Barriers and facilitators to the integration of mental health services into primary health care: a systematic review

Wakida, Edith K.; Talib, Zohray; Akena, Dickens; Okello, Elialilia S.; Kinengyere, Alison Annet; Mindra, Arnold; Obua, Celestino

doi:10.1186/s13643-018-0882-7

Cited by 117 publications

(116 citation statements)

References 54 publications

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“…Increasing evidence and awareness about the effects of maternal mental health on the developing child has led to calls to develop wide‐spread screening and prevention programs for mothers during the prenatal and postpartum periods (Glover, 2014; Murray, Fearon, & Cooper, 2015). However, implementation of universal screening has lagged, with providers citing a lack of knowledge about mental health diagnoses and community resources as prime barriers (Wakida et al, 2018). Furthermore, physician screening for mental health problems, when it exists, is almost exclusively tied to the prenatal and early postpartum period.…”

Section: Discussionmentioning

confidence: 99%

The chronicity and timing of prenatal and antenatal maternal depression and anxiety on child outcomes at age 5

et al. 2020

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Background Maternal depression and anxiety have been associated with deleterious child outcomes. It is, however, unclear how the chronicity and timing of maternal mental health problems predict child development outcomes. The aim of the current study was to assess the effect of both chronicity and timing of maternal anxiety and depression in pregnancy, infancy, and the toddler period on children's internalizing and externalizing symptoms, as well as social and communication skills at age 5. Method Participants were 1,992 mother–child pairs drawn from a large prospective pregnancy cohort. Mothers reported on anxiety and depression symptoms with clinical screening tools at six time points between <25 weeks gestation and 3 years postpartum. Child outcomes were assessed at age 5. Results Effect sizes were small for brief incidents of depression/anxiety and increased for intermittent and chronic problems (i.e., three or more timepoints) compared with mothers who had never experienced clinical‐level anxiety or depression. Maternal anxiety/depression during pregnancy, infancy, and toddlerhood predicted all child outcomes, even after controlling for depression/anxiety during the other timepoints. However, maternal anxiety and depression during toddlerhood had a stronger association with child internalizing/externalizing symptoms and communication skills than either prenatal or postpartum depression/anxiety. Conclusions Increasing number of exposures to clinical‐level anxiety and depression is related to poorer child outcomes. Neither prenatal nor postpartum periods emerged as “sensitive” periods. Rather, maternal depression and anxiety during toddlerhood was more strongly associated with child outcomes at age 5. Results highlight the need for continued support for maternal mental health across early childhood.

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Section: Discussionmentioning

confidence: 99%

The chronicity and timing of prenatal and antenatal maternal depression and anxiety on child outcomes at age 5

et al. 2020

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“…We have also identi ed other barriers like; poor knowledge of community members, lack of indicators in the reporting system, lack of need from students to join mental health professions so and so forth. A systematic review has also revealed that the same barriers happen in other low income settings (42).…”

Section: Discussionmentioning

confidence: 95%

“…Most of primary health care facilities like primary hospitals and health centers have no any mental health professionals (38,41). Likewise, nance is the other big problem to implement mental health services up to the household level (42). It would also be a big problem in countries dependent on external fund.…”

Section: Discussionmentioning

confidence: 99%

Barriers and Facilitators to Implementing Mental Health Services into the Ethiopian Health Extension Program: A Qualitative Study

Yitbarek

Birhanu

Terefe

et al. 2020

Preprint

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Background: Mental health problem is the major health problem globally and nationally in Ethiopia. To address this problem the Ministry of health of Ethiopia integrated mental health services in to the community health service. However, the preliminary reports showed the service has not been implemented yet. Therefore, the aim of this study was to explore the barriers and facilitators of mental health service implementation in to the Ethiopian health extension program.Methods: A qualitative case study was conducted in the Ethiopian primary health care system from 12 August to 25 September 2019. We have conducted about ten purposively selected key informant interviews from the Ministry of Health and community level workers (i.e. health extension workers). All interviews were recorded using voice recorder and transcribed verbatim and translated for analysis. The data then analyzed manually in relevant themes. Results: Mental health problem currently is a major health issue in Ethiopia. However, the service is not ready to respond for the existing health service need. The recently designed integration of mental health services in to health extension program was not implemented so far. The basic identified barriers were, low political commitment, shortage of resources, non-functional referral system, lack of interest from private health service organizations, attitudinal problems from both the society and service providers, the lack of reporting system for mental health problems. On the contrary, there are also facilitators for the service like well-designed primary health care system, trained health extension workers, changing political commitment and attitude of the community.Conclusion: Although mental health problems are widely spread and increasing in alarming rate, in Ethiopia, the existing health system is not capable enough to respond. This problem is complex and intertwined. A series of activities to solve the major barriers are expected especially from the health system leaders to implement follow up and evaluate mental health services at the health extension programs.

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“…Although all these factors are in conformity with what other studies have found, contextualization is very important in order to address them. Poor or low accessibility of care for patients with mental health problems may have been cited by various researchers, [7,[36][37][38][39][40][41][42][43] however, the contexts within which these constraints occur are unique to communities and should not be looked at in isolation. In this study, low financial resources, difficult geographical terrain, and family indifferences towards mental illness compounded and contextualized the challenge of low accessibility of mental healthcare services in rural Mbarara district.…”

Section: Discussionmentioning

confidence: 99%

Health system constraints in integrating mental health services into primary healthcare in rural Uganda: perspectives of primary care providers

Wakida

Okello

Rukundo

et al. 2019

Int J Ment Health Syst

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Background: The World Health Organization issued recommendations to guide the process of integrating mental health services into primary healthcare. However, there has been general as well as context specific shortcomings in the implementation of these recommendations. In Uganda, mental health services are intended to be decentralized and integrated into general healthcare, but, the services are still underutilized especially in rural areas. Purpose: The purpose of this study was to explore the health systems constraints to the integration of mental health services into PHC in Uganda from the perspective of primary health care providers (PHCPs). Methods: This was a cross sectional qualitative study guided by the Supporting the Use of Research Evidence (SURE) framework. We used a semi-structured interview guide to gain insight into the health systems constraints faced by PHCPs in integrating mental health services into PHC. Results: Key health systems constraints to integrating mental health services into PHC identified included inadequate practical experience during training, patient flow processes, facilities, human resources, gender related factors and challenges with accessibility of care. Conclusion: There is need to strengthen the training of healthcare providers as well as improving the health care system that supports health workers. This would include periodic mental healthcare in-service training for PHCPs; the provision of adequate processes for outreach, and receiving, referring and transferring patients with mental health problems; empowering PHCPs at all levels to manage and treat mental health problems and adequately provide the necessary medical supplies; and increase the distribution of health workers across the health facilities to address the issue of high workload and compromised quality of care provided.

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Barriers and facilitators to the integration of mental health services into primary health care: a systematic review

Cited by 117 publications

References 54 publications

The chronicity and timing of prenatal and antenatal maternal depression and anxiety on child outcomes at age 5

The chronicity and timing of prenatal and antenatal maternal depression and anxiety on child outcomes at age 5

Barriers and Facilitators to Implementing Mental Health Services into the Ethiopian Health Extension Program: A Qualitative Study

Health system constraints in integrating mental health services into primary healthcare in rural Uganda: perspectives of primary care providers

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