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      Factors influencing medical students and psychiatry residents in Ghana to consider psychiatry as a career option – a qualitative study

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          Abstract

          Background

          Currently, Ghana has 14 actively practicing psychiatrists and about 26 psychiatric residents for a population of over 28 million people. Previous research suggests a lack of interest by Ghanaian medical students and medical graduates in considering psychiatry as a career option.

          Objectives

          To examine the perception of medical students and psychiatry residents in Ghana about the barriers which hinder Ghanaian medical graduates from choosing careers in psychiatry and how these barriers could be overcome.

          Methods

          This was a cross-sectional qualitative study with data gathered using focus group discussion. Twenty clinical year medical students were selected through block randomization from the four public medical schools in Ghana and invited to participate in one of two focus group discussions. Also, four psychiatric residents were invited to participate in the focus group discussions.

          Results

          The main barriers identified by participants could be grouped under four main themes, namely: (a) myths and stigma surrounding mental health and patients, (b) negative perceptions of psychiatrists, (c) infrastructure and funding issues, (d) lack of exposure and education. To address the barriers presented, participants discussed potential solutions that could be categorized into five main themes, namely: (a) stigma reduction, (b) educating professionals, (c) addressing deficient infrastructure, (d) risk management, and (e) incentivizing the pursuit of psychiatry among students.

          Conclusion

          Health policy planners and medical training institutions could consider implementing proposed solutions to identify barriers as part of efforts to improve the psychiatrist to patient ratio in Ghana.

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          Most cited references33

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          Public attitudes towards psychiatry and psychiatric treatment at the beginning of the 21st century: a systematic review and meta-analysis of population surveys.

          Public attitudes towards psychiatry are crucial determinants of help-seeking for mental illness. It has been argued that psychiatry as a discipline enjoys low esteem among the public, and a "crisis" of psychiatry has been noted. We conducted a systematic review and meta-analysis of population studies examining public attitudes towards various aspects of psychiatric care. Our search in PubMed, Web of Science, PsychINFO and bibliographies yielded 162 papers based on population surveys conducted since 2000 and published no later than 2015. We found that professional help for mental disorders generally enjoys high esteem. While general practitioners are the preferred source of help for depression, mental health professionals are the most trusted helpers for schizophrenia. If respondents have to rank sources of help, they tend to favor mental health professionals, while open questions yield results more favorable to general practitioners. Psychiatrists and psychologists/psychotherapists are equally recommended for the treatment of schizophrenia, while for depression psychologists/psychotherapists are more recommended, at least in Europe and America. Psychotherapy is consistently preferred over medication. Attitudes towards seeking help from psychiatrists or psychologists/psychotherapists as well as towards medication and psychotherapy have markedly improved over the last twenty-five years. Biological concepts of mental illness are associated with stronger approval of psychiatric help, particularly medication. Self-stigma and negative attitudes towards persons with mental illness decrease the likelihood of personally considering psychiatric help. In conclusion, the public readily recommends psychiatric help for the treatment of mental disorders. Psychotherapy is the most popular method of psychiatric treatment. A useful strategy to further improve the public image of psychiatry could be to stress that listening and understanding are at the core of psychiatric care.
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            Stigma about depression and its impact on help-seeking intentions.

            Research has shown that people are reluctant to seek professional help for depression, especially from mental health professionals. This may be because of the impact of stigma which can involve people's own responses to depression and help-seeking (self stigma) as well as their perceptions of others' negative responses (perceived stigma). The aim of this article was to examine community help-seeking intentions and stigmatizing beliefs associated with depression. A total of 1,312 adults randomly sampled from the Australian community completed a questionnaire providing a depression vignette and measures of self- and perceived-stigmatizing responses, source-specific help-seeking intentions, current depressive symptoms and depression experience, and demographics. Many people reported they would feel embarrassed about seeking help from professionals, and believed that other people would have a negative reaction to them if they sought such help. Some expected professionals to respond negatively to them. Responses varied according to the sources of professional help. Self-embarrassment and expectations that others would respond negatively predicted the likelihood of help-seeking from professional sources. Self- and perceived-stigmatizing responses to help-seeking for depression are prevalent in the community and are associated with reluctance to seek professional help. Interventions should focus on minimizing expectations of negative responses from others and negative self-responses to help-seeking, and should target younger people.
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              Reducing the stigma of mental illness

              H. Stuart (2016)
              This paper presents a narrative review of anti-stigma programming using examples from different countries to understand and describe current best practices in the field. Results highlight the importance of targeting the behavioural outcomes of the stigmatization process (discrimination and social inequity), which is consistent with rights-based or social justice models that emphasize social and economic equity for people with disabilities (such as equitable access to services, education, work, etc.). They also call into question large public education approaches in favour of more targeted contact-based interventions. Finally, to add to the research base on best practices, anti-stigma programs are encouraged to create alliances with university researchers in order to critically evaluate their activities and build better, evidence informed practices.
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                Author and article information

                Journal
                Glob Ment Health (Camb)
                Glob Ment Health (Camb)
                GMH
                Global Mental Health
                Cambridge University Press (Cambridge, UK )
                2054-4251
                2020
                03 November 2020
                : 7
                : e31
                Affiliations
                [1 ]Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta , Edmonton, Canada
                [2 ]Alberta Health Services, Edmonton, Canada
                [3 ]St James School of Medicine, Anguilla, Anguilla
                [4 ]Tempo School , Edmonton, Canada
                [5 ]Cumming School of Medicine, University of Calgary , Calgary, Canada
                [6 ]Department of Psychiatry, University of Alabama , Alabama, USA
                [7 ]Ghana Mental Health Authority, Accra, Ghana
                Author notes
                Author for correspondence: Vincent I.O Agyapong, E-Mail: agyapong@ 123456ualberta.ca
                Author information
                https://orcid.org/0000-0002-2743-0372
                Article
                S2054425120000242
                10.1017/gmh.2020.24
                7786269
                33489247
                50823126-b442-4ca6-b365-f7fd13bafe51
                © The Author(s) 2020

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 05 January 2020
                : 19 September 2020
                : 06 October 2020
                Page count
                References: 35, Pages: 5
                Categories
                Other
                Brief Report

                careers,incentives,medical students,psychiatry,stigma,risk
                careers, incentives, medical students, psychiatry, stigma, risk

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