The community intervention project aimed to address depression in the Narhman community in Ghana. The objectives were to identify factors causing depression, help people make adjustments using cognitive behavioral therapy, and refer severe cases to specialists. Through one-on-one sessions, some participants were found to have mild depression, low self-esteem, or anxiety. Severe cases were referred to nurses. While funding limitations reduced the project scope, the objectives were achieved and lessons learned will strengthen future projects. Addressing mental health in Ghana requires more research, funding, and infrastructure development.

1. First-Order Steps to Mental Health
Community Intervention Report
Written by: Anaman Pauline & Armah Ernest
| March 2015

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Contents
About SERVE ................................................................................................................................................ 1
Introduction ................................................................................................................................................3
The Problem.................................................................................................................................................3
Community Intervention Project on Depression.............................................................................. 6
 About Narhman Community ..................................................................................................... 6
 Objectives....................................................................................................................................... 6
Methodology............................................................................................................................................7
Key Findings ............................................................................................................................................... 8
Project Limitations: Lessons for the Future .......................................................................................11
Conclusion & Lessons Learnt................................................................................................................. 12
List of Volunteers ..................................................................................................................................... 14
About SERVE
SERVE Global is a non-governmental, non-partisan, not-for-profit organization on
a mission to drastically improve the socio economic development of disadvantaged
persons in society through research, advocacy and direct interventions. SERVE is an
acronym for Service for Empowerment. We are registered in Ghana under the
Companies Act, 1963, Act 179.
SERVE seeks to achieve true, replicable and scalable results by addressing pressing
issues at the micro-level whilst sustaining advocacy at the national level in the areas
of Education, Governance, Psychological well-being and human development. We
also conceptualize and execute direct intervention programs to tackle community
challenges.
Most of SERVE’s direct intervention programs are geared toward youth
empowerment and community development. In the past, we have conducted free

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mental health advocacy exercises, awarded scholarships, distributed over 65 books
and stationary materials to adolescents and youths to promote reading,
reproductive health counseling, free health insurance registration for over 100
indigents, blood donation exercise and community health and sanitation programs.

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Introduction
Mental health is an important element of a person’s overall wellbeing and should
receive equal attention in health care provision. The World Health Organization
defines health as “…a state of complete physical, mental and social well-being and
not merely the absence of disease or infirmity.1" In a mentally healthy state, every
individual is able to realize his or her own potential, cope with the stressors of
life, work productively and fruitfully, and make a meaningful contribution to her or
his community2. The saying that there is no health without mental health indeed
holds true.
The Problem
General understanding of mental illness in most parts of Ghana is restricted to
schizophrenia (popularly known as ‘madness’). Even with schizophrenia, the illness
is reported to a Psychiatric hospital only when the problem is well-advanced.
Ignorance of mental illness and the lack of effective coping systems have had serious
implications for the country’s mental health system and on victims and families as
well.
After Ghana’s independence in 1957, part of a comprehensive plan for the health
sector was the construction of five new mental hospitals backed by Psychiatric units
- to be ready by 1970- to accommodate over 1,000 people. At the time, Ghana’s
population was below 8 million.3 Currently, there are only three public psychiatric
1 Preamble to the Constitution of the World Health Organization as adopted by the International Health
Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official
Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
2 http://www.who.int/mediacentre/factsheets/fs220/en/ Accessed on 28 April 2015
3
Dark Days in Ghana by Dr Kwame Nkrumah

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hospitals (Accra, Pantang and Ankaful) and four privately operated ones to a
population of about 25 million people. All Psychiatric hospitals are based in the
South. Also, there are only about 18 Psychiatrists across the country with only one
Psychiatrist serving the three Northern regions (Northern, Upper West and Upper
East regions). Meanwhile, an estimated 3.2 million of Ghana’s population is likely to
experience mental disorder at a point in time.4
But the situation in the Psychiatric hospitals falls short of institutional capacity to
handle such enormous numbers across the country: medications and logistics are
inadequate whilst Psychiatric nurses have embarked on numerous strikes due to
unpaid salaries and other work benefits.
There is still stigma hovering around mental health illness and this is explained by
the high level of ignorance about the subject. This is manifested in the harsh
4
Human Rights Watch (2014); NGO appeals to government to prioritize mental health service.
Ghana News Agency, March 5, 2014;

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treatment and neglect of the mentally ill. The recently passed Mental Health Act
(Act 846), which replaced the Mental Health Decree of 1972, lacks teeth to bite.
According to the Director of the Mental Health Society of Ghana, Humphrey Kofie,
“the rights of mental health patients are continually abused or trampled upon
because there is no LI (Legislative Instrument) to enforce the Mental Health Act
(Act 846) and there are no resources for the governing board (Mental Health Board)
to operate.”5 Implementation of the provisions contained in the Act which include
improvement in the access to in-patient and out-patient mental health care in the
communities in which people live, regulation of mental health practitioners and
traditional leaders, fight against stigmatization and discrimination against the
mentally ill and protection of their rights cannot happen by sheer enthusiasm alone;
it requires financial and human resources.6
Since the mental health system is positioned in a curative paradigm, there is no
conscious effort on the part of the Psychiatric hospitals to reach out to the public.
Besides, absence of adequate funds would make it difficult for them to be proactive
in preventing an escalation of mental illness.
This report is an account of our first community intervention project on depression
at Narhman, Accra.
5
The Africa Report. November 12, 2014.
6
http://www.thekintampoproject.org/news/2012/12/22/ghanas-new-mental-health-act-a-brief-
guide.html

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Community Intervention Project on Depression
 About Narhman Community
Narhman is located in the Ga East district of the Greater Accra region. It is
cosmopolitan due to its multi-ethnic settlers. Crop farming and small scale
enterprises in the form of provision stores and table top eateries dominate economic
activity. Infrastructure development at Narhman is yet to take shape. The roads are
untarred, mobile network connectivity is weak and public utilities (water and
electricity) are inadequate. It is thus a relatively poor community where minimum
standard of living quality life is hardly met. We were convinced that helping people
take control over their minds, personal circumstances and daily experiences in such
a community could have a spill-over effect on the community’s overall positive
development.
 Objectives
Our objectives for the community intervention were three fold;
1. To identify peculiar factors on the ground which make people depressed,
2. To help people utilize their internal resources to make appropriate
adjustments in the face of stressors
3. To identify severe cases which require referral to mental health specialists.

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Methodology
Our initial decision to conduct in-focus group discussion was replaced by one-on-
one interactions and in one particular case, a group discussion. In our interaction
with members of the community, we observed demographic differences among
participants (age, family status, and experiential differences). Our team members
were thus divided into cohorts
to match with participants’
differences. Out of a total of 23
participants, 14 were females
and nine were males; three
were in a relationship, six were
single, 13 were married with
kids and one was a widow.
We developed a working
definition for depression which
was, “an extreme sadness as a
result of certain factors that
makes a person less functional”.7
As simplistic as it may sound, this definition allowed us to translate the term easily
into the local dialect of participants (predominantly Ga and Twi). Facilitators
explained prior to the session, the impact of depression on behavior and how they
could affect our professional and social lives.
7
This definition was coined by the team to make it easy for participants (mostly with little or no
education to understand)

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We used the Cognitive Behavioral Therapy (CBT) technique for the intervention.
The theoretical foundation of the CBT is that our thought patterns directly
influence our behavior. Three systematic processes are involved: recognition of
destructive thinking (negative thought patterns), evaluation of the validity
of thought patterns and replacement of destructive thoughts with healthier,
simple and better ways of thinking (constructive thinking).
Key Findings
Participants has been anonymized8 and names mentioned in this report are
pseudonyms. Most of the responses elicited from participants revolved around
mild depression (mostly due to the ongoing power crisis), poor self-esteem, panic
and anxiety attacks. Some participants were initially hesitant to come to terms
with their situation and placed more emphasis on how external factors (how
people relate to them and treated them in the past) are contributing to their
8
This also explains why their pictures were not included in the report.
“I had a kid with my boyfriend…but his family did not approve of the
relationship…the situation made me very sad. Especially when I came to
know that he had three other ladies aside me. The relationship ended about 3
years ago… but when I was with him, he spoke to me anyhow, even in
public…calling me all manner of names…negative things. Right now, I feel
bad about myself…my experience with him has affected my subsequent
relationships. Right now, I am scared of men. I don’t even think I am worthy
of love. When someone says he loves me, I would find it very difficult to
believe…”
Serwaa, an apprentice in late twenties

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predicament. A case in point is Serwaa (not the real name) whose heart was
broken about three years ago.
After that terrible experience, Serwaa is finding it difficult to be in another
relationship. During the session, she said she was unworthy of love severally and
stressed the maltreatment the former boyfriend meted out to her. However, after
going through the various steps in CBT, she came to realize how baseless her
thoughts of unworthiness are and the destructive effects they were having on her
life. She was introduced to the practice of positive affirmations as well.
Moreover, some of the cases due to the severity of its nature were handed to our
experienced Psychiatric Nurses. The session for these individuals were conducted
in an enclosed area with no access to cameras. The cases in this regard included
suicidal tendencies, drug abuse and family issues.
Not all participants were entirely helpless in their circumstances. Some were already
using a number of coping mechanisms to stay resilient in the face of challenges. Mr
Addo (not the real name) is a quintessence in this regard. We had a session for
children from the ages of 12 to assess how their social ecology affects their learning
and psycho-social development. Their strengths as well as weaknesses in various
“I had this chronic sickness. Even after recovery, I feel these strange sensations; my heart
beats fast, chronic headaches and negative thoughts (thoughts of death). This has been
happening to me in the past three months. I realized that when I talk to people, it helps.
And I also have this gospel song that I sing anytime I start having these thoughts.”
Mr Addo, a Mason in mid-thirties

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subjects were explored. Feedback was given to the headmaster of their school to
enable their parents and teachers make the necessary adjustments.

12. Project Limitations: Lessons for the Future
Our major drawback was financing. At the time the community project was
executed (i.e. 21st March 2015), we were barely three months old and still finding
our feet. The team was mostly about sharing ideas internally and raising awareness
of mental health issues through social media. The community project idea had
already been discussed. But we did not envisage that it would happen too soon.
The enthusiasm of team members sparked through knowledge sharing and the
signaling of strong commitment towards the cause led to planning and executing
the project under 1 month. This also meant that the time to raise funds was very
limited.
Even with limited time to plan and raise funds, we aimed very high. Our initial
budget was five times bigger than the budget we finally adopted. Because funds
were not forthcoming (as many potential donors found our project interesting but
our financial proposal quite impromptu), a large portion of the funds were
generated internally. With our passion still high, we quickly adjusted our plan to
suit the budget. The implication was to cut down on a number of inputs, including
number of volunteers and also our target audience.
Looking back, the community intervention project on depression at Narhman has
been a success. Our ability to carry the project through despite our financial
challenge is an indication of the tenacity of a committed and passionate team. We
are convinced that in the future, with ample time for planning, we would have
even greater outcomes.

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We see the Narhman project as a tester for future projects. We have tested the
waters to know what works and what does not work. Now we know that having
passion and commitment is great, but having adequate time and financial
resources are equally important to making greater impacts. What this means for us
is to adopt a proactive and innovative fund-raising avenues that will also be
sustainable.
Conclusion & Lessons Learnt
We have learnt useful lessons from our first community intervention project. We
did not give ample time for fundraising which affected some aspects of the project.
We could not also draw in on expected collaborations due to limited time. In
subsequent projects, these issues would be given adequate attention.
Notwithstanding our challenges, our objectives were achieved. We were able to
equip people with techniques to make positive adjustments in challenging times.
We also identified serious cases which were referred to mental health specialists as
well as factors which makes people depressed (most of which were already
captured in our literature review).
We are not giving room for complacency though. We are determined to leverage
on our first step for the miles ahead.
More research needs to be done especially in the area of epidemiology (prevalence
and distribution) of mental illness in Ghana. Government must also take mental
health needs of Ghanaians seriously be giving it equal attention in terms of

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funding and infrastructure development. The loss of about 7 percent of our Gross
Domestic Product as a result of psychological distress could be curbed if we invest
more in preventative mental health.9
We believe change happens from within; in the very guts and bones of our being.
There is no way we can change if we do not appreciate the power of our mind in
the process. This is the message we are taking to everyone in our quest to make
people mentally fit, resilient and productive.
9
Canavan, M., Sipsma, H., Adhvaryu, A., Ofori-Atta, A., Jack, H., Udry, C., Osei-Akoto, I., &
Bradley, E. (2013). Psychological Distress in Ghana: Associations with employment and lost
productivity. International Journal of Mental Health Systems 2013, 7:9

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List of Volunteers
Adwoa Ewuenye
Anaman Pauline
Armah Ernest
Charlene Bellow
David Selorm Atsu
Kobby Blay
Lolan Ekow
Solomon Yamoah