Leadership and governance of mental healthcare and integration at the community level: a mixed methods study in Ghana

Leadership and governance are key components of health systems, nevertheless research into leadership and governance of mental healthcare at the community level is probably the least well researched and understood part of these systems. As part of assessing the integration of mental health in Primary Health Care in Ghana, the leadership and governance organisation and structures to ensure oversight and coordination were examined. A concurrent mixed-methods design involving both quantitative and qualitative research methods approach was adopted. The quantitative data were collected through a questionnaire, which was either self-administered or interviewer administered, on 1010 respondents with 830 completed (response rate 82%). Key informant interviews and focus group discussions were used to collect the qualitative data. Thematic content analysis with the use of NVivo 12 was applied for the qualitative field data and Stata SE16 was used for quantitative data. Data triangulation strategy was used to report the qualitative and quantitative results. The study showed that leadership and governance of mental health at the PHC level were lowly developed due to the modest level of awareness of the Mental Health Law, inadequate functioning of mental health units and coordination, low level of private sector participation in mental health care services, and low levels of provision of monitoring, supervision, and evaluation. This affected the integration of mental health at the PHC level, which was also gauged as low. The study concludes that despite the presence of legislation and policy aiming to achieve decentralised and integrated mental health services at the PHC level, mental health care is still a low-level priority within the health care system in Ghana and tends to operate within a silo. The study recommends that more practical and concerted leadership of mental health at the regional and district levels is required to drive decentralisation and integration at these levels. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial This is not a clinical trial ### Funding Statement The corresponding author is paid salary by BasicNeeds-Ghana while he is studying for his PhD ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Ghana Health Service (GHS) Ethics Review Committee provided approval, which is numbered GHS-ERC018/12/19. Written permission(s) were also received from various regional and district health directorates and health facilities and social welfare departments which facilitated the study's field activities. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data underlying the findings are available