Mixed-methods evaluation of mental healthcare integration into tuberculosis and maternal-child healthcare services of four South African districts

Autor: Jennifer J. Mootz, Catherine Carlson, André van Zyl, Andrew Medina-Marino, Phuti Ngwepe, Samantha L. Lammie, Sharon N. Paul, Rachel C. Shelton, Annika C. Sweetland, Milton L. Wainberg, Kathryn L. Lovero
Rok vydání: 2019
Předmět:
Male
Mental Health Services
medicine.medical_specialty
Maternal-Child Health Services
Population
Mental disorders
Health administration
South Africa
03 medical and health sciences
Health systems
0302 clinical medicine
Pregnancy
Health care
medicine
Humans
Tuberculosis
030212 general & internal medicine
Child
10. No inequality
education
Health policy
Mixed-methods
education.field_of_study
Sub-Saharan Africa
Primary Health Care
Delivery of Health Care
Integrated
business.industry
lcsh:Public aspects of medicine
030503 health policy & services
Health Policy
Public health
Nursing research
lcsh:RA1-1270
Primary care
Mental illness
medicine.disease
Mental health
3. Good health
13. Climate action
Implementation
Family medicine
Healthcare integration
Female
Health Services Research
0305 other medical science
business
Delivery of Health Care
Research Article
Zdroj: BMC Health Services Research
BMC Health Services Research, Vol 19, Iss 1, Pp 1-12 (2019)
ISSN: 1472-6963
DOI: 10.1186/s12913-019-3912-9
Popis: Background The South African National Mental Health Policy Framework and Strategic Plan 2013–2020 was adopted to address the country’s substantial burden and inadequate treatment of mental illness. It outlines measures toward the goal of full integration of mental health services into primary care by 2020. To evaluate progress and challenges in implementation, we conducted a mixed-methods assessment of mental health service provision in tuberculosis and maternal-child healthcare services of four districts in South Africa. Methods Forty clinics (ten per district) were purposively selected to represent both urban and rural locations. District-level program managers (DPMs) for mental health, tuberculosis, and maternal-child healthcare were qualitatively interviewed about district policy and procedures for management of mental illness and challenges in integrating mental health services into primary care. Clinic nurses and mental health practitioners (MHPs) completed a quantitative questionnaire to assess their engagement with stepped care for patients with mental illness. Qualitative and quantitative data were collected concurrently and compared to triangulate progress in implementation of integrated services. Results A total of 59 nurses and 17 MHPs completed questionnaires, and nine DPMs were interviewed (total n = 85). DPMs indicated that nurses should screen for mental illness at every patient visit, although only 43 (73%) nurses reported conducting universal screening and 26 (44%) reported using a specific screening tool. For patients who screen positive for mental illness, DPMs described a stepped-care approach in which MHPs diagnose patients and then treat or refer them to specialized care. However, only 7 (41%) MHPs indicated that they diagnose mental illness and 14 (82%) offer any treatment for mental illness. Addressing challenges to current integration efforts, DPMs highlighted 1) insufficient funding and material resources, 2) poor coordination at the district administrative level, and 3) low mental health awareness in district administration and the general population. Conclusions Though some progress has been made toward integration of mental health services into primary care settings, there is a substantial lack of training and clarity of roles for nurses and MHPs. To enhance implementation, increased efforts must be directed toward improving district-level administrative coordination, mental health awareness, and financial and material resources.
Databáze: OpenAIRE
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