Prepared by Helen Jack (Student, Yale University) based on research on Ghana’s mental health workforce
Key finding #1: Staff highlight the significance of motivating feedback, but note that it is often
absent. Respondents described that merit-based feedback was often lacking, which made them feel apathetic about their work. Staff sought not only monetary compensation for high-quality work, but also verbal feedback and merit-based promotions to positions with more prestige and responsibility.
Possible ways to address this in the LI:
O Maintain the provision that the National Welfare Committee organize award
ceremonies for staff.
O Add a function about addressing staff motivation to the responsibilities of the Hospital
Welfare Committee, such as “Shall organize awards and feedback for hospital staff to
increase motivation.” Workers should be rewarded not only at the national-level, but also at the hospital-level. This would allow more workers to have their good work praised and highlighted as a model for others.
O Add a function addressing staff awards and motivation to the responsibilities of the
District Mental Health Sub-Committee and the Regional Mental Heath Sub-
Committee. The current version of the LI does not contain any provisions about awards, feedback, or motivation for staff at the district or community levels.
Key finding #2: Staff speak about fear of patient aggression and regular attacks. Staff described being attacked by their patients, often worked in fear of patient violence, and were rarely, if ever, compensated for injuries.
Possible ways to address this in the LI:
O Maintain the function that the Hospital-based Human Rights Committee address staff
complaints about assault.
O Add a function about training workers on how to reduce patient assault to the
responsibilities of the Hospital-based Human Rights Committee. Rather than only addressing assaults after they happen, the Human Rights Committee could work to prevent the assaults from happening.
O Add a function about addressing staff complaints about assault and preventing staff assaults to the District Mental Health Sub-Committee and the Regional Mental Health
Sub-Committee. The current version of the LI does not have any provisions about assaults on staff that take place outside the hospital.
Key finding #3: Staff emphasize the importance of the hospital community. Staff felt motivated by their close relationships with many of their colleagues, but they were demotivated by rigid relationships with their superiors.
Possible ways to address this in the LI:
O Add a function about providing leadership and management training for hospital staff in supervisory roles to the responsibilities of the National Welfare Committee and the
Hospital Welfare Committee.
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Research Methods:
O 28 open-ended interviews with staff at Ghana’s three public psychiatric hospitals during
June and July, 2011
O Staff interviewed include psychiatric nurses, nurses in leadership or administrative roles, physicians, medical assistants, pharmacists, social workers, psychologists, and nurse assistants
O Interviews were transcribed then the constant comparative method for qualitative data analysis was used
O Research was done for senior thesis at Yale University, academic articles for publication, and to inform mental health policy development
Key finding #1: Staff highlight the significance of motivating feedback, but note that it is often absent.
Interview transcripts were reviewed and all quotes related to motivation, accountability, and feedback were extracted. Themes from those selections informed this finding and are illustrated in the quotes below.
O “Sometimes the people that I report to giving me thumbs up. The commander will say, we are doing this and we think it’s great. Keep on doing it. Yeah…It’s not about my salary going up anyway. So that, that, that’s what keeps motivating me.” – Psychiatric nurse
O “People doing extra things to help run the hospital are never spotted and you know, say, oh, that is a well done, thumbs up for you. That is not there. So people then get, realize that ‘oh, if I continue to do this, it does not get recognized, why then do it at all?’” –
Psychiatric nurse
O “The hospital cannot decide to motivate workers by any award unlike other general hospitals where they generate income so they can institute something like best worker award.” – Psychiatrist
O “Most of our staff, we are very apathetic because that [monetary reward] is not coming
from management, for example.” – Psychiatric nurse
Key finding #2: Staff speak about patient aggression and the value of risk pay.
During transcripts review, researchers identified descriptions of patient aggression and staff reaction to violent behavior as a key theme throughout all of the interview transcripts even though respondents were not directly asked about these issues.
O “There was an incident when I was in a consulting room and then this guy came and then when I entered the room he used his leg to hit my stomach.” – Psychiatric nurse
O “When I entered psychiatry, the patient gave me a hit, bam, bam, bam I collapsed outright.” – Psychiatric nurse
O “I’m a specialist in psychiatry. A specialist within internal medicine, he’s not exposed to the same dangers I am exposed to. They attack us all the time. For example, these new
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patients, they attack us several times, they knock at us, break our teeth, but I take the
same salary as a specialist in another specialty.” –Psychiatrist
O Risk pay could help with recruitment of mental health workers: “There is no incentive for someone to become a mental nurse as of now” because mental health nurses make the
same amount of money as nurses in other hospitals. – Psychiatric nurse
Key finding #3: Staff emphasize the importance of the hospital community.
Nurses working on inpatient wards, more so than other staff, described that they felt driven to continue working at a psychiatric hospital because of their relationships with their colleagues.
O “One thing that motivates us to work mostly is our colleagues. Sometimes you come and you are tired, but your colleague says, my friend, let’s get up and do the work and so I
am motivated to just go.” – Psychiatric nurse
O “This place is a small community and the sense of belonging is high. Everyone wants to
greet you, people ask you about issues, and people are very caring.” – Psychiatric nurse
Staff reported taking a team approach to dealing with aggressive or difficult patients.
O “It was day time, so there was staff there, but they were all ladies so they just shouted
for help and some males came…to my aid” – Psychiatric nurse
O “Nurses are supposed to be one another’s keeper in order to enhance the work that we
do especially in the psychiatric hospital.” – Psychiatric nurse
Respondents shared a number of incidents in which the hierarchical management system of the hospital inhibited their motivation to work. Respondents who noted this tension expressed resentment about the rigid power structure and said that their interpersonal interactions with their superiors made their work environment unpleasant.
O “Those ahead of you are superiors so they look down on you, they, the manner they
might even address you is very, very, you know, is very intimidating.” – Psychiatric nurse
O “You can’t help someone who is senior here, even if that person is doing something
wrong.” – Psychiatric nurse
Contact information:
Helen Jack
Helenjack18@gmail.com
Skype: helenjack18
Phone (Ghana): 0248233828
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