Abstract
BackgroundLow and middle income countries face many challenges in meeting mental health needs in their regions. Treatment of patients with mental disorders is inadequate in most of these countries and majority of individuals with severe mental disorders remain untreated. The bad news is that mental health problems in these countries are on the rise due to socioeconomic challenges being faced. Regardless of guidelines and directives provided by WHO for organizing mental health services, these countries continue to face many challenges in the effort to cater for mental health needs. Such challenges include lack of human resource for mental health especially at primary health care level, inadequate training of human resource for mental health, misplacement of human resource for mental health, lack of drugs, wrong priorities, problematic insurance coverage for mental disorders, and stigma. This study aimed at exploring mental health care and delivery system at Temeke district hospital, and how services were organized to meet the increasing mental health needs of its population.MethodsA qualitative study was conducted at Temeke hospital in Dar es Salaam, involving 7 in-depth interviews with mental health care providers, 7 in-depth interviews with mentally ill patients, and 2 focus group discussions with caregivers. A convenient sampling procedure was used to select participants for the study. All interviews were audio-recorded in Kiswahili and transcribed. A qualitative Content Analysis was used to analyze data after translation with the aid of Nvivo 10 software.ResultsThree main themes were identified. These were resource challenges, environmental/system challenges, and satisfaction with mental health services. Temeke health facility faced resource and environmental/system challenges, and there were mixed feelings on satisfaction with services. Funding and priority issues were found to mainly affect delivery of appropriate services to clients.ConclusionHealth facilities that provide mental health services in the community need to be well equipped with necessary resources to meet the vast needs of people they serve. Having a political will, improving the health systems governance for mental health, and priority setting, are necessary to address the challenges experienced in the delivery of mental health services.
Highlights
Low and middle income countries face many challenges in meeting mental health needs in their regions
“But for those of us who know our capacity, for example those who need inpatient management, those who need psychological psychotherapy, may be those who need occupational therapy; we do not have all these departments, so we only provide diagnosis and the management needed at that moment”. (Assistant Medical Officer)
This study reveals limited mental health services which were being offered at Temeke hospital including outpatient clinic, counselling for drug abusers, and psycho-education
Summary
Low and middle income countries face many challenges in meeting mental health needs in their regions. Regardless of guidelines and directives provided by WHO for organizing mental health services, these countries continue to face many challenges in the effort to cater for mental health needs. Such challenges include lack of human resource for mental health especially at primary health care level, inadequate training of human resource for mental health, misplacement of human resource for mental health, lack of drugs, wrong priorities, problematic insurance coverage for mental disorders, and stigma. There is a need to scale up treatment for mental disorders in low and middle income countries where most of the treatment gap exist [6] This is thought to be potentially cost-effective and would result into many communities of the world to be more functional and productive [1]. These principles include accessibility, comprehensiveness, coordination and continuity of care, effectiveness, equity, respect for human rights, and coordination of specialized services with primary care and intersectoral collaboration
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