Care for patients with psychiatric disorders: the attitude and role of primary health care medical doctors towards integration of mental health into primary health care in Soweto
Date
2021
Authors
Mavie-Shibanda, Nokuthula Mavis
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Abstract
Introduction: Mental health is an integral part of health.However, health systems have not been able to respond adequately to the burden of mental health. There is a wide gap between the mental health needs of the community and the available mental health services in Soweto. Therefore, integration of mental health into primary health care (PHC) services is one solution to the treatment gap. This requires task shifting from mental health specialists to a range of non-specialist health workers including doctors providing PHC service. Aimof the study: To determine the perception, attitude and role of medical doctors working in PHC regarding caring for patients with mental illness and barriers towards integration of mental health care into PHC. The objectives of the study were (1) to describe the demographics of PHC doctors, (2) to assess the level of understanding of mental illness among PHC doctors, (3) to determine the attitudes and role of PHC doctors in caring for patients with mental illness, and (4) to assess the barriers towards integration of mental health care into PHC. Methods: This is a cross sectional study using a quantitative approach among doctors working in PHC clinics in Soweto. The study was conducted in Lillian Ngoyi PHC, a facility where doctors meet every Friday morning for in-service training. A self-administered questionnaire was used to collect data on the basic demographics and practice employment history, respondents’ feelings regarding psychiatric disorders and views on how the disorders should be treated. Data was also collected on tasks in the acute and long-term phase, care for family, self-experienced competencies, and need for continual professional training and development in mental health to enable doctors to communicate with psychotic patients. Attitudes towards mental health care provision and perceptionsregarding the barriers towards the successful integration of mental health care programs into PHCwere also determined. Data were analyzed using STATA 14. Results: The total number of doctors working in the PHC clinics in Soweto in December 2015 to January 2016 was 67. However, a total sample of 30 doctors was obtained for the study. Males were nine (30%) and females were 21 (70%). The results showed that 14 (46.7%) of the respondents were aged ≤30 years while 16 (53.3%) were aged above 30 years. Most of the respondents with workexperience ≤20 years were females (n=19) representing 63.3%of the study samplewhile only 10.5% (n=2) of these females had work experience over 20 years. PHC doctors didnot have a negative attitude to mental illness but were opposed to full integration of psychiatric patients in the PHC clinic. They suggested that psychiatric patients should be separated from patients with other medical conditions attending the PHC clinics. Doctors were also aware of their roles in terms of supporting the patients and their families but did not think that they had a role to play in the care of chronic psychiatric patients, which could be due to the lack of skills and exposure to psychiatry. The identified barriers to the integration of mental health services into PHC included lack of training, overcrowding, lack of resources and lack of support. Doctors were willing to be upskilled in order for them to be able to treat some of the mental illnesses at PHC. Conclusion: Ongoing in-service training, mentoring and support of PHC doctors are a priority. Improvement of collaboration between PHC and secondary psychiatric services will also enhance integration. The success of integration also requires increased consensus, commitment and political will within the government to place mental health on the national agenda and secure funding for the sector.
Description
A research report submitted to the Faculty of Health Sciences, University of Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Medicine (Psychiatry)