Integration of mental health counselling into chronic disease services at the primary health care level: Formative research on dedicated versus designated strategies in the Western Cape, South Africa

Abstract

Objective To explore health care providers’ views on the acceptability and feasibility of two models for integrating facility-based counsellor delivered mental health counselling into chronic disease care, and how such an approach could be improved in South Africa. Methods Fourteen focus group discussions and 25 in-depth individual interviews were conducted with 109 health care workers and facility managers from 24 primary health clinics in the Western Cape, South Africa. Results Findings suggested that despite recent efforts to integrate mental health counselling into chronic disease services for common mental disorders, there remains limited availability of psychosocial and psychological counselling. Feedback on the two models of integration suggested equipoise and the potential of a hybrid approach where these approaches may be tailored to the specific needs and available resources of each facility. Participants identified constraints within the health system and broader social context that require consideration for integrating mental health counselling into chronic disease care. Conclusion Although study participants unanimously agreed that counselling for common mental disorders should be integrated into chronic disease services, they had differing views on the type of model that should be adopted. There is a need for further testing of the two models and aspects of the health service that may require strengthening to implement any such model.

Associations Between Patterns of Alcohol Use and Viral Load Suppression Amongst Women Living with HIV in South Africa

“…Nonetheless, our results suggest that rates of viral suppression could be improved if evidence-based interventions focused on the detection and reduction of frequent HED are incorporated into HIV treatment services for women. At present, these behavioural health interventions are not part of the HIV treatment service offering within South Africa's public health system [45]. In contrast, and like studies with men [20,23], occasional HED was associated with greater risk of suboptimal ART adherence but did not seem to infer greater risk of viral non-suppression relative to alcohol consumption patterns characterised by abstinence or light drinking.…”

Integrating task-sharing psychological treatments within primary health care services: Systems considerations

“…8 Lastly, 'people' are an essential pillar of health systems, 4 and poor mental health literacy is another area that requires attention. While mental stigma was reported as a barrier to counselling uptake by Sorsdahl et al, 3 it is also responsible for poor demand for services. Psychoeducational interventions within communities and PHC facilities to promote greater awareness of symptoms of MHSU problems, self-help strategies, as well as the benefits of treatment, including psychological treatments, to health and wellbeing are needed to increase demand and uptake of such services.…”

“…1 Much of the evidence is, however, from controlled trials, 2 with the need for evidence of how to successfully scale-up this strategy in a way that is feasible, acceptable and effective in real world settings. The paper by Sorsdahl et al 3 in this issue provides some useful insights into some of the barriers and facilitators of task sharing of psychological treatments within a collaborative care approach in chronic PHC settings in South Africa. The authors focused on the potential merits of designated versus dedicated facilitybased counsellors providing this service.…”

“…The paper by Sorsdahl et al. 3 in this issue provides some useful insights into some of the barriers and facilitators of task sharing of psychological treatments within a collaborative care approach in chronic PHC settings in South Africa. The authors focused on the potential merits of designated versus dedicated facility-based counsellors providing this service.…”

“…First, there needs to be recognition that mental health integration, including co-located counselling services, requires additional resources within PHC. 4 While the designated route was deemed to be financially more viable by Sorsdahl et al., 3 adequate costing of the additional time required for existing staff to provide this service is required. Resources for supervision and mentoring support, including debriefing, are also essential.…”