A Review of Telepsychology and Mental Health Mobile Apps in Advanced Countries: Opportunities for Ghana’s Mental Health Care

and social being with impacts on the way one thinks, feels and acts. The state of an individual’s mental health affects how stress is handled, how relationships are managed, and the decisions that one makes. Just like physical health, mental health is important in every phase of life, from childhood to adulthood. In childhood for Abstract Sustainable development denotes the development of nations in ways that are not restrictive for future generations in their efforts to meet their own needs. Without healthy human beings, sustainable development cannot be successfully carried out or assessed as a goal. For this reason, health, which forms the third arm of sustainable development goals have received much attention across nations. In Ghana, however, the aspect of health which has not received as much attention lies in the area of mental health. This paper addresses how mental health care and access in Ghana can be improved through the use of applied science and technology. Specifically, recommendations are made about the prospects that telepsychology and mental health mobile apps hold for applications in Ghana. This concept is introduced in the paper by reviewing telemental health practices and the use of mobile mental health apps in more advanced countries like the United States and Britain. The paper addresses how these two concepts can be introduced in Ghana, and guided by the experiences of other African countries, the potential associated challenges of implementation are also discussed. The paper ends with recommendations on how to overcome these challenges and makes note of the impossibility of fully achieving sustainable development goals for health when Ghana’s mental health care system remains in such dire states.

example, mental health plays a role in the bond between parents and their children. It helps set a solid foundation for life. During adolescence, mental health plays an integral role in the way the adolescent develops a sense of morality, and in adulthood, mental health plays a significant role in the way work, family and intimate relationships develop and evolve. In a pandemic such is currently being experienced with the coronavirus, its associated distresses of grief, social isolation, fear, panic and pre-existing mental health conditions mandate the pursuit of mental health can be ameliorative.
Problems with mental health can come in mild, moderate or severe forms. They can impact how one deals with mandatory social isolation or social distancing during a pandemic. They can impact a child's understanding of social cues, for example, as can be the case with Autism Spectrum Disorders. Issues with mental health can influence the way the student is able to take in, process and understand information as can be the case with learning disorders.
In the case of the new mother, problems with mental health can impact the way she is able take care of her child as can be the case with post-partum depression. Early detection and intervention tend to yield better outcomes for individuals with mental health disorders. In Ghana, however, access to mental health care and mental health professionals are severely lacking. According to the World Health Organization's situational analysis report on Ghana, there is a mental health treatment gap of 98% in Ghana, meaning that only 2 out of every 100 Ghanaians with mental health issues will get the care they need. Advancements in technology have played a crucial role in the evolution of health care treatment and prevention. From electronic medical record keeping systems to portable diagnostic devices, health care systems are making use of technological advancements that bring about more efficiency.
Diagnostic devices are being produced to be more sensitive in ways that can lead to early diagnosis and now, because of technology, healthcare devices are being made in sophisticated ways that allow for transfer and use in countries and areas that do not have easy access to such mechanisms. The impact that technology has had on medical science has been enormous and continues to evolve daily. In the field of psychology, technology has had impacts although not as great as that of the field of medicine. During a pandemic such as the world is currently facing with the coronavirus, many occupational fields, not just medical or psychological are turning to technology to provide care and services. Ghana can explore ways that technology can positively influence mental health care and access. This paper explores a few of these ways.

Methodology
The methodology for this research paper involved a review of the telepsychology practices and mobile mental health app use in advanced countries, particularly the United States and the United Kingdom. The APA and BPS telepsychology guidelines were reviewed in addition to the United Kingdom's National Health Service digital library for mobile mental health apps and the APA's mobile mental health app evaluation model. These countries were selected based on the major advances they have made with regard to regulating the use of telepsychology practice and mobile mental health apps. A literature review was also conducted on the application of telepsychology and mental health mobile apps in other African countries. This review was conducted mainly to balance the opportunities of telepsychology and mobile mental health apps observed in the advanced countries like the United States and United Kingdom with the potential real-life implementation challenges that have been discovered in similar cultural contexts.

Review of Telepsychology and Mental Health Mobile Apps
The trends of telepsychology and mental health mobile apps in more advanced countries can serve as learning opportunities for Ghana's mental health system. The following sub-sections discusses some of these opportunities and makes suggestions for implementation [2][3][4].

Telepsychology and mental health care access
Telepsychology can be defined as the provision of psychological services using telecommunication technologies. Psychological services provided with such a modality can be in lieu of or in addition to traditional therapy or treatment. With telecommunication mechanisms like e-mail, texting, mobile apps and videoconferencing, mental health services can be provided without the need for inperson interactions. Telepsychology presents as a unique option for patients who are not ambulatory or for people and families who are unable to travel to the psychologist's office to access services. For individuals whose diagnoses (such as agoraphobia or the fear of social situations) prevent them from leaving the house to get to the psychologist, telepsychology presents as an opportunity to begin the process of treatment that would eventually help them overcome their fear and potentially transfer to in-person treatment. The practice of some form of telepsychology or online counseling is not a novel concept in Ghana or abroad. Telepsychology has been around since the launch of the internet in 1972 (Alleman [2]). to go to in order to seek mental health care especially one that is not located in a psychiatric hospital. In recent years, the Ministry of Health has made provisions to allow for the placement of clinical psychologists in its hospitals. However, mental health care access continues to be a problem because of location, insufficient numbers of clinical psychologists and stigma among other reasons. Today, one is more likely to gain access to a clinical psychologist in the nation's capital of Greater Accra than in any of the other regions of Ghana. This problem is worsened by reported estimates from Osei [3], the former Chief Psychiatrist of the Accra Psychiatric Hospital of a doctor-patient ratio of 1:1.7 million in the mental health sector (Awaf [4]). Stigma can be a deterrent when it comes to seeking mental health care even among people who have relatively easy access to these services. With clinical psychology facilities sometimes being housed in places like the Accra Psychiatric Hospital, individuals may be afraid to seek out these services for fear of being perceived as 'mad'. In cases like these, the practice of telepsychology holds the potential for ameliorating such problems by abbreviating the distance between the prospective patient and psychologist, for allowing easy access to psychologists and for reducing the potential stigma of accessing the psychologist in a setting that could potentially be stigmatizing.  [5]). The formation of these guidelines was a response to the increasing rate of the use of telecommunication strategies among its psychologists. While the APA and BPS recognized the potential for telepsychology to increase access to psychological services, it also recognized the need for the formal regulation of tele psychological practices because of the potential challenges it presented. It is possible for Ghana to take a cue from these guidelines in order to pre-empt any potential challenges, and to keep itself from being reactive when tele psychological services rise to the capacities experienced in more developed countries. The formulation of such a guideline for Ghana's psychologists will also serve as a mechanism to permit the use of such a service delivery mechanism as a solution to Ghana's mental health care access problems [6]. For the APA (and BPS),

Mobile apps and mental health care access
Mobile applications serve as mechanisms through which the problem of mental health care access can also be solved or improved upon. A mobile application or mobile app is an application software that is designed to run on mobile devices such as smart phones or tablets. With advances in technology, it is more common now to find individuals using smart phones which come with the capability of having apps such as those for emails, social media, messaging, shopping, gaming, and other areas of interest. Today, some smart phones have already built-in mobile apps that are geared towards health. Some apps for example allow people to track their food and water intake, physical activity and even stress levels. There are mental health apps (also known as mHealth apps) too that, for example, provide support for teenagers struggling with depression like the Code Blue app and apps that guide people through breathing exercises for stress management like the Breathe2Relax app. The individual who is seeing a psychologist for anxiety related problems, for example, can have an app that provides resources for coping such as breathing exercises.
According to Henderson et al. [7] , one factor that affects the seeking out of mental health services includes lack of knowledge to identify features of mental illnesses. It is possible for people with mental health problems to experience difficulties that they either do not understand or which they brush aside. Sometimes the responsibilities of daily life can prevent one from attending to mental health problems until symptoms reach a point where they become severe enough to require psychiatric hospitalization or attempts are made to commit suicide. There is a great need for Ghanaians to be educated on mental health and through psychoeducation, convey the importance of seeking help while normalizing mental health help seeking behaviours to that of physical health seeking behaviors. When people are made to conceptualize seeking mental health help the same way they would seek medical help, fears

Development of mhealth apps and opportunities for ghana
The American Psychological Association has developed an app evaluation model in response to the increasing use of mHealth technologies. This decision to develop the evaluation model was also a response to questions received from mental health care professionals concerning the efficacy and risks of these mobile mental health apps. It appears the expanding use of mobile mental health apps was such that the development of the evaluation model was a better alternative to running every available app through an approval process and advertising those as APA-approved. In contrast

Finding and Recommendation
Telepsychology and mental health mobile apps hold unique opportunities for improving mental health care and access in Ghana when adopted. Like most opportunities, these two concepts present with challenges that will be discussed in the sections to follow with recommendations on how to overcome these obstacles in order to improve mental health care and access. When mental health care and access is improved upon, the nation's sustainable development goals for health can make gains towards a more complete picture of fulfillment. Ghana's sustainable development goals for health cannot be entirely met if its mental health care problems persist.

Human health resources
Telepsychology and mobile apps provide potential solutions to mental health care problems in Ghana, but certain issues currently impede its implementation. These issues are not unlike the issues discovered in an analysis of tele mental health in South Africa (Jefee-Bahloul et al., [8] ). Just like in South Africa, Ghana does not have sufficient human health resources. As already discussed, there aren't enough mental health professionals to meet the current demand in the nation. For this reason, there is the need for mental health or psychology training up to the highest level possible in the country. There is also the need for the profession to be properly supported by the government in order to keep from deterring other professional aspirants from the field of mental health care or psychology. mechanisms require. The use of telepsychology mandates adequate bandwidths that might not be available or which may be too expensive to acquire. Also, while messaging apps like WhatsApp and Skype can be used for telepsychology, these also require adequate amounts of data which could be relatively expensive when used at the levels that would be required for appropriate treatment. Again, should the problem of expense be addressed, another potential problem arises in the requirement of stable network connectivity which is not always the case in Ghana.

Political will
Until the year 2012 when Ghana's mental health bill was passed, the country operated under a mental health law that was put into effect in 1972. Although Ghana made tremendous strides with the passing of the 2012 mental health act, five years later, the Legislative Instruments which will serve to assist the implementation of the bill is yet to be passed (Boateng [5]). Improvement in mental health care and access through recommendations of modalities like telepsychology and the use of mental health mobile apps would also only be more successful with government or political backing.
Without support from Ghana's government to improve upon mental health care, Ghana will likely continue to lag behind when it comes to attaining the advances that have been seen in the more developed countries with mental health care practice [9][10][11].