A practice framework to enhance the implementation of the policy on integration of mental health care into primary health care in KwaZulu-Natal province

Abstract

Background Policy on Integration of Mental Health Care into primary health care (PHC) was developed in 1997 at the time when the White Paper for the Transformation of the Health System in South Africa was published (Republic of South Africa 1997). The White Paper made provision for a new health care system based on the principles of the PHC approach to care. This was followed by the promulgation of the Mental Health Care Act No. 17 of 2002 which is based on the principle that mental health care should be integrated into PHC; however there have been challenges with regard to implementation of this policy. Aim of the study The aim of the study was to analyse the implementation of Policy on Integration of Mental Health Care into PHC with the ultimate aim of developing a practice framework for PHC nurses to enhance such implementation in KwaZulu-Natal (KZN). Methodology A qualitative approach using grounded theory design was used to develop a practice framework to enhance the implementation of Policy on Integration of Mental Health Care into PHC in KZN. A non-probability sampling approach using purposeful sampling and theoretical sampling was used. PHC managers, operational managers and professional nurses were selected for collection of data. The sample consisted of 42 participants. Data was collected by means of one-on-one interviews and focus group interviews. Strauss and Corbin’s approach of data analysis was used for analysing data. Three coding procedures were used for analysing data, namely, open coding, axial coding and selective coding. The paradigm model as described by Strauss and Corbin was used as a guide to develop a practice framework to enhance implementation of Policy on Integration of Mental Health Care into PHC in KZN. Results The findings of this study are that integration of mental health care into PHC is understood as provision of comprehensive care that is needed by all mental health care users at the clinic, and is being offered using either a supermarket approach or a one-stop-shop approach at PHC clinics. Strategies that can be used at PHC clinics in KZN to ensure that integration of mental health care into PHC is implemented include screening of all patients that come to the PHC clinic for mental illness, fast tracking of mental health care users once they have been assessed and found to be mentally ill, and chronic management of all patients including mental health care users. The practice framework developed identifies comprehensive mental health care being offered to mental health care users using either a supermarket approach or one-stop-shop approach depending on the availability of staff with a qualification in Psychiatric Nursing Science. It emerged that there should be an enabling environment for integration of mental health care to take place namely adequate space for consultation of mental health care users, adequate medication, protocol and procedure for referral and management of mental health care users, a qualification in Psychiatric Nursing Science and Primary health care for all nurses working in PHC clinic as well as availability of Psychiatrist and advanced psychiatric nurses at each PHC clinic.