Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal.
Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
BMC Fam Pract. 2020 Sep 28;21(1):202. doi: 10.1186/s12875-020-01266-y.
Integration of mental health services into primary health care systems has been advocated as a strategy to minimize the tremendous mental health treatment gap, particularly in low- and middle-income countries. Barriers to integration of mental health into primary health care have been widely documented; however, very little is known about the perception of service users and their caregivers on primary care-based mental health services. This study assessed service users' and caregivers' perceptions of mental health services provided by trained primary health care workers in Nepal.
A qualitative study was conducted among people with depression, psychosis, alcohol use disorder and epilepsy, and their caregivers in Chitwan, a district in southern Nepal. Semi-structured interviews were conducted with 43 service users and 38 caregivers to assess their perceptions about the accessibility of the services, types of services they received, skills and competencies of health care providers, satisfaction and barriers to receiving services.
Overall, both service users and caregivers were satisfied with the mental health services provided by primary health care providers. They also perceived health workers to be competent and skillful because the services they received were effective in reducing their mental health problems. Both psychological and pharmacological services were made available free of cost, however, they considered psychological services more effective than pharmacological treatment. Major challenges and difficulties accessing services were associated with frequent transfer of trained health workers, non-availability of the same health care provider at follow-ups, frequent stock-out of medicines or non-availability of required medicines, lack of a confidential space for consultation in health facilities, and stigmatizing and negative behavior of some health workers.
The results demonstrated that both service users and caregivers perceived primary care-based mental health services to be accessible, acceptable and effective. The key recommendations emerging from this study for improving mental health services in primary care include the provision of a separate cadre of psychosocial workers to provide psychological interventions, developing quick and efficient mechanisms for the procurement and supply of psychotropic medicines, establishing a confidential place within health facilities for consultation, and further training of health workers to reduce stigma.
将心理健康服务整合到初级卫生保健系统中，被提倡为缩小巨大的心理健康治疗差距的策略，特别是在低收入和中等收入国家。将心理健康整合到初级卫生保健中的障碍已被广泛记录；然而，对于服务使用者及其照顾者对基于初级保健的心理健康服务的看法，知之甚少。本研究评估了尼泊尔受训的初级卫生保健工作者提供的心理健康服务，服务使用者和照顾者的看法。
在尼泊尔南部的奇特旺地区，对抑郁症、精神病、酒精使用障碍和癫痫患者及其照顾者进行了一项定性研究。对 43 名服务使用者和 38 名照顾者进行了半结构式访谈，以评估他们对服务可及性、接受的服务类型、医疗保健提供者的技能和能力、满意度以及接受服务的障碍的看法。
总的来说，服务使用者和照顾者都对初级卫生保健提供者提供的心理健康服务感到满意。他们还认为卫生工作者有能力和技能，因为他们接受的服务有效地减轻了他们的心理健康问题。心理和药物服务都是免费提供的，但他们认为心理服务比药物治疗更有效。获得服务的主要挑战和困难与培训卫生工作者频繁调动、后续随访中没有相同的医疗保健提供者、药物经常短缺或无法提供所需药物、卫生设施缺乏咨询的保密空间以及一些卫生工作者的污名化和负面行为有关。
结果表明，服务使用者和照顾者都认为基于初级保健的心理健康服务是可及、可接受和有效的。这项研究提出的改善初级保健中心心理健康服务的主要建议包括提供一个专门的心理社会工作人员队伍，提供心理干预措施；制定快速有效的精神药物采购和供应机制；在卫生机构内建立一个保密的咨询场所；并进一步培训卫生工作者，以减少污名化。
