Abstract
IntroductionThere is a need to scale-up mental health service provision in primary health care. The current extent of integration of mental health in primary care is pertinent to promoting and augmenting mental health at this level. We describe a facility mapping exercise conducted in two low-income/primary health facilities in Kenya to identify existing barriers and facilitators in the delivery of mental health services in general and specifically for peripartum adolescents in primary health care as well as available service resources, cadres, and developmental partners on the ground.Method and measuresThis study utilized a qualitative evidence synthesis through mapping facility-level services and key-stakeholder interviews. Services-related data were collected from two facility in-charges using the Nairobi City County Human Resource Health Strategy record forms. Additionally, we conducted 10 key informant interviews (KIIs) with clinical officers (Clinicians at diploma level), Nurses, Community Health Assistants (CHAs), Prevention of Mother-to-child Transmission of HIV Mentor Mothers (PMTCTMs), around both general and adolescent mental health as well as psychosocial services they offered. Using the World Health Organization Assessments Instrument for Mental Health Systems (WHO-AIMS) as a guideline for the interview, all KII questions were structured to identify the extent of mental health integration in primary health care services. Interview transcripts were then systematically analyzed for common themes and discussed by the first three authors to eliminate discrepancies.ResultsOur findings show that health care services centered around physical health were offered daily while the mental health services were still vertical, offered weekly through specialist services by the Ministry of Health directly or non-governmental partners. Despite health care workers being aware of the urgent need to integrate mental health services into routine care, they expressed limited knowledge about mental disorders and reported paucity of trained mental health personnel in these sites. Significantly, more funding and resources are needed to provide mental health services, as well as the need for training of general health care providers in the identification and treatment of mental disorders. Our stakeholders underscored the urgency of integrating mental health treatment, prevention, and well-being promotive activities targeting adolescents especially peripartum adolescent girls.ConclusionThere is a need for further refining of the integrated care model in mental health services and targeted capacity-building for health care providers to deliver quality services.
Highlights
There is a need to scale-up mental health service provision in primary health care
Our findings show that health care services centered around physical health were offered daily while the mental health services were still vertical, offered weekly through specialist services by the Ministry of Health directly or non-governmental partners
There is a need for further refining of the integrated care model in mental health services and targeted capacity-building for health care providers to deliver quality services
Summary
There is a need to scale-up mental health service provision in primary health care. The current extent of integration of mental health in primary care is pertinent to promoting and augmenting mental health at this level. In 2010, mental and substance use disorders were the leading causes of years lived with disabilities (YLDs) in sub-Saharan Africa (SSA) with a total burden of 18.94% [1], and projected to rise from 20 million to 45 million YLDs by 2050 [2]. Previous publications such as the 1990 Global Burden of Disease (GBD) review have underscored the rising burden of mental illness in SSA and global LMIC contexts [3]. Widespread beliefs that mental illness is a result of witchcraft alters health-seeking behavior [15]; stigma, discrimination, lack of accurate information about mental health conditions, where to seek services, and economic challenges make it difficult for patients to afford consultation, medication, and rehabilitative services are some of the barriers to access mental health services [16]
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