For community members of the Ketu South Municipality in Ghana, it is very common to seek care from religious leaders rather than from medical professionals when it comes to mental health conditions. While religious leaders are perfectly positioned to recognize that someone needs mental health care, they sometimes feel overwhelmed with the demand and with the requests (as they cannot prescribe medications, for example). On the other side, medical professionals are faced with a revolving door phenomenon (clients need to get admitted repeatedly due to medication non-compliance or persistent psychosocial stressors) and defaulting patients (patients do not show up for appointments). Despite all the work of the religious leaders and medical professionals, these two groups barely talk to each other to discuss how best they can join hands to improve their efforts to take care of community members with mental health conditions. 

In collaboration with stakeholders from the Ketu South Municipality and our partners from Ashesi University, we invited mental health professionals, religious leaders, patients and their friends and relatives, and other stakeholders from the Ketu South Municipality for a co-participatory workshop in which the status quo of mental health and potential solutions to identified challenges were discussed. 

This workshop also led to building trust between religious leaders and medical professionals and a wish for ongoing collaboration. In the next step, On The Move e.V. organized a workshop in which both groups trained each other: mental health professionals trained religious leaders in the basics of mental health and cognitive behavioral therapy, and religious leaders trained mental health professionals on the importance of religiosity and spirituality in the healthcare setting. The participants also discussed the idea of spirituality-infused cognitive behavioral therapy and brainstormed concrete next steps for collaboration – two of the questions addressed centered around how can community members with mental health conditions be identified (not diagnosed or treated) by religious leaders and referred to mental health professionals and how can mental health professionals refer back community members to religious leaders to increase medication compliance, prevent defaulting, or assist with psychosocialspiritual needs.

Through additional workshops, which were supported through the Ketu South Municipality with regards to finances and human resources, the participants developed a mental health screening tool that aimed to identify community members with mental health conditions and identify specific target groups in terms of mental health preventive activities. Religious leaders and mental health professionals have used the screening tool more than 1,000 times at this point. They have identified numerous patients with mental health conditions and referred them to the appropriate level of mental health care. Members from Ashesi University, who were part of the co-participatory workshops from the very beginning, ran additional workshops with the religious leaders and medical professionals to further work on designing and prototyping solutions to some of the identified challenges. Ashesi University will also assist with the implementation and testing of the solutions as well as their re-design in the future to improve them further.  

The so-called Brain Spirit Desk activities are one of the innovative community-based mental health interventions that we teach during our Erasmus+Program (see here for more information). The design and the outcomes of the Brain Spirit Desk also have the potential to inform community-based mental health interventions in the Global North. Initially, On The Move e.V. took a very active role in financing the mental health activities and connecting relevant stakeholders; however, at this point, the stakeholders collaborate mostly independently from us to improve access to high-quality community-based mental health care in the Ketu South Municipality. 

Impressions from a design thinking session as part of the Brain Spirit Desk