Abstract
Background: This study aimed to understand the offer of mental health care at the primary care level, collecting the views of psychologists, primary health care providers (PHCPs), and patients, with a focus on health services in which patients attend regularly and who present a higher prevalence of mental disorders. Methods: A qualitative study was conducted in antenatal care, tuberculosis, HIV/AIDS, and chronic diseases services from six primary health care centers. Semi-structured interviews were conducted with psychologists, PHCPs, and patients working in or attending the selected facilities. Results: A total of 4 psychologists, 22 PHCPs, and 37 patients were interviewed. A high perceived need for mental health care was noted. PHCPs acknowledged the emotional impact physical health conditions have on their patients and mentioned that referral to psychologists was reserved only for serious problems. Their approach to emotional problems was providing emotional support (includes listening, talk about their patients’ feelings, provide advice). PHCPs identified system-level barriers about the specialized mental health care, including a shortage of psychologists and an overwhelming demand, which results in brief consultations and lack in continuity of care. Psychologists focus their work on individual consultations; however, consultations were brief, did not follow a standardized model of care, and most patients attend only once. Psychologists also mentioned the lack of collaborative work among other healthcare providers. Despite these limitations, interviewed patients declared that they were willing to seek specialized care if advised and considered the psychologist's care provided as helpful; however, they recognized the stigmatization related to seeking mental health care. Conclusions: There is a perceived need of mental health care for primary care patients. To attend these needs, PHCPs provide emotional support and refer to psychology the most severe cases, while psychologists provide one-to-one consultations. Significant limitations in the care provided are discussed.
Highlights
Worldwide, mental disorders are highly prevalent[1], and represent 10% of the global burden of disease[2]
We proposed to understand the current offer of mental health care at the primary care level, collecting the views of psychologists, primary health care providers (PHCPs), and patients
Despite the awareness of the importance to attend primary care patients’ mental health and the activities conducted by PHCPs and psychologists to address it, there are significant limitations in the care provided
Summary
Mental disorders are highly prevalent[1], and represent 10% of the global burden of disease[2]. Mental disorders remain underdiagnosed and undertreated in Peru[5], where only 31% of people who expressed having a mental health problem, gain access to treatment[3] This situation is explained by the insufficiency and inequitable distribution of resources, the small budget allocated to mental health, and the poor integration of mental health care into primary care[6]. This reform proposes, among other things, that primary health care providers (PHCPs) detect and treat mental disorders in their patients (detection is through the use of a common mental disorders’ screening, the Self Report Questionnaire SRQ)[8,9] This would reduce the mental health treatment gap, as evidence in other countries reports that many people requiring mental health care attend other primary care services[10].
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