Abstract
BackgroundReferral of patients from tertiary specialist psychiatric hospitals to primary healthcare settings is a worldwide goal. This is of particular importance in South Africa with its considerable burden of mental disorders and limited resources. However, patients are often reluctant to be referred and studies have shown that patients may prefer a dedicated psychiatric service over an integrated primary healthcare service.AimThis study explored the opinions of patients receiving care at a tertiary psychiatric hospital’s outpatient department (OPD) about referral to a primary healthcare clinic (PHCC).SettingThe study was conducted at Weskoppies Psychiatric Hospital OPD.MethodsThis was a qualitative study based on grounded theory. Participants were recruited through purposive-theoretical sampling. Data were collected by means of individual interviews and mini-essays.ResultsFrom the 80 participants, 18 had individual interviews and 62 wrote mini-essays. Thirty-nine participants had previously attended a PHCC, while 41 had not. Perceived advantages of referral to PHCCs included: close proximity to participants’ homes, resulting in saving on travelling time and transport costs, as well as the convenience of receiving psychiatric and other medical treatment at the same healthcare facility. Perceived disadvantages of PHCCs included: unavailability of treatment; lack of doctor-based care; lack of specialised care; loss of established relationships with hospital healthcare workers; mistreatment by PHCC nursing staff; longer waiting times; more stigmatisation.ConclusionThe perceived disadvantages of referral from a tertiary psychiatric hospital to a PHCC outweighed the perceived advantages. Nonetheless, participants expressed willingness for such a referral if their concerns were addressed.
Highlights
It is a worldwide goal to shift from centralised mental healthcare services to integrated, community-based services.[1,2]
In the most recent World Health Organization (WHO) Mental Health Atlas country profile, the burden of mental disorders in South Africa is estimated at 3.191 disability-adjusted life years per 100 000 population
The importance of these two sections and how they were disregarded regarding institutionalised mental healthcare users was recently highlighted by the Office of the Health Ombud, in ‘The Report into the Circumstances Surrounding the Deaths of Mentally Ill Patients: Gauteng Province’
Summary
It is a worldwide goal to shift from centralised mental healthcare services (provided by specialist psychiatric hospitals) to integrated, community-based services.[1,2] This goal is very relevant to mental healthcare in South Africa, with its high prevalence of mental disorders and limited resources.[3,4,5] In the most recent World Health Organization (WHO) Mental Health Atlas country profile, the burden of mental disorders in South Africa is estimated at 3.191 disability-adjusted life years per 100 000 population. Referral of patients from tertiary specialist psychiatric hospitals to primary healthcare settings is a worldwide goal. This is of particular importance in South Africa with its considerable burden of mental disorders and limited resources. Patients are often reluctant to be referred and studies have shown that patients may prefer a dedicated psychiatric service over an integrated primary healthcare service
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