Hidden risks in mental health services: Workplace drivers of substance use among psychiatric staff in Accra

Abstract

Substance use among psychiatric health professionals poses a critical but under-recognised threat to patient safety, quality of care, and workforce well-being. Impaired judgment, diminished performance, and increased risk of clinical errors make this a core occupational and patient safety issue, yet empirical data from low- and middle-income settings remain scarce. This study assessed the prevalence and determinants of cigarette and alcohol use among psychiatric staff in the Accra Metropolis to inform institutional and national policy responses. A cross-sectional survey was conducted among 219 randomly selected psychiatric health professionals from Accra and Pantang psychiatric hospitals. Multivariable logistic regression was used to identify workplace factors associated with substance use. Overall, 11% of staff had ever smoked and 3.7% were current smokers. Alcohol use was more prevalent: 30.6% had ever consumed alcohol, 27.4% reported use in the past year, and 23.3% in the past 30 days. Combined alcohol and cigarette use was 26%. Hospital policies (adjusted odds ratio [aOR]=0.04, p=0.031), workplace culture (aOR=0.15, p=0.012), and work fatigue (aOR=0.11, p=0.024) were significantly associated with substance use. These findings demonstrate that substance use among psychiatric staff is not negligible and is strongly shaped by modifiable organizational factors rather than individual characteristics alone. For policymakers and hospital managers, the results provide actionable evidence to strengthen occupational health and patient safety frameworks. Specifically, they underscore the need for clear and enforceable institutional substance use policies, investments in healthy workplace culture, and interventions to reduce fatigue such as adequate staffing, workload redistribution, and supportive supervision. At a broader level, the study supports integrating staff substance use screening, confidential support services, and mental health promotion into national mental health and human resources for health policies. By highlighting both the magnitude of the problem and concrete leverage points for intervention, this study offers a compelling evidence base for reforms aimed at protecting patients, safeguarding the mental health workforce, and improving the overall quality and safety of psychiatric care in Ghana and similar contexts.

Key words: substance use, alcohol, cigarette smoking, psychiatric staff, health professionals.