Community Mental Health Team Staffing Mix and Physical Restraint Use in Ghanaian Inpatient Units: A Multilevel Estimation of Skill-Mix Exposure
Year: 2026
Type: article
Abstract: Physical restraint remains a contested practice in inpatient mental health care, and the composition of community mental health teams may shape its use through the skill mix available at the point of admission. Because no unit-level restraint register was available for secondary analysis, the study is framed as a multilevel estimation design that specifies the exposure, the outcome, the hierarchical structure and the identification assumptions required for a future empirical application. The design uses a two-level structure in which repeated quarterly observations are nested within inpatient units, and skill-mix exposure is defined as the share of team clinical hours contributed by each cadre. The paper derives the variance decomposition, the within-between estimator and the sensitivity bounds that would be needed to interpret a skill-mix coefficient as causal. It also reports the distribution of a related community-level indicator drawn from the Demographic and Health Surveys for fifteen African countries between 2021 and 2025, with a mean of 29.733 and a standard deviation of 17.495, to illustrate the scale of cross-country variation in community mental health exposure. The contribution is a pre-specified estimation framework that makes the skill-mix mechanism testable and falsifiable in Ghanaian inpatient settings.
Institution: University of Nairobi
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7223236068