Mental health policy process: a comparative study of Ghana, South Africa, Uganda and Zambia

The study countries and respondents were purposively selected to represent different levels of mental health policy and system development to allow comparative analysis of the factors underlying the different forms of mental health policy development and implementation. Data were collected using semi-structured interviews and document analysis. Data analysis was guided by conceptual framework that was developed for this purpose. A framework approach to analysis was used, incorporating themes that emerged from the data and from the conceptual framework.Mental health policies in Ghana, South Africa, Uganda and Zambia are weak, in draft form or non-existent. Mental health remained low on the policy agenda due to stigma and a lack of information, as well as low prioritisation by donors, low political priority and grassroots demand. Progress with mental health policy development varied and respondents noted a lack of consultation and insufficient evidence to inform policy development. Furthermore, policies were poorly implemented, due to factors including insufficient dissemination and operationalisation of policies and a lack of resources.Mental health policy processes in all four countries were inadequate, leading to either weak or non-existent policies, with an impact on mental health services. Recommendations are provided to strengthen mental health policy processes in these and other African countries.Mental health is a corner stone of health [1]. Mental illnesses are increasingly recognised as a leading cause of disability worldwide [2], with neuro-psychiatric conditions accounting for 14% of the global disease burden [2]. Depression currently affects over 450 million people, most of them poor and from developing countries [3]. By 2020 unipolar depressive diseases will be the second most important cause of disability [4].However, despite the growing burden of mental illness and the resultant level of suffering for individuals and society, efforts to address it are