted training on the specific challenges
for women leaders.
Lessons learned
- Volunteers are crucial in reducing disability-related stigma as well as
supporting implementation of district and community-level programmes. - Volunteers from the community can bridge gaps between formal healthcare
services and the community as they bring cultural competence, local knowledge
and community trust. This makes mental health services more accessible,
accepted and effective within communities. - Training on safeguarding awareness among community volunteers enhances
protection of people with mental health conditions from actual or potential harm
and encourages community volunteers to report concerns.
Resources produced on this topic
- Rights-based advocacy toolkit for self-help groups, June 2022
- Community entry toolkit for organisations supporting self help groups,
October 2022 - Training manual for community health volunteers, November 2022
- Learning product: The value of community volunteers in mental health
and psychosocial support services, April 2023 - The role of interface meetings between Self-Help Groups and Metropolitan
Municipal and District Assemblies, July 2023 - Webinar: The value of interface meetings between self-help groups and
metropolitan, Municipal and District Assemblies, August 2024
