Setting Mental Health Priorities in Ghana: A 15-Year Contextual Analysis of the Presidential State of the Nation Address

Comment

Authors’ response

Page №

Reviewer 1

1

Overall, the study was timely, interesting and well conducted.

Considering its key hypothesis that inclusion in the State of the Nation addresses would increase public awareness and drive investment, and that mental health had suffered in this regard from not being included in SONA speeches, I would like to see some evidence that other (health) issues, which have been covered, have subsequently benefitted from this. The impact of such discussions on AIDS, or child and maternal health, warrants mentioning, for example, particularly as both are mentioned as having been covered in several SONAs - was subsequent investment and improvement observed and to what degree? Did SONA coverage help with dispelling stigma as well as driving policy and investment? Does mention in the SONA primarily drive subsequent investment or celebrate prior investment? If mentions are largely celebratory then the lack of coverage could be due to insufficient investment thus far to generate impressive enough results to celebrate. I would like to see this section expanded somewhat to address these issues.

We thank the reviewer for this useful comment. We agree with the reviewer. However, as the reviewer has also indicated in their comment 5, we have considered it more appropriate to intersperse the Results section with our responses to this comment. We strongly believe that including our responses in the Introduction section of the paper will rather pre-empt the results/findings of the study.

3, 5-8

2

Line 255 - this quote is presented as fact but it seems more like opinion. Is it accurate? If not, or if the author is not sure, it should be presented as opinion rather than fact. 

Thank you for this suggestion. We have now re-presented this as a fact reported by the Chief Executive Officer of the Ghana Mental Health Authority himself – and this is duly referenced.

6-7

3

Line 280 - 'only 94 clinical psychologists' how does this compare with WHO recommended ratios per 1000 population and neighbouring countries in the region? e.g.: https://www.oecd-ilibrary.org/docserver/health_glance-2009-30-en.pdf?expires=1628119228&id=id&accname=guest&checksum=27683493AC8718BF8E1BE6E7F4F5EBE3 or https://www.who.int/mental_health/media/en/244.pdf

Thank you for this comment. We have addressed this in the introduction section, where we discussed mental health (care) in Ghana.

2

4

323-326 - The mention of medical tourism is interesting. Is there evidence from other countries of an economic benefit from psychiatric health tourism? Does Ghana match characteristics of other countries that have successfully commoditised (or not) psychiatric treatment? e.g: http://saio.world.coocan.jp/Medtourism-JSPN.pdf; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2548194/

We thank the reviewer for this comment. Even though the discussion on medical tourism is beyond the scope of this paper, we have reflected briefly on Ghana’s potential for the commoditisation psychiatric care within the sub-Saharan African region.

8

5

 Lines 334-336 - show that the conditions specifically mentioned did receive investment and that this did lead to measurable improvement and better health. 

As we have indicated in response to the reviewer’s comment 1 above, we have now interspersed the Results section with specific conditions mentioned in the SONAs that received investment and desirable improvement.

5-8

6

The paper would also have benefited from a brief examination of whether any alternative groups are stronger advocates for mental health, including whether there is a political dimension (were the Presidents that did raise mental health all from the same political party or different ones? Are competing parties equally apathetic or is one more engaged than others?

We have now included additional text to indicate that during the period of interest to this study (2007-2021), the four presidents of Ghana have come from only two political parties. Within the lens of party politics and manifesto promises, it appears that presidents from both parties have been generally apathetic and less inclined to direct massive investment in mental healthcare, relative to medical care.

8

Comment

Authors’ response

Page №

Reviewer 2

1

Page 1, 2, Lines 25 to 95: Include a more robust discussion in the introduction to contextualization, using literature from previous years to the present on the topic;

Thank you for this comment. W have now included additional text to further contextualise our study. We also wish to indicate that contrary to the view of the reviewer, the introduction (and for that matter the contextualisation) of our study spans lines 25 – 120; not 25-95. More importantly, as we indicated in lines 55-56, the approach of using speeches by political leaders to gauge the agenda setting on a matter health concern is rare. The implication is that one would hardly find a published study that have used this approached to study the agenda setting for mental health. In fact, our own systematic search of PubMed, MEDLINE, Global Health, CINAHL, and African Journals Online (AJOL) found no study that has applied the analysis of political speeches as an agenda-setting tool for mental health prioritisation in Africa or elsewhere. We believe our study makes a novel contribution in this respect.

2

Page 2, line 97 to 113: To further explore the discussion of the researched theoretical basis, I suggest adding more current textual elements and references;

Thank you for this suggestion. Even though it is not clear what the reviewer expects, we believe we have included some of the key references in this section. We also want to mention that the discussion of the SONA is exhaustive and contextually intelligible, as can be said about the discussion of the agenda-setting theoretical framework.

3

Page 3, lines 137 to 160: Expand this section “Materials and Methods” to situate the reader of all methods used, in more detail;

Thank you for this suggestion. We have now added extra text to clarify the methods we used.

3-4

4

Page 4, line 162 to 328: The section “3. Results”, is adequate to the objectives;

We have expanded the Results with additional text to support the objectives.

5

Page 7, line 330 to 328: Further develop section “4. Discussion”, based on the consulted literature and on the new literature, discussing other elements that support the construction of this section;

We thank the reviewer for this comment. However, as we have stated in response to the reviewer’s comment 1 above, there are neither new nor extant literature specifically on the approach used by this study (i.e. using political speeches to gauge mental health priorities). So, we have elected to discuss our key findings within the Ghanaian context and broadly within the African situation. We believe this approach makes the discussion more relevant and useful – rather than relying on, mostly likely, Western literature to contextualise our findings. Also, we wish to point out that we have been careful not to overly stretch our data: our data is less encompassing and any attempt at drawing elaborate extrapolations and interpretation of the findings would not be warranted and not fully grounded in the evidence presented.

6

Page 8, line 386 to 395: In the conclusions section, the article fulfilled its purpose, but it can present a more in-depth discussion in order to offer a more significant contribution to the literature.

I hope I contributed to the improvement of the study.

Thank you for this suggestion. As we have indicated in response to comment 5, we are hesitant to include additional text to the discussion, considering the relatively limited nature of our data. We believe a much more concise discussion (as we have done) within the remit of the findings is fair, as it carries the key message of the paper.