Strengths and Challenges to the Integration of Mental Health Services into the Primary Health Care System in Developing Countries: A Systematic Review

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DOI: 10.21522/TIJAR.2014.09.02.Art001

Authors : Roxanne Stowe Maloney

Abstract:

The existence of a treatment gap for persons with mental disorders has led the WHO to implore leaders around the world to integrate mental health services into the community or primary health care system. Whilst there are strengths, there are great challenges to the integration process that are hindering the implementation of this initiative in developing countries. The aim of this paper is to synthesize evidence from various researchers regarding the strengths and challenges to the integration of mental health services into the primary or community health care system in developing countries. The sources of information included Pubmed, Medline, Google Scholar, Ebsco Host, and the WHO website. Seventeen (17) studies met the inclusion criteria out of the search results of 2,200. The challenges most reported were inadequate support and supervision structures; lack of key resources, limited Knowledge, inadequate training, and lack of experience of healthcare providers in mental health; time constraints for the primary healthcare workers; lack of regulatory measures to encourage the integration. The strengths most reported were health care workers’ acceptance of responsibility to provide mental health services in the community setting. This paper has proven a number of strengths and challenges regarding the integration of mental health services into the primary or community health care system. It is hoped that this paper will assist stakeholders and policymakers in overcoming the majority of the challenges identified in the integration of mental health services in the primary health care system.

Keywords: Challenges, Developing countries, Integration, Mental health services, Primary health care, Strengths.

References:

[1] World Health Organization, 2020, Constitution: WHO remains firmly committed to the principles set out in the preamble to the constitution, https://www.who.int/about/governance/constitution.

[2] Ayano, G., Assefa, D.G., Haile, K., & Bekana, L., 2016, Experiences, Strengths and Challenges of Integration of Mental Health into Primary Care in Ethiopia. Experiences of East African Country. Family Medicine and Medical Science Research, 5, 1-4, http://dx.doi.org/10.4172/2327-4972.1000204.

[3] Rathod, S., Pinninti, N., Irfan, M., Gorczynski, P., Rathod, P., Gega, L., & Naeem, F., 2017, Mental Health Service Provision in Low- and Middle-Income Countries. Health services insights, 10, 1178632917694350, https://doi.org/10.1177/1178632917694350.

[4] World Health Organization, 2019, The WHO Special Initiative for Mental Health (2019-2023): Universal Health Coverage for Mental Health, https://apps.who.int/iris/bitstream/handle/10665/310981/WHO-MSD-19.1-eng.pdf?sequence=1&isAllowed=y.

[5] World Health Organization, 2011, Global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level:  Report by the Secretariat, https://apps.who.int/gb/ebwha/pdf_files/EB130/B130_9-en.pdf.

[6] World Health Organization, 2008, Integrating mental health into primary care: a global perspective. World Health Organization, Switzerland.

[7] World Health Organization 2013, Mental health action plan 2013-2020, https://www.who.int/mental_health/action_plan_2013/bw_version.pdf?ua=1.

[8] Wakida, E.K., Obua, C., Rukundo, G.Z., Maling, S., Talib, Z.M., & Okello, E.S., 2018, Barriers and facilitators to the integration of mental health services into primary healthcare: a qualitative study among Ugandan primary care providers using the COM-B framework. BMC Health Serv Res 18, 890, https://doi.org/10.1186/s12913-018-3684-7.

[9] Abera, M., Tesfaye, M., Belachew, T. & Hanlon, C., 2014, Perceived challenges and opportunities arising from the integration of mental health into primary care: a cross-sectional survey of primary health care workers in south-west Ethiopia. BMC Health Serv Res 14, 113, https://doi.org/10.1186/1472-6963-14-113.

[10] Hussain, S. S., Khan, M. M., Gul, R. B., Asad, N., 2018, integration of mental health into primary healthcare: Perceptions of stakeholders in Pakistan. Eastern Mediterranean Health Journal, 24(2), 146-153, https://ecommons.aku.edu/pakistan_fhs_mc_psychiatry/109.

[11] Athié, K., Menezes, A. L., da Silva, A. M., Campos, M., Delgado, P. G., Fortes, S., & Dowrick, C., 2016, Perceptions of health managers and professionals about mental health and primary care integration in Rio de Janeiro: a mixed-methods study. BMC health services research, 16(1), 532, https://doi.org/10.1186/s12913-016-1740-8.

[12] Hanlon, C., Eshetu, T., Alemayehu, D., Fekadu, A., Semrau, M., Thornicroft, G., Kigozi, F., Marais, D.L., Petersen, I. & Alem, A., 2017, Health system governance to support scale-up of mental health care in Ethiopia: A qualitative study. International Journal of Mental Health Systems 11, 38, https://doi.org/10.1186/s13033-017-0144-4.

[13] Hickling, F.W., Robertson-Hickling, H. & Paisley V., 2011, Deinstitutionalization and attitudes toward mental illness in Jamaica: a qualitative study. ev Panam Salud Publica. 29(3):169–76, https://www.scielosp.org/article/ssm/content/raw/?resource_ssm_path=/media/assets/rpsp/v29n3/04.pdf.

[14] Wakida, E.K., Okello, E.S., Rukundo, G.Z. Akena, D., Alele, P.E., Talib, Z.M. & Obua, C., 2019, Health system constraints in integrating mental health services into primary healthcare in rural Uganda: perspectives of primary care providers. Int J Ment Health Syst 13, 16, https://doi.org/10.1186/s13033-019-0272-0.

[15] Ayano, G., Assefa, D., Haile, K., Chaka, A., Haile, K., Solomon, M., Yohannis, K., Awoke, A. & Jemal, K., 2017, Mental health training for primary health care workers and implication for the success of the integration of mental health into primary care: evaluation of the effect on Knowledge, attitude and practices (KAP). Int J Ment Health Syst 11, 63, https://doi.org/10.1186/s13033-017-0169-8.

[16] Adebowale, T., Umukoro, O.L., Gater, R., Akinhanmi, A., Ogunlesi A., Helme, C., Wood, G. & Ibikunle, I., 2014, Evaluation of a Mental Health Training Course for Primary Health Care Workers in Ogun State, Southwest, Nigeria. Journal of Psychiatry, 17:5, 14-25, http://dx.doi.org/10.4172/Psychiatry.1000141.

[17] Jenkins, R.; Othieno C.; Okeyo, S.; Aruwa, J.; Kingora, J. & Jenkins, B., 2013, Health system challenges to the integration of mental health delivery in primary care in Kenya- perspectives of primary care health workers. BMC Health Services Research 13, 368, https://doi.org/10.1186/1472-6963-13-368.

[18] Luitel, N.P.; Jordans, M.J.D.; Subba, P.; & Komproe, I.H., 2020, Perception of service users and their caregivers on primary care-based mental health services: a qualitative study in Nepal. BMC Family Practice 21, 202, https://doi.org/10.1186/s12875-020-01266-y.

[19] Rahman, T., Amjad, T., Minhas, F. A., Kamran, J., & Shah, N., 2019, Integration of Mental Health into Primary Healthcare - a Challenge for Primary Care Physicians. Pakistan Armed Forces Medical Journal, 69, S286–S292, https://www.pafmj.org/index.php/PAFMJ/article/view/2892.

[20] Cowan, J., Raja, S., Naik, A. & Armstrong, G., 2012, Knowledge and attitudes of doctors regarding the provision of mental health care in Doddaballapur Taluk, Bangalore Rural district, Karnataka. Int J Ment Health Syst 6, 21. https://doi.org/10.1186/1752-4458-6-21.

[21] Petersen, I., Marais, D., Abdulmalik, J., Ahuja, S., Alem, A., Chisholm, D., Egbe, C., Gureje, O., Hanlon, C., Lund, C., Shidhaye, R., Jordans, M.,
Kigozi, F., Mugisha, J., Upadhaya, N., & Thornicroft, G., 2017, Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies, Health Policy, and Planning, 32(5), 699–709, https://doi.org/10.1093/heapol/czx014.

[22] Martinez, W., Galván, J., Saavedra, N., & Berenzon, S., 2017, Barriers to Integrating Mental Health Services in Community-Based Primary Care Settings in Mexico City: A Qualitative Analysis. Psychiatric services (Washington, D.C.), 68(5), 497–502, https://doi.org/10.1176/appi.ps.201600141.

[23] Miguel-Esponda, G., Bohm-Levine, N., Rodríguez-Cuevas, F.G., Cohen, A. & Kakuma, R., 2020, Implementation process and outcomes of a mental health programme integrated into primary care clinics in rural Mexico: a mixed-methods study. Int J Ment Health Syst 14, 21, https://doi.org/10.1186/s13033-020-00346-x.