‘To overcome struggles, you must have a foundation – family’

The summer before my final year of university loomed… how was I going to make the most of it? What could I, a Psychology student, do in these next few months that could refine me and prepare for the new academic year? On reflection, I realised that volunteering abroad could be an option. 

Volunteering wasn't new to me, but I wanted more hands-on experience with clinical Psychology. It didn't take long to find a placement that was affordable and suitable. I was introduced to an organisation called 'Plan My Gap Year' who offered Psychology and mental health placements. After reading more, I decided to spend four weeks in Ghana: enough time to explore and learn about how mental health services work outside the UK. I decided to make the most of every opportunity. My placement was to observe and be immersed in learning about psychological and neuropsychological disorders, but I felt it was just as important to bring back what I have learnt and share it.

First week

My first week in Ghana was about how mental health services actively engage in the support and care of their patients. The input of psychologists and psychiatrists in the hospitals I worked in were very sparse. Instead, psychiatric units were mainly delivered by psychiatric nurses; they ultimately represented the usual multidisciplinary team crammed into one role. 

The nurses I shadowed openly agreed that many mental health cases are undiagnosed, or misdiagnosed. Similar to the UK, they use psychological tests to assess the mental state of each patient. However, they take a slightly different approach. As a substitute to using the standard DSM-V model for formulating and diagnosing mental illnesses, the system used in Ghana considers several factors such as memory, mood, motivation and insight, that measure the severity of a mental disorder. These elements allow the psychiatric nurses to conclude what the patient is suffering with.

After observing many consultations, I began to understand how intricate these factors were and the impact they had on the psychological wellbeing of each patient. Whilst performing psychological assessments on patients, I was able to liaise with the staff formulating and discussing what the patients' mental illness could be. I even facilitated clinical review sessions with other members of staff looking at effective treatment for epilepsy, an area of neurology that the psychiatric unit also treats. 

At one point I had the opportunity to analyse a patient's CT scan, to examine areas of the brain that had been damaged during a wood chopping accident. The patient had been suffering from seizures. The CT scan revealed impressions in the right parietal ventricle and cortex, later concluding that further testing using an MRI would be beneficial to investigate the whole anatomy of the patient's brain. We had considered neuroimaging techniques as a part of my degree, so I felt a bond with the other members of staff as I shared my thoughts.

Medication and stigma

Psychotherapy and counselling skills are at least partly incorporated in consultations in Ghana, but prescribed drugs remain the preferred option for treating mental health conditions. Surprisingly, despite only being an undergraduate student, I was authorised to help write up prescriptions with guidance from the psychiatric nurses. Through this, I was exposed to a variety of medicine, produced for a range of varying mental illnesses such as depression, anxiety, bipolar, and schizophrenia. I was informed that patients diagnosed with schizophrenia or schizoaffective disorder were prescribed typical antipsychotics alongside Artane, which is used to reduce the common side effects. 

As my time in Ghana progressed, I began to recognise that although there was a stigma around poor mental health, the staff in these hospitals were seeking to tackle it through education in the community. Rather than only being in the hospitals, I had the option to visit patients' in their homes, with the other psychiatric nurses. The aims of these visits were to review the patients' living conditions and make sure that they were taking their medication correctly. On one of these visits, the team and I encountered a patient who had not visited the hospital in over a year and had stopped taking their medication. As the staff acknowledged that this patient was unaware of the severity of their mental disorder, they took the time to educate the patient on their condition in the hope that they will take treatment more seriously. At this moment, I became aware of the importance of empathy when interacting with a patient, and how critical this feature is to overcoming hurdles between staff and client. 

I found myself taking part in what they call health talks, where members of staff actively visit the local community to provide talks and discussions about specific mental health conditions, aimed primarily at mothers. I can't speak the local language, known as Twi, so my involvement in these talks mainly included observation and feedback from the mental health nurses. It was apparent that to some extent local communities are aware of these complex issues, but talking about preventive measures was also key. 

Family

Alongside the importance of how mental illnesses are experienced in Ghana, I became aware of the surrounding factors that influence treatment: in particular, the involvement of families. A large part of the Ghanaian culture is having close-knit families, fundamentally for support and cooperation. Many of the clients registered in the psychiatric unit did not voluntarily register themselves at the hospital, but with the support and cooperation of their family members, they were persuaded to receive the help that they needed. It was very rare to see a patient on their own during a consultation, because of the amount of concern and input these families have for each other. That was a delight to witness. This changed my perspective on how poor mental health should be dealt with; I realised that to overcome struggles, you must have a foundation – family.  

Overall, I consider this trip life-changing. The risks and challenges I overcame only made me stronger as an individual. Exploring a part of Africa alone granted me invaluable experience that I will take along with me throughout the rest of my studies and career. I came to Ghana to aid my portfolio of work experience and gain insight into working with clinical populations. However, I left attaining more than I could have ever imagined. I thank 'Plan My Gap Year' for their guidance, support, and the eye-opening experience I had.