Paper short abstract:

International campaigns promote psychotropic drugs to treat psychosis. However research with people with mental illness in Ghana revealed dissatisfaction with the effects of antipsychotics suggesting a need to develop interventions which are more responsive to the experiences of those who use them.

Paper long abstract:

Global campaigns to 'scale up' mental health services promote psychotropic medication as the first line of 'evidence-based' treatment for psychotic disorders. However, such campaigns pay insufficient attention to the experiences of those who take antipsychotics including unpleasant and dangerous side effects, limited perceived efficacy, and discontinuation of treatment. Whilst these responses are well-documented for users of mental health services in high-income settings, there has been very little research in low-income countries. This paper reports on ethnographic research in Ghana with people with long-standing mental illness and family members. Despite a perception among health workers that many families were ignorant of biomedical treatment for mental illness, most informants had used psychiatric services including antipsychotic drugs. However despite valued effects such as calming aggression or agitation and facilitating sleep, discontinuation of treatment was common in the long term due to feelings of weakness and prolonged drowsiness. Such experiences conflict with perceptions of health as strength and a desire for medicines to enhance strength and endurance, particularly when physical exertion is required for most farming and household chores. Furthermore, the failure of antipsychotics to bring about a lasting cure could paradoxically reinforce spiritual perceptions of mental illness since illnesses which recur despite medical treatment are suspected to have a spiritual cause. This paper concludes by arguing that mental health initiatives should attend more closely to the evidence of those who experience mental distress and its treatment and work with families to develop innovative interventions which are responsive to their needs.