Akoma Ntoaso: Improving Mental Health for children and adolescents with chronic disease in Ghana

Adolescents with chronic illnesses are vulnerable to mental health comorbidity and are especially at risk to care gaps and barriers. In Ghana, fragmented and inequitable resource distribution, poor collaboration between traditional and Western healing practices and stigma for young people needing mental health treatment compound these care gaps. Our team continues to aim for integrated and collaborative mental and chronic health care, inspired by existing cultural values like ‘Akoma Ntoaso’: Creating Resources through joining of Hearts.

As a team that has been collaborating for many years, we organically-derived context-driven Collaborative Care Models (CCM) and have gradually implemented to support integrated mental and chronic care across Komfo Anokye Teaching Hospital (KATH), in Kumasi, Ghana. Three adjacent programs have been developed: (a) Pediatric to Adult Transition Joint Clinics with patients above the age of 14 enrolled in pediatric chronic-care clinics  (b) Child and Adolescent Neuropsychiatric Joint Clinic, which involves multi-disciplinary teams to provide care to children and adolescents with neurological and mental health comorbidity, and (c) Chronic disease support groups which support holistic, preventive mental health care by community collectiveness. 

For the pediatric to adult transition program (a), 78 patients have been successfully transitioned through this process to adult-based care.  To date, approximately 120 children and adolescents have been managed at the neuro-psychiatric joint clinic (b). This  includes education and support for caregivers through an in-person and virtual group. Though gravely impacted by funding challenges and the COVID-19 pandemic, support groups (c ) continue to prove efficacious with 65% attendees reporting strongly agree and 20% agree that meetings and collaborative care they received help them “feel less alone.” Surveys of group members revealed that 95% rated the support groups as beneficial.

CCM models have not been implemented previously in this context; nor have they incorporated other features (beyond task-sharing) to better consider structural issues underlying the mental health and chronic disease syndemic. Derived from cultural values, these programs aim to reduce stigma, increase social capital, and include traditional healing practices alongside Western medicine. Our team is now engaged in further participatory needs assessments to better understand how integrated care methods promote community and overall wellness, while illustrating resource-sharing methods.