Patient preferences for the integration of mental health counseling and chronic disease care in South Africa

Abstract

PurposeTo describe patient perceptions of the acceptability of integrating mental health counseling within primary care facilities in the Western Cape province of South Africa and their preferences for the way in which this care is delivered.Patients and methodsQualitative interviews with 30 purposively selected patients receiving treatment for HIV or diabetes within primary care facilities who screened positive for depression using the Center for Epidemiological Studies Depression Scale or hazardous alcohol use through the Alcohol Use Disorders Identification Test.ResultsParticipants articulated high levels of unmet need for mental health services and strong associations between poor mental health and the challenges of living with a chronic disease. Consequently, they considered it acceptable to offer screening and mental health counseling within the context of chronic disease care. They thought counseling would be highly relevant if it helped patients develop adaptive strategies for coping with stress and negative emotions. Irrespective of chronic disease, patients indicated a preference for lay counselors rather than existing clinicians as potential delivery agents, supporting a task-shared approach to mental health counseling delivery in primary care settings. Some expressed concern about the feasibility of using lay counselors already present in facilities to deliver this service, suggesting that additional counselors might be needed.ConclusionFindings demonstrate a need for mental health counseling within the context of chronic disease care in South Africa. Task-shared approaches, using lay counselors, seem acceptable to patients – provided counselors are selected to ensure they possess the qualities associated with effective counselors. Findings have informed the design of a task-shared mental health program that is responsive to the preferences of patients with chronic diseases.

Young South African Women on Antiretroviral Therapy Perceptions of a Psychological Counselling Program to Reduce Heavy Drinking and Depression

“…This extends what we know about the need to strengthen the coping strategies of PLWH who drink to improve adherence to ART [25,37] by focusing on the role that trauma and environmental factors play in women's drinking and feelings of depression. While previous studies have described how avoidant approaches to dealing with life stressors can lead to drinking and depression among PLWH [32,38], far less attention has been given to the role of traumatic life experiences and social circumstances. Although there have been some efforts to develop interventions that address traumatic stress among South African women who are living with HIV [39,40], these interventions have not included a focus on alcohol use and depression which intersect with experiences of trauma; other trauma-focused substance use interventions have been developed but have not focused on young women using ART specifically [35,41].…”

“…In describing their relationships with counsellors, young women described individuals who were supportive, empathetic, non-judgemental, comforting, trustworthy and reassuring. Lay counsellors were chosen as intervention delivery agents given the emphasis on task-sharing mental health counselling to non-specialist providers in South Africa and similar low-and middle-income countries [23], patient preferences for lay counsellors [38], the feasibility of training lay counsellors to deliver this particular intervention [32] and evidence of the effectiveness of lay counsellor-delivered psychological interventions [46,47]. Our findings emphasize the value placed by young women on the relationship with the LHW and the importance of identifying lay counsellors who possess key qualities to effect change in a manner acceptable to young women during the hiring and training process.…”

Assessing capability for implementing mental health counselling within primary care facilities in a middle‐income country: A feasibility study

“…In addition, the availability of confidential space emerged as an important consideration. This is not surprising as confidential space is a pre‐requisite for the delivery of mental health counselling and impacts on the uptake and delivery of counselling services (Myers, Carney, & Wechsberg, ; Myers, Joska, et al, ). Other sub‐Saharan African countries address this infrastructural challenge through delivering counselling on the grounds of (instead of within) the facility (Chibanda et al, ).…”

“…Although specialist providers, such as nurses with training in mental health, are available in the primary care system, their main function is the administration of medication to patients with severe mental illness. As they are a scarce resource and often work across several facilities, they have limited time to provide counselling for common mental disorders (Myers, Joska, et al, ). Task sharing this function with CHWs could potentially reduce the treatment gap in this context.…”

Mutual Capacity Building to Reduce the Behavioral Health Treatment Gap Globally

“…First, LHWs may help mental health treatment programs develop a better understanding of culturally appropriate care and engage stigmatized groups. In South Africa, CHWs have expanded access for the maintenance of antiretroviral therapy and provided care with outcomes similar to physicians, possibly by making HIV care more acceptable for people who feel stigmatized and shamed by their disease (Myers et al 2018). Second, LHWs could expand the coverage of services beyond the facilities where these services are generally provided, helping reach marginalized and vulnerable people.…”