Patients’ opinions about referral from a tertiary specialist psychiatric hospital to primary healthcare

Abstract

BackgroundReferral of patients from tertiary specialist psychiatric hospitals to primary healthcare settings is a worldwide goal. This is of particular importance in South Africa with its considerable burden of mental disorders and limited resources. However, patients are often reluctant to be referred and studies have shown that patients may prefer a dedicated psychiatric service over an integrated primary healthcare service.AimThis study explored the opinions of patients receiving care at a tertiary psychiatric hospital’s outpatient department (OPD) about referral to a primary healthcare clinic (PHCC).SettingThe study was conducted at Weskoppies Psychiatric Hospital OPD.MethodsThis was a qualitative study based on grounded theory. Participants were recruited through purposive-theoretical sampling. Data were collected by means of individual interviews and mini-essays.ResultsFrom the 80 participants, 18 had individual interviews and 62 wrote mini-essays. Thirty-nine participants had previously attended a PHCC, while 41 had not. Perceived advantages of referral to PHCCs included: close proximity to participants’ homes, resulting in saving on travelling time and transport costs, as well as the convenience of receiving psychiatric and other medical treatment at the same healthcare facility. Perceived disadvantages of PHCCs included: unavailability of treatment; lack of doctor-based care; lack of specialised care; loss of established relationships with hospital healthcare workers; mistreatment by PHCC nursing staff; longer waiting times; more stigmatisation.ConclusionThe perceived disadvantages of referral from a tertiary psychiatric hospital to a PHCC outweighed the perceived advantages. Nonetheless, participants expressed willingness for such a referral if their concerns were addressed.

Provision of HIV services to psychiatric inpatients in Botswana: Challenges and recommendations

“…These complaints may have been raised because of fear of disclosure and double stigma. 38 While confidentiality is an ethical obligation and the right of patients, it is important that during initial consultation with patients, psychiatrists should explain that there is 'shared confidentiality' among healthcare providers specifically when it involves referrals for further treatment or care. 39,40 Patients will then understand the necessity of information sharing among healthcare providers while respecting and maintaining their confidentiality.…”

Experiences of mental healthcare providers regarding integration of mental healthcare into primary healthcare at the iLembe health district in KwaZulu-Natal province

“…According to Department of Health, RSA (2007), proper criteria for referral of mental healthcare users should be established and followed by all stakeholders. This is further supported by Hattingh and Joubert (2019), who stated that clients must access mental health services closer to their homes (thus avoiding costs associated with seeking specialist care at distant locations).This would minimise stigmatisation and discrimination associated with mental health services delivered at primary care and ensure holistic treatment that addresses both physical and mental healthcare needs.…”

“…This leads to relapse of treatment in many mental healthcare users which contributes to poor integration of mental healthcare into primary healthcare. Hattingh and Joubert (2019) stated that referral to a primary healthcare was generally viewed as something negative that could even adversely affect patient's mental health, for example, by relapsing or turning to substances for relief. Therefore, it is imperative to have clear guidelines on how mental healthcare users are referred from one institution to another, specifically to primary healthcare centres.…”

“…Therefore, the governments have to ensure that sufficient funds are allocated to purchase the basic essential psychotropic medicines and make sure that they are available at primary care settings (WHO 2007). The South African Primary Healthcare Level Standard Treatment Guidelines and Essential Medicines List make provision for a limited range of psychiatric drugs for primary healthcare centres (Hattingh & Joubert 2019). Professional nurses should be supported by management with adequate resources such as medicines to be issued to mental healthcare patients.…”

“…These consequences could include, amongst others, relapse from treatment of such patients. The mental healthcare requires public health sector to ensure that primary healthcare must have adequate infrastructure, staff, expertise and resources to provide necessary care for mental patients (Hattingh & Joubert 2019). Failure of primary healthcare service providers to render adequate and efficient care to mental patients may lead to absence of patients from scheduled appointments, and not collecting and adhering to their prescribed psychotropic treatment.…”