Devkota Gaurav, Basnet Puspa, Thapa Bijay, Subedi Madhusudan
Patan Academy of Health Sciences, Lalitpur, Nepal
Patan Academy of Health Sciences, Lalitpur, Nepal.
BMJ Open. 2025 Jan 2;15(1):e080163. doi: 10.1136/bmjopen-2023-080163.
To explore factors at different socioecological levels that affect mental health service delivery from primary healthcare (PHC) facilities of Arghakhanchi district, a western hilly district of Nepal.
Mental health service delivery has seen four transformational shifts from Alma Ata to Astana Declaration. Mental Health Gap Action Programme has facilitated the delivery of evidence-based interventions on mental, neurological and substance use disorders by non-specialised health workers in PHC settings as well as advocated scaling up of mental healthcare through integration of mental health in PHC.
A cross-sectional qualitative study was conducted in Arghakhanchi district of Nepal from July to August 2019 that collected information through face-to-face key informant interviews of 16 purposively selected participants using validated interview guidelines. Thematic analysis was performed using RQDA package for EZR software. Validation of translated transcripts, member checking and inter-coder percent agreement were performed to maintain rigour in the study.
Lack of mental health training and no authority to prescribe psychotropic medications coupled with lack of mental health commodities acted as barriers for mental health service delivery. Awareness regarding mental health and modalities of treatment to the community and provision of training and authority to prescribe psychotropic medicines were recommended by the participants for proper mental health service delivery.
Awareness regarding mental illness treatment modalities to the community and mental health training for healthcare service providers would help increase mental health service delivery from PHC facilities. Moreover, strengthened referral system and availability of psychotropic medicines at the PHC level would assist in mental health service delivery from PHC facilities. However, regular monitoring and supervision of the services being delivered is essential.
探讨尼泊尔西部山区阿尔加坎奇区基层医疗保健（PHC）机构心理健康服务提供过程中，不同社会生态层面的影响因素。
心理健康服务提供经历了从《阿拉木图宣言》到《阿斯塔纳宣言》的四次变革性转变。《精神卫生差距行动规划》推动了基层医疗保健环境中非专科卫生工作者对精神、神经和物质使用障碍实施循证干预，并倡导通过将心理健康纳入基层医疗保健来扩大精神卫生保健服务。
2019年7月至8月在尼泊尔阿尔加坎奇区开展了一项横断面定性研究，通过对16名经过目的抽样选取的参与者进行面对面关键 informant 访谈，利用经过验证的访谈指南收集信息。使用EZR软件的RQDA包进行主题分析。为确保研究的严谨性，对翻译后的笔录进行了验证、成员核对和编码员间百分比一致性检验。
缺乏心理健康培训、没有开具精神药物的权限以及缺乏心理健康用品成为心理健康服务提供的障碍。参与者建议向社区宣传心理健康和治疗方式，并为提供适当的心理健康服务提供培训和开具精神药物的权限。
向社区宣传精神疾病治疗方式以及为医疗服务提供者提供心理健康培训，将有助于增加基层医疗保健机构的心理健康服务提供。此外，加强转诊系统以及在基层医疗保健层面提供精神药物，将有助于基层医疗保健机构提供心理健康服务。然而，对所提供服务进行定期监测和监督至关重要。
