Mental health prescription practices and medication availability among ghanaian psychiatric hospitals

Background: Mental health disorders account for 13% of the global burden of disease and low-income countries are ill-equipped to address this burden. Problems due to limited staffing as well as the potential for polypharmacy have been documented; however, limited research has assessed psychiatric prescription practices in low-income countries. Accordingly, we sought to identify prescription patterns and medication availability in a low-income country. We selected Ghana as it is planning major mental health care reform, which would benefit from our findings.

Methods: We used patient-level data from the Ghana Mental Health Information Systems (MHIS) for all outpatients cared for in one of the three major psychiatric hospitals in Ghana between May 1, 2009 and April 30, 2010. We examined the prescription practices and medication availability for each different diagnostic category and evaluated differences by hospital and patient demographic factors.

Results: Among the 14,092 patients, the most common diagnosis was schizophrenia and other delusional disorders (45.5%) followed by epilepsy (18.6%), mood disorders (16.8%), and substance abuse disorders (5.8%). Among individuals diagnosed with schizophrenia, medication classes that were not indicated by the diagnosis were prescribed in 64.4% of cases. For visits where individuals were given an antipsychotic prescription, 10.8% of the time it was not available. Additionally, these percentages differed significantly by hospital (p-value <0.001).

Conclusion: Despite the severity of mental illness, many patients are prescribed medications that are not indicated for their diagnosis and proper prescriptions are not uniformly available. These findings underscore the importance of standardizing prescription practices in low-income countries.