Table 1.

Summary of training and clinical duties for the community mental health workers

Training and clinical responsibilities	Community mental health workers (CMHWs)
	Community mental health officers (CMHOs)	Clinical psychiatric officers (CPOs)	Community psychiatric nurses (CPNs)
Admission requirement to training institution	Certificate in Community Health (or its equivalent from a recognized health training institution) or the possession of a Certificate in Community Health Nursing (or its equivalent from a recognized health training institution) plus a minimum professional service of 2 years in deprived areas or 3 years in non-deprived areas.	Advanced Diploma in Community Medicine and Health or an Advanced Diploma in Community Oral Health and Medicine plus a minimum professional service of 2 years in deprived areas or 3 years in non-deprived areas.	West African Senior School Certificate Examinations, the Senior Secondary School Certificate Examination or equivalent high school diplomas.
Specialized mental health training	Duration of Course: 12 months full-time training Curriculum content: General psychiatry and psychology, Community mental health practice, drugs, medication, physical health and psychiatry, team building and communication, ethics and professionalism, research, audit and evidence-based practice, basic clinical psychopharmacology, psychosocial aspects of treatment, child psychiatry, learning disability, and older peoples mental health (26). Qualification awarded: Diploma in Community Mental Health	Duration of course: 24 months full-time training plus 1–3 months ‘housemanship’ in specialist hospitals Curriculum content: General psychiatry; psychosocial perspectives of psychiatric practice; community mental health practice; leadership; team building and communication; managing change, supervision, and appraisal; ethics and professionalism; research and evidence-based practice; psychopharmacology; psychosocial intervention; history of psychiatry in Ghana; psychiatry and the law. Epilepsy, substance misuse psychiatry, liaison psychiatry, child psychiatry, learning disability and rehabilitation (23). Qualification awarded: Degree in Community Medicine and Clinical Psychiatry	Duration of course: 36 months full-time training (first 18 months involves general nursing training, and the second 18 months is devoted to mental health nursing) plus working as clinical mental health nurses for 2 years, and then in-service training of up to 3 months under an experienced CPN Curriculum content: Anatomy, physiology, pharmacology, obstetrics and gynecology, medicine, general nursing, psychology, psychopharmacology, clinical psychiatry Qualification awarded: Diploma in Nursing
Mental health clinical duties	- Conduct house-to-house visits to detect cases of mental disorder - Provide psychosocial support, such as family support and education, informal counseling and rehabilitation - Monitoring and supervision of patient's adherence to treatment (case management) - Refer cases to CPNs, CPOs, and other appropriate health professionals - Produce reliable data on mental disorders at the community level	- Have clearly delineated guidelines on which disorders to manage and which to refer - They have clear protocols for treatment and a limited range of drugs for prescribing - They are not be able to diagnose detailed subcategories of conditions outside those they treat (e.g. they might recognize anxiety disorder but would not differentiate generalized anxiety disorder from panic disorder; they might recognize personality disorder but they would not subtype it)	- Case detection and case management within the community, including monitoring patients’ compliance with psychotropic medication. - Case referral to District Medical Officers and psychiatrists.
	- Organize mental health promotion activities at the community level - Ensure community participation to promote mental health - Develop effective professional relationships with clients and their families - Do not prescribe medication or carry out any other independent form of treatment (26).