Public healthcare personnel's experiences and opinions on access and readiness to provide mental health care in a remote rural area in South Africa.

Abstract

Introduction: WHO encourages decentralising mental health care away from the tertiary locus of care into lower levels of care so as to reform mental healthcare worldwide. Recently, attempts have been made to facilitate the integration of public mental health care into general healthcare systems in South Africa. It is well established that the country's public healthcare system faces numerous multifaceted challenges - including very limited human, structural and material resources needed to accommodate and treat patients. We studied the experiences and opinions of public healthcare workers at primary healthcare clinics and the associated referral hospitals, focusing mainly on exploring their views on the ability and readiness for access to and provision of mental health to state health patients.

Methods: The Mental Health Knowledge Schedule (MAKS), the Mental Illness: Clinicians' Attitudes Scale (MICA-4) and a purpose-made questionnaire were used for data collection. The data from the MAKS and MICA-4 were imported into IBM SPSS Statistics Software to yield descriptive information, and Spearman's rank correlations were performed between the measures. The purpose-made questionnaire produced descriptive quantitative data and qualitative data that were analysed through conventional content analysis.

Results: Results from the MAKS suggest that participants experienced gaps in mental health knowledge and had fair levels of familiarity and ability to recognise different mental health conditions. Results from the MICA-4 suggest that participants in our study generally displayed a positive attitude towards people with mental illness and aspects involving psychiatry. Quantitative results from the purpose-made questionnaire describe aspects around mental health services, training, resources and care. Qualitative findings suggest healthcare workers wished for more mental-health-specific resources and contact with the healthcare system to facilitate interventions and care.

Conclusion: This research presents possible solutions to the challenges faced in public mental health care. Some of these solutions are within workers' control, while many of the solutions to the successful integration of more comprehensive basic care are out of their ambit of control, remaining locked up in policy and implementation rather than in field-level practice.