Article Information

Peter Mintir Amadu^1,2,3, Rejoice Enyonam Hoedoafia^1,2

¹Department of Mental Health, School of Medicine, University for Development Studies, Tamale, Ghana.

²Department of Internal Medicine, Psychology Unit, Tamale Teaching Hospital, Tamale, Ghana.

³Total Life Enhancement Centre Ghana - TOLECGH, Tamale, Ghana.

^*Corresponding Author: Peter Mintir Amadu, Department of Mental Health, School of Medicine, University for Development Studies, Tamale, Ghana.

Received: 02 February 2024; Accepted: 09 February 2024; Published: 19 March 2024

Citation: Peter Mintir Amadu, Rejoice Enyonam Hoedoafia. Mental Health Issues and Challenges in Northern Region of Ghana: Practitioners Perspectives. Journal of Psychiatry and Psychiatric Disorders. 8 (2024): 70-76.

Abstract

Keywords

Mental Health Issues, Northern Region, Mental Health Disorders, Practitioners, Psychologists.

Article Details

1. Introduction

The Northern part of Ghana is a beautiful traditional place which houses vast savannas, colorful economic ventures, ancient mud-brick mosques, Paga crocodile pond, the famous Gambaga scarp and the largest game reserve (Mole National Park) among others which is inhibited by hospitable people of different cultures and religions. The Northern Region is confronted with a myriad of mental health issues and challenges that have profound implications for the well-being of its residents. This region's unique geographic, cultural, and socioeconomic characteristics create a complex landscape in which mental health concerns manifest and persist.

Mental health disorders, such as depression, anxiety, posttraumatic stress disorder (PTSD), psychotic disorders, and substance abuse, have become increasingly prevalent in the Northern Region, impacting individuals of all ages and backgrounds. The prevalence of these conditions are influenced by various factors, including social isolation, unemployment, poverty, cultural beliefs, impact of conflicts, social upheavals, low level of mental health literacy and limited access to mental health services, particularly in remote and rural communities.

According to [1], cultural beliefs and attitudes surrounding mental health play a pivotal role in shaping help-seeking behaviours and treatment outcomes. Stigma and discrimination act as barriers, preventing individuals from seeking timely support and exacerbating the challenges in addressing mental health challenges effectively [2].

This documentation is to set the stage for a comprehensive exploration of the mental health landscape in the Northern Region, emphasizing the urgency of developing targeted interventions and collaborative strategies to improve mental health outcomes in the region.

2. Methodology

To comprehensively investigate the mental health issues and challenges in the Northern Region, a qualitative approach was employed together with the perspectives of the practitioners in the region. These practitioners are among few who have taken up the challenge to practice in a resource constrain environment amidst several opportunities outside the region and abroad. This approach allows for a more holistic understanding of the complex interplay between various factors contributing to mental health concerns in the region.

Qualitative Interviews: In-depth qualitative interviews were conducted with mental health professionals, healthcare providers, community leaders/members, stakeholders and individuals with lived experiences of mental health issues. These interviews explored the nuances of cultural perceptions, barriers to accessing mental health services, and the efficacy of existing support systems.

Focus Group Discussions: Focus group discussions (FGD) were organized to facilitate dialogue and gather insights from various stakeholders, including community members, educators, and policymakers among others. These discussions explored community-specific challenges and potential solutions to address mental health concerns effectively.

Data Analysis: The qualitative data from interviews and focus group discussions were subjected to thematic analysis. The triangulation of data from various sources provided a more comprehensive understanding of mental health issues in the Northern Region.

Ethical Considerations: The study adhered to ethical guidelines, ensuring the confidentiality and anonymity of participants. Informed consent was obtained from all individuals involved in the research.

3. Burden of Mental Health challenges In Northern Region

The burden of mental health challenges in the Northern Region is a pressing public health concern that significantly impacts individuals, families, and communities with a potential to derail the gains made towards the sustainable development goals (SDGs) and universal health coverage (UHC). In the work of (1, 2, 3), the burden of mental health encompasses a range of mental health issues, including mood disorders, anxiety disorders, substance use disorders, and psychotic disorders. These were truly collaborated with the work of (5). The Northern Region's unique characteristics, such as its geographical isolation, cultural diversity, and socioeconomic disparities, contribute to the complexity of this burden (6, 7. 8).

The findings from this comprehensive study shed light on the mental health landscape in the Northern Region, offering valuable insights to inform the development of targeted interventions, policies, and strategies to address mental health challenges and promote well-being in the region.

In the Northern Region of Ghana, mental health issues present a significant yet often overlooked challenge, impacting individuals, families, and communities. This seeks to shed light on the complexities of mental health struggles in the region, exploring both the pervasive stigma and the pressing need for accessible and culturally sensitive support systems. Following the FGD and the interviews with the relevant stakeholders in this work the views or the voice of the people as captured shade their understanding and the need to prioritize mental health care in the region. 

Healthcare Professionals: "Limited resources and training hinder our ability to adequately address mental health issues. There's a pressing need for more mental health facilities and specialists in the region."

Community Leaders: "Stigma surrounding mental illness persists, preventing many from seeking help. We must educate our communities and challenge harmful beliefs to promote understanding and support."

Traditional Healers: "We play a crucial role in mental health care, but collaboration with modern healthcare systems is essential. Together, we can provide holistic support to those in need."

Local Residents: "Poverty and unemployment exacerbate mental health struggles. Access to affordable treatment and counseling services is critical for our well-being."

Educators: “we recognize the profound impact of mental health on our students' academic performance and overall well-being. We need more advocacy toward increased support services, including counseling and mental health education, to address stigma and ensure a nurturing learning environment conducive to mental wellness”. “Our counselling units in the various schools are poorly equipped, with a limited profession (Guidance and counselling) to man the unit, couple with extreme work load on the few professionals who sometime also double as subject’s teacher conflicting with their roles as counselors (mental health professionals) for the schools”. “We wish to call on GES to solely engage counselors to practice as mental health professional for the schools.

Religious: The view or opinion of religious stakeholders in the mental health evaluations in the northern region varies. Some argue for their inclusion, citing spiritual wellbeing's importance. Others caution against potential bias or misunderstanding of medical needs. Overall, perspectives reflect a complex intersection of faith, culture, and mental health practices.

Youth: The youth as stakeholders in the mental health FGD in the northern region is multifaceted. Some advocate for greater involvement, emphasizing their unique perspectives and needs. Others express concerns about stigma or distrust of mental health services, highlighting the necessity for accessible and youth-friendly support systems.

Women: ‘’It's important to recognize and address these negative views to promote mental health awareness, reduce stigma, and improve access to culturally sensitive and gender-responsive mental health services in Northern Ghana. Efforts to empower women through education, community outreach, and advocacy can help challenge these negative perceptions and promote a more supportive environment for mental health and well-being’’.

Men: ‘It's crucial to acknowledge and address these challenges to promote mental health and well-being among men in Northern Ghana. Culturally sensitive interventions that recognize and respect men's unique experiences, while also challenging harmful gender norms and stigma, can help encourage help-seeking behavior and improve access to support services. Additionally, community-based initiatives that engage men as advocates for mental health awareness and destigmatization can be effective in fostering positive change’.

NGO Representatives: "We advocate for increased funding and awareness of mental health issues. By partnering with local organizations, we can implement sustainable interventions and support systems." ‘As members of the CSOs space we must commend the effort by Total Life Enhancement Centre Ghana -TOLECGH towards enhancing mental health literacy and service usability in the region””.  “In our engagement with (TOLECGH) we notice the adoption of a comprehensive approach to mental health, focusing on holistic well-being and community empowerment. TOLECGH strives to address the multifaceted needs of individuals struggling with mental health issues in northern Ghana. Their approach emphasizes culturally sensitive interventions, community engagement, and capacity building to reduce stigma, increase awareness, and improve access to mental health services. Through counseling, support groups, education, and advocacy, TOLECGH aims to promote mental wellness and resilience, empowering individuals to lead fulfilling lives”.

These voices reflect the diverse perspectives of stakeholders in the Northern Region, highlighting the multifaceted nature of mental health challenges and the need for collaborative efforts to address them effectively.

Mental health remains a global pressing concern, with particular significant for regions like the northern region of Ghana where access to resources and awareness are limited. The findings from our focus group discussion (FGD) and interviews of stakeholders to explore their perspective of mental health issues of the region yielded different result which are presented here to inform and direct policy formulation regarding mental health for the region and Ghana as a whole.

From the practitioners’ perspectives, it could be reported that their experiences could help shape the mental health dialogue in the region and beyond and they explored the underlisted following their experiences

Prevalence and Incidence: The Northern Region experiences a high prevalence and incidence of mental health challenges. In the works of some researchers, factors such as social isolation, limited access to mental health services, and adverse economic conditions contribute to the vulnerability of populations to these conditions (9,10). These aligns very much with the situation of northern Ghana.

Impact on Individuals: Mental health challenges in the Northern Region as gathered can severely affect individuals' quality of life, hindering their ability to function effectively in daily life, hold steady employment, and maintain stable relationships. According to (11), untreated mental health issues can lead to a cycle of distress and impaired functioning of the individual affecting personal and national development.

Impact on Families: In the work of (12), mental disorders often exert a significant emotional, social, and financial toll on families and caregivers. The strain of caring for a family member with a mental illness can lead to caregiver burnout and strained family dynamics (13,14)). Our interviews and FGD also revealed that the people of northern region who have nursed a relation with mental health challenges experience similar challenges as described in these articles.

Healthcare System: Research in the area of mental health have place emphases on the burden of mental health on the health system. In the works of (15, 12, 16, 17), the burden of mental disorders places considerable strain on the healthcare system, This is also the case of the Northern Region of Ghana with limited resources regarding mental health service provision. Limited mental health resources and professionals, particularly in remote and rural areas, can lead to delays in access to care and inadequate treatment options. This is collaborated with (17).

Economic Implications: Mental health challenges account for more economic costs than chronic somatic diseases such as cancer or diabetes (18).  The economic burden of mental disorders in the Northern Region could include direct healthcare costs, lost productivity, and increased disability as gethered from our discussion with some key stakeholders in the region. These burden mental health challenges can further perpetuate the cycle of poverty and limited access to mental health services (19, 20, 21).

Stigma and Discrimination: According to (22) and recent research work have emphasized the adverse effects of stigma on minority groups’ mental health. Governments and service agencies have put much effort into combating stigma against a variety of conditions.  This Stigma and discrimination surrounding mental health issues persist in the Northern Region, leading to a reluctance to seek help and hindering early intervention efforts. (23), recommended that addressing the burden of mental disorders is a multifaceted approach that includes education, awareness campaigns, challenging stereotypes, promoting empathy, and fostering supportive communities. Their work also correlated with the work of (24, 25) culminating in the underlisted strategies towards reducing mental health stigma. This could stem from, increasing awareness and understanding of mental health issues to reduce stigma, improving access to mental health services, particularly in remote and underserved areas, Strengthening the capacity of the healthcare system to provide comprehensive and culturally sensitive care and implementing targeted interventions to address the specific challenges faced by vulnerable populations.

The burden of mental health challenges in the Northern region of Ghana as discovered from the FGD, interviews and the professional experiences, underscore the complex interplay of cultural, socioeconomic, and systemic factors shaping the mental health experiences of the people. By addressing the burden of mental health challenges in the Northern Region proactively, it is possible to enhance the overall well-being and resilience of its population and foster a healthier and more inclusive society.

4. Issues and Challenges of Mental Health in Northern Ghana:

Mental health phenomena emerge from the interplay of multiple contributing subsystems and require multisystemic thinking to be understood. This work will further the discussion on the issues of mental health in northern Ghana. Each of these issues is a piece of the overall picture, and even this brief overview shows the interlocking nature of the concerns. These issues as captured also reveal the opinions of our participants who have stayed in the northern for sometimes now. following our FGD and interviews and discussed in the context of the practitioners. These practitioners are sharing their perspectives on mental health in the Northern region. This collaborative piece (stakeholders’ engagement and professional perspectives) are aimed at shading light on the mental health challenges of northern region of Ghana towards a policy shift to enhance the mental well-being of the people for and holistic development.

Low level of mental health literacy: People with inadequate mental health literacy are more at risk of physical and mental illnesses and incur greater health costs than people with appropriate mental health literacy (26).  Unfortunately, there exist more than 98% treatment gap in Ghana as regards mental health care (27, 28). These also affect the northern of Ghana negatively and aligns with the discussion and the perspectives of the study participants.

Stigma and Discrimination: Stigma surrounding mental health remains a significant challenge globally. People with mental disorders often face prejudice, misunderstanding, and discrimination, which can lead to social isolation, reluctance to seek help, and delayed treatment. This is wide spread in the region under focus.

Substance Abuse among Youth: Substance abuse is a public health problem globally. The prevalence of substance abuse among youth is alarming. The problem not only harms individuals but also negatively affects families and society (29).

Lack of access to Mental Health Services: Limited access to mental health services is a critical issue in many regions especially in Northen region of Ghana. Inadequate resources, long waiting lists, and a shortage of mental health professionals can impede timely diagnoses and treatment, leaving individuals without the support they need.

Lack of Integrated Care: Mental health is often compartmentalized from physical health, leading to fragmented care. The lack of appropriate integration between mental health services and other healthcare systems does hinder the overall well-being of individuals with comorbid conditions in northern region of Ghana.

Socioeconomic Factors: Mental health challenges are closely linked to socioeconomic factors such as poverty, unemployment, and limited education. These factors can both contribute to the development of mental health issues and act as barriers to accessing appropriate mental health care.

Cultural and Language Barriers: Cultural beliefs and language barriers can prevent individuals from seeking help or fully understanding mental health conditions and treatment options. Culturally sensitive approaches are essential to address these challenges effectively.

Co-Occurring Substance Use: Substance use disorders often co-occur with mental health issues, creating a complex challenge known as dual diagnoses. Treating both conditions simultaneously can be challenging, requiring integrated and specialized care.

Early Intervention and Prevention: Early intervention is crucial for improving outcomes in mental health. However, lack of awareness, stigma, and limited resources for prevention programs pose challenges in identifying and addressing mental health issues at an early stage.

Mental Health in Schools and Workplace: there exist a lot of mental health challenges following advocacy in schools and workplace. There is therefore the need to ensure that schools and workplaces which play a significant role in mental health support are supported with the needed resources. Addressing mental health challenges in these settings requires adequate resources, training, and destigmatizing attitudes.

Mental Health in Vulnerable Populations: Certain groups, such as ghetto youth, women and rural communities, are more susceptible to mental health issues due to specific stressors and traumas. Tailored interventions and support are essential to meet their unique needs.

Funding and Policy: Insufficient funding for mental health initiatives and a lack of comprehensive mental health policies can hinder the development and implementation of effective strategies to address mental health challenges.

Addressing these issues and challenges requires a comprehensive, multi-level approach involving governments, healthcare systems, communities, and individuals. Increasing awareness, reducing stigma, improving access to services, promoting early intervention, and fostering collaboration are vital steps toward improving mental health outcomes and creating a supportive environment for individuals with mental health challenges the practitioners noted.

Child, Early and Forced Marriage. (CEFM) and Sexual and Gender-Based Violence (SGBV): child, early and forced marriage and sexual gender-based violence (SGBV) in the Northern Region of Ghana inflict profound mental health challenges on victims. The trauma and psychological distress resulting from these experiences can lead to depression, anxiety, post-traumatic stress disorder (PTSD), and other mental health disorders. Victims often suffer in silence due to stigma and lack of support services. Addressing these issues requires holistic interventions that prioritize prevention, survivor support, and community awareness. Efforts must focus on empowering individuals, fostering gender equality, and creating safe spaces where survivors can access mental health care and rehabilitation services.

Comorbid Mental Health and Physical Health Challenges in Northern Region: In the Northern Region of Ghana, individuals often face comorbid mental health and physical health challenges, exacerbating their overall well-being. For instance, conditions like depression or anxiety coexist with chronic physical ailments such as hypertension, diabetes, cancers or respiratory illnesses among others. The interplay between mental and physical health can create a cycle of worsening symptoms, decreased treatment adherence, and reduced quality of life. Limited access to healthcare services further complicates management. Addressing these comorbidities requires integrated healthcare approaches that prioritize both mental and physical well-being, along with improving access to comprehensive healthcare services in the region.

Way Forward Regarding Mental Health in the Northern Region:

The Way Forward Regarding Mental Health in the Northern Region must prioritize destigmatization, increase access to culturally appropriate services, and integrate mental health into broader healthcare agendas. Collaboration between stakeholders, community engagement, and advocacy for policy reforms are essential for fostering a supportive environment and improving mental health outcomes.

Enhancing Awareness and Education: Promote mental health literacy through public awareness campaigns, educational programs in schools, organizations and community workshops. Increase understanding about mental health, reduce stigma, and encourage help-seeking behaviors.

Improving Access to Mental Health Services: Increase the availability and accessibility of mental health services in the Northern Region, particularly in rural and remote areas. This includes recruiting and training mental health professionals, establishing telehealth services, and integrating mental health into primary healthcare settings.

Community-Based Interventions: Develop community-based mental health programs that engage local organizations, community leaders, and grassroots initiatives. Foster partnerships between mental health professionals, community organizations, and support networks to provide culturally sensitive and community-specific interventions.

Strengthening Support Systems: Establish and enhance support systems for individuals with mental health issues and their families. This can include peer support groups, helplines, and community centers that offer counselling, rehabilitation, and social support services.

Addressing Socioeconomic Factors: Addressing the social determinants of mental health by implementing policies that focus on reducing poverty, improving education, and creating employment opportunities. Support initiatives that promote financial stability, housing security, and access to social services. This paper will wish to call on stakeholders to explore opportunities to rollout Social Emotional, and Economic Empowerment through Knowledge of Group Support Psychotherapy (SEEK GSP) program in the Country. SEEK GSP is an innovative mental health program that creates mental health awareness, train community lay health workers, to recognize and respond to depression and by extension other mental health challenges by delivering Group Support Psychotherapy (GSP)

Early Intervention and Prevention: Implement early intervention programs in schools, workplaces, and healthcare settings to identify and address mental health concerns at an early stage. Provide training for educators, employers, and healthcare professionals to recognize signs of mental distress and facilitate appropriate support.

Culturally Sensitive Approaches: Incorporate cultural competence into mental health services to address the specific needs and beliefs of diverse communities in the Northern Region. Collaborate with local cultural leaders and community organizations to develop culturally appropriate interventions that will promote help-seeking behaviours.

Policy Development and Funding: Advocate for full implementation of mental health Act and policies at the district, regional and national levels that prioritize mental health promotion, prevention, and treatment. Allocate adequate funding to support mental health initiatives, research, and the expansion of mental health services in the Northern Region.

Research and Data Collection: Invest in research studies and data collection efforts to gather accurate information on the prevalence of mental health disorders, risk factors, and effectiveness of interventions in the Northern Region. This evidence-based approach will inform decision-making and policy formulation.

Collaboration and Partnerships: Foster collaboration among government agencies, healthcare providers, community organizations, and stakeholders to develop a coordinated and integrated approach to mental health. Establish partnerships to leverage resources, share best practices, and ensure a comprehensive response to mental health challenges in the Northern Region.

By implementing these strategies, the Northern Region can work towards improving mental health outcomes, reducing the burden of mental health challenges, and creating a supportive and inclusive environment that promotes the well-being of its residents, improved quality of life and enhancing self and national development.

5. Conclusion

From the perspective of the practitioners and stakeholders hold the view that addressing mental health challenges in the Northern Region of Ghana is imperative to foster a healthier and more resilient population. The region faces unique challenges stemming from socioeconomic factors, stigma, and limited access to services due to limited professional, infrastructure, low level of mental health literacy and other logistics. To overcome these obstacles, increasing awareness, integrating mental health into primary care, and establishing community-based interventions are crucial. Culturally sensitive approaches and early intervention strategies can lead to better outcomes. Through collaborative efforts, improved policies, and adequate funding, the Northern Region can create a supportive environment that prioritizes mental well-being and enhances the overall quality of life (QOL) for its residents.

Acknowledgements:

We wish to sincerely thank all our participants for taking the time to fill in the survey and to all who contributed in varied ways to the success of this work we say thank you.

Funding

No funding has been received for this study.

Competing Interest

The authors declare that they have no competing interests.

References

1. Bin Hassan, M. F., Hassan, N. M., Kassim, E. S., & Hamzah, M. I. (2018). Issues and challenges of mental health in Malaysia. International Journal of Academic Research in Business and Social Sciences, 8(12), 1685-96.
2. Mak, W. W., Poon, C. Y., Pun, L. Y., & Cheung, S. F. (2007). Meta-analysis of stigma and mental health. Social science & medicine, 65(2), 245-261.
3. Ustün, T. B. (1999). The global burden of mental disorders. American journal of public health, 89(9), 1315-1318.
4. Wainberg, M. L., Scorza, P., Shultz, J. M., Helpman, L., Mootz, J. J., Johnson, K. A., ... & Arbuckle, M. R. (2017). Challenges and opportunities in global mental health: a research-to-practice perspective. Current psychiatry reports, 19, 1-10.
5. Vigo, D., Thornicroft, G., & Atun, R. (2016). Estimating the true global burden of mental illness. The Lancet Psychiatry, 3(2), 171-178.
6. Sulemana, M. (2009). Understanding the causes and impacts of conflicts in the Northern Region of Ghana.
7. Abdul-Razak, M., & Kruse, S. (2017). The adaptive capacity of smallholder farmers to climate change in the Northern Region of Ghana. Climate Risk Management, 17, 104-122.
8. Van der Geest, K. (2011). North-South migration in Ghana: what role for the environment?. International Migration, 49, e69-e94.
9. Cohen, A., Raja, S., Underhill, C., Yaro, B. P., Dokurugu, A. Y., De Silva, M., & Patel, V. (2012). Sitting with others: mental health self-help groups in northern Ghana. International journal of mental health systems, 6, 1-8.
10. Read, U. M., & Doku, V. C. K. (2012). Mental health research in Ghana: a literature review. Ghana Medical Journal, 46(2), 29-38.
11. Fournier, O. A. (2011). The status of mental health care in Ghana, West Africa and signs of progress in the greater Accra region. Berkeley Undergraduate Journal, 24(3).
12. Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in the Public Interest, 15(2), 37-70.
13. Hsiao, C. Y. (2010). Family demands, social support and caregiver burden in Taiwanese family caregivers living with mental illness: The role of family caregiver gender. Journal of clinical Nursing, 19(23-24), 3494-3503.
14. Ntsayagae, E. I., Myburgh, C., & Poggenpoel, M. (2019). Experiences of family caregivers of persons living with mental illness: A meta-synthesis. Curationis, 42(1), 1-9.
15. Viron, M. J., & Stern, T. A. (2010). The impact of serious mental illness on health and healthcare. Psychosomatics, 51(6), 458-465.
16. Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in the Public Interest, 15(2), 37-70.
17. Wong, S. Y. S., Zhang, D., Sit, R. W. S., Yip, B. H. K., Chung, R. Y. N., Wong, C. K. M., ... & Mercer, S. W. (2020). Impact of COVID-19 on loneliness, mental health, and health service utilisation: a prospective cohort study of older adults with multimorbidity in primary care. British Journal of General Practice, 70(700), e817-e824.
18. Trautmann, S., Rehm, J., & Wittchen, H. U. (2016). The economic costs of mental disorders: Do our societies react appropriately to the burden of mental disorders?. EMBO reports, 17(9), 1245-1249.
19. Xu, J., Wang, J., Wimo, A., & Qiu, C. (2016). The economic burden of mental disorders in China, 2005–2013: implications for health policy. BMC psychiatry, 16(1), 1-9.
20. Ssebunnya, J., Kigozi, F., Lund, C., Kizza, D., & Okello, E. (2009). Stakeholder perceptions of mental health stigma and poverty in Uganda. BMC International Health and Human Rights, 9(1), 1-9.
21. Ridley, M., Rao, G., Schilbach, F., & Patel, V. (2020). Poverty, depression, and anxiety: Causal evidence and mechanisms. Science, 370(6522), eaay0214.
22. Mak, W. W., Poon, C. Y., Pun, L. Y., & Cheung, S. F. (2007). Meta-analysis of stigma and mental health. Social science & medicine, 65(2), 245-261.
23. Acosta, J. D., Becker, A., Cerully, J. L., Fisher, M. P., Martin, L. T., Vardavas, R., ... & Schell, T. L. (2014). Mental Health Stigma.
24. Javed, A., Lee, C., Zakaria, H., Buenaventura, R. D., Cetkovich-Bakmas, M., Duailibi, K., ... & Azeem, M. W. (2021). Reducing the stigma of mental health disorders with a focus on low-and middle-income countries. Asian journal of psychiatry, 58, 102601.
25. Harris, J. I., Leskela, J., Lakhan, S., Usset, T., DeVries, M., Mittal, D., & Boyd, J. (2019). Developing organizational interventions to address stigma among mental health providers: A pilot study. Community mental health journal, 55, 924-931.
26. Palpant, R. G., Steimnitz, R., Bornemann, T. H., & Hawkins, K. (2006). The Carter Center Mental Health Program: addressing the public health crisis in the field of mental health through policy change and stigma reduction. Preventing chronic disease, 3(2).

27. Ae-Ngibise, K. A., Sakyi, L., Adwan-Kamara, L., Lund, C., & Weobong, B. (2023). Prevalence of probable mental, neurological and substance use conditions and case detection at primary healthcare facilities across three districts in Ghana: findings from a cross-sectional health facility survey. BMC psychiatry, 23(1), 280.
28. Read, U. M., & Doku, V. C. K. (2012). Mental health research in Ghana: a literature review. Ghana Medical Journal, 46(2), 29-38.
29. Peter Mintir Amadu, Rejoice Enyonam Hoedoafia, Vivian Kapio Abem, Nicholas Danzima Yakubu, Mohammed Imoro, Abass Mohammed Sherif, Abdul Rahaman Abdul Razak. Substance Abuse among the Youth of Northern Region: The Realities of Our Time. Journal of Psychiatry and Psychiatric Disorders. 8 (2024): 15-23.