Mental health services in Ghana, like those in other African nations, are facing many challenges, including a shortage of psychiatrists. The stigma attached to mental health deters many people from considering a career in psychiatry. There is even strong evidence of stigmatization in the attitudes of Ghanaian medical students to psychiatry. They perceive a low prestige for psychiatrists among the public and among other medical disciplines and feel that fellow students interested in psychiatry are seen as strange or neurotic. The majority also report feeling uncomfortable with patients with mental illness (1). Similar findings were obtained in a survey to assess the attitude of medical students in Papua, New Guinea (2). Many have commented on the low status of the specialty and the unsympathetic attitude and lack of respect shown by other professions and faculty members, especially physicians and surgeons (3). Also, students’ perceptions of psychiatry as less scientifically rigorous than other specialties make it less attractive (4).

Given the low level of interest in psychiatry by Ghanaian medical students and the lack of adequate investment, innovative steps are required to promote psychiatry as a career option. This study aimed to assess the impact of a public-speaking competition on the level of interest in psychiatry by Ghanaian medical students.

The study was approved by the review board of the Ghana College of Physicians and Surgeons. Sponsorship was obtained from two hospitals in Dublin, Ireland. The sponsorship included four scholarships to enable 4-week elective placements in psychiatry at two psychiatry teaching hospitals in Ireland for medical students participating in the competition.

The event was internally advertised among fourth- and fifth-year students in the two Ghanaian medical schools based in Accra and Kumasi. Expressions of interest were sought from the students, and local contests were organized by the psychiatry departments of both schools to select two students to represent each school. The competition was held at the main auditorium of the Ghana College of Physicians and Surgeon in Accra on the 6th of December 2010.

In the week preceding the event, several media interviews were granted by the organizers to popularize the event among members of the general public and the event itself was broadcast live on national television. The topic for the maiden competition was “A developing country like Ghana needs to invest more in mental health care.” A public speaking competition rather than debate format was adopted in order to avoid the polarization of the topic. This model was seen as a key to ensuring the success of the project. Consequently, both schools spoke in favor of the topic, and the winner was determined by an eminent panel of judges based on objective criteria assessing various aspects of each speaker’s presentation, including clarity of their presentations, strength of the arguments, and team coordination; ability to engage the audience, effectiveness of their summary, and ability to handle questions from the judges and audience.

Feedback questionnaires were developed by the organizers and distributed to the four contestants and all 118 persons present in the audience. The feedback form consisted of a self-administered questionnaire including eight items as 5-point Likert scales. The questionnaire had been reviewed by a multidisciplinary group of three experts (a researcher and two psychiatrists) and pretested with five medical students not included in the study sample. It generally took 5 minutes to complete, and no financial incentive was offered to respondents. The results of this feedback were compiled and analyzed using descriptive statistics with SPSS Version 17.

Of the 122 feedback forms distributed, 80 were completed and returned, giving a response rate of 66%. Overall, 37 (46.2%) of the forms were completed by medical students; 2 (2.5%) by physicians; 19 (23.8%) by other health professionals, mainly nursing students; and 22 (27.5%) by persons working in the media. Table 1 shows the level of agreement by all the respondents to some statements on the feedback forms.

Some responses from medical students were sub-analyzed. This showed that 7 (18.9%) strongly agreed that the competition had helped change their perception about psychiatry; 22 (59.5%) of them agreed with this statement; 8 (21.6%) neither agreed nor disagreed; and none disagreed with the statement.

Again, 1 medical student (2.7%) strongly agreed that competition would help stimulate the interest of Ghanaian medical students in Psychiatry; 21 (56.8%) agreed with this statement; 13 (35.1%) neither agreed nor disagreed with this statement; and 2 medical students (5.4%) disagreed with the statement.

Finally, 10 medicals students (27%) indicated that they would consider training in psychiatry if the government were to offer attractive incentive packages to those wishing to train in the specialty.

To-date, after an extensive review of the literature from MEDLINE, PubMed, ERIC, Web of Science, Science Direct, and PsycINFO, using search terms including inter-medical school, psychiatry, public-speaking competition, career option, impact, and feedback, no study was found that assesses the impact of a public-speaking competition to promote psychiatry as a career-option among medical students. Many scholarly activities, including quizzes, debates, public-speaking, and essay competitions have, however, been used in various countries around the world to stimulate the interest of medical students in the basic sciences and medical subspecialties, including psychiatry (5–9). The student sample in our study is representative of the clinical-year student population in Ghana, as it included students from only the two medical schools with clinical-year students. The results may therefore not be directly applicable to pre-clinical students, including students from the two other medical schools in Tamale and Cape Coast that did not participate in the competition—which is a limitation of the study.

The large presence of media practitioners at the competition and the live broadcast of the event on national television underscore the growing interest of the media and the public at large in mental health issues in Ghana. Despite this growing interest, mental health continues to be under-resourced, a fact recognized by the respondents, with only 2.3% of the total national health budget for 2009 allocated to mental health (10).

According to the World Health Organization, 650,000 people out of the total population of over 22 million Ghanaians are suffering from a severe mental disorder, with a further 2,166,000 suffering from a moderate-to-mild mental disorder (11). The World Health Organization estimates that, with fewer than 14 psychiatrists, there is a treatment gap of 98% for the total population expected to have a mental disorder (10, 11). This calls for radical steps to reform the mental-health sector, a situation that justifies initiatives such as ours to promote psychiatry as a career-option for Ghanaian medical students.

Our study has shown that many medical students (78.4%) indicated that their attitudes to psychiatry had been changed by the competition. Many (59.5%) also agreed that the competition would help stimulate the interest of medical students in psychiatry. Studies in countries with advanced mental health systems, like the U.S.A., U.K., and Australia, indicate that the number of students choosing psychiatry as their future specialty has decreased considerably in the last few decades (12–15). Our study shows that about one-quarter (27%) of students reported they would consider a career in psychiatry if incentives were provided by the government. This indicates that our initiative could achieve greater success if it were coupled with increased investments in mental health infrastructure, education, and improved remuneration for psychiatrists and other staff working in mental health. It is therefore important for the government of Ghana, like all other developing countries with poor mental health infrastructure, to consider increasing the budgetary allocation devoted to mental health service provision, staff training, and motivation if they are to attract medical students into the specialty.

Stigma attached to the psychiatric profession deters medical students from considering a career in psychiatry. An inter-medical school public-speaking competition is an innovative way of encouraging medical students in a developing country like Ghana to develop an interest in psychiatry. Such a competition may encourage medical students to consider psychiatry as a career option, in particular, if coupled with the provision of adequate infrastructure and attractive incentives for doctors who want to train in the field.

The authors thank the management of both St. Patrick’s University Hospital and St. John of God Development Company in Dublin, Ireland, for sponsoring the competition and for offering scholarships. For helping to organize the competition, we also thank the Chief Psychiatrist of the Ghana Health Service, Dr. Akwasi Osei; the former Chief Psychiatrist of the Ghana Health Service, Dr Joseph B. Asare; the General Secretary of the Ghana Medical Association, Dr. Sodzi Sodzi Tetteh; the president of the Ghana College of Physicians and Surgeon, Professor Sir G.W. Brobby; the Chairperson of the Department of Psychiatry and Behavioral Medicine & Interim Dean, University of Alabama School of Medicine, Professor Thaddeus P. M. Ulzen, and the faculties of the Departments of Psychiatry at the School of Medical Science, Kwame Nkrumah University of Science and Technology; and the University of Ghana Medical School. We also thank the management of the Ghana Broadcasting Corporation for providing free national television coverage for the competition.

Declaration of interest: None.