Selohilwe One, Fairall Lara, Bhana Arvin, Kathree Tasneem, Zani Babalwa, Folb Naomi, Lund Crick, Thornicroft Graham, Petersen Inge
Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa.
Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa.
Int J Ment Health Syst. 2023 Mar 30;17(1):7. doi: 10.1186/s13033-023-00575-w.
The treatment gap for mental health services is a growing public health concern. A lay-counselling service located at primary health care (PHC) level could potentially help to close the large treatment gap for common mental disorders in South Africa. The aim of this study was to understand multilevel factors contributing to implementation and potential dissemination of such a service for depression at PHC level.
Process qualitative data of the lay-counselling service for patients with depressive symptoms was collected alongside a pragmatic randomized controlled trial evaluating a collaborative care model that included a lay-counselling service for patients with depressive symptoms. Semi-structured key informant interviews (SSI) were conducted with a purposive sample of PHC providers (lay-counsellors, nurse practitioners, operational managers), lay-counsellor supervisors, district and provincial managers, and patients in receipt of services. A total of 86 interviews were conducted. The Consolidated Framework for Implementation Research (CFIR) was used to guide data collection as well as Framework Analysis to determine barriers and facilitators for implementation and dissemination of the lay-counselling service.
Facilitators identified include supervision and support available for counsellors; person focused counselling approach; organizational integration of the counsellor within facilities. Barriers included lack of organizational support of the counselling service, including lack of counselling dedicated space; high counsellor turnover, resulting in a counsellor not available all the time; lack of an identified cadre to deliver the intervention in the system; and treatment of mental health conditions including counselling not included within mental health indicators.
Several system level issues need to be addressed to promote integration and dissemination of lay-counselling services within PHC facilities in South Africa. Key system requirements are facility organizational readiness for improvement of integration of lay-counselling services; formal recognition of counselling services provided by lay counsellors as well as inclusion of lay counselling as a treatment modality within mental health treatment data element definitions and the need for diversification of the roles of psychologists to include training and supervision of lay counsellors was also emphasized.
心理健康服务的治疗缺口是一个日益受到关注的公共卫生问题。位于初级卫生保健（PHC）层面的非专业咨询服务可能有助于缩小南非常见精神障碍的巨大治疗缺口。本研究的目的是了解促成在初级卫生保健层面实施和潜在推广此类抑郁症服务的多层次因素。
在一项评估协作护理模式（其中包括为有抑郁症状的患者提供非专业咨询服务）的务实随机对照试验中，收集了针对有抑郁症状患者的非专业咨询服务的过程定性数据。对初级卫生保健提供者（非专业咨询师、执业护士、运营经理）、非专业咨询师督导、地区和省级管理人员以及接受服务的患者进行了有目的抽样的半结构化关键信息访谈（SSI）。共进行了86次访谈。采用实施研究综合框架（CFIR）指导数据收集，并运用框架分析法确定非专业咨询服务实施和推广的障碍与促进因素。
确定的促进因素包括为咨询师提供的监督和支持；以人为本的咨询方法；咨询师在机构内的组织整合。障碍包括对咨询服务缺乏组织支持，包括缺乏专门的咨询空间；咨询师更替率高，导致并非随时都有咨询师可用；系统中缺乏确定的实施干预的人员队伍；以及心理健康状况的治疗，包括咨询未纳入心理健康指标。
需要解决几个系统层面的问题，以促进南非初级卫生保健机构内非专业咨询服务的整合与推广。关键的系统要求包括机构在改善非专业咨询服务整合方面的组织准备情况；正式认可非专业咨询师提供的咨询服务，并将非专业咨询纳入心理健康治疗数据元素定义中的一种治疗方式，同时还强调了心理学家角色多样化的必要性，包括对非专业咨询师的培训和监督。
