Referral Challenges in the Mental Health Program in the Primary Health Care System: A Qualitative Study

Abstract

Background. One of the main activities that plays a significant role in the prevalence of mental illnesses is the issue of referral, and according to the evidence, the lack of proper implementation of the referral system is one of the obvious weaknesses of the primary health care (PHC) system. Therefore, this study aimed to investigate the challenges of referring mental health clients in the PHC system, and the weaknesses in this process were examined from the perspective of mental health experts in health centers. Methods. The present study is a conventional qualitative content analysis. Data were collected through semi-structured interviews with primary health care psychologists. Fifteen people were selected through purposive sampling. After transcription of the interviews, the data were analyzed based on the Graneheim and Landman model. Results. Two themes and twelve categories were acquired through the present study. The theme of intra-centered referential challenges included categories such as weaknesses in health care providers screening and low referrals, clients' lack of trust in health care providers, clients' lack of cooperation, physicians' poor cooperation, and Barriers to clients' desire to visit a psychologist. Outer-centered referential challenges also included a shortage of referral centers, lack of transparency in referrals, lack of direct referrals, poor follow-up, barriers for clients to go to a higher level, and Barriers to clients’ referral to the institute. Conclusion. The findings of the present study show that poor intra-sectoral and inter-sectoral communication is one of the main challenges that has disrupted the referral process in the field of mental health in the primary health care system. It seems that many challenges such as lack of designated referral centers, poor follow-up due to lack of referral feedback, clients' financial inability to refer to a higher level, etc. can be improved by strengthening cross-sectoral communications such as two-way communication with support organizations and psychiatric and psychotherapy centers.