Perceptions of health managers and professionals about mental health and primary care integration in Rio de Janeiro: a mixed methods study

Abstract

BackgroundCommunity-based primary mental health care is recommended in low and middle-income countries. The Brazilian Health System has been restructuring primary care by expanding its Family Health Strategy. Due to mental health problems, psychosocial vulnerability and accessibility, Matrix Support teams are being set up to broaden the professional scope of primary care. This paper aims to analyse the perceptions of health professionals and managers about the integration of primary care and mental health.MethodIn this mixed-method study 18 health managers and 24 professionals were interviewed from different primary and mental health care services in Rio de Janeiro. A semi-structured survey was conducted with 185 closed questions ranging from 1 to 5 and one open-ended question, to evaluate: access, gateway, trust, family focus, primary mental health interventions, mental health records, mental health problems, team collaboration, integration with community resources and primary mental health education. Two comparisons were made: health managers and professionals’ (Mann-Whitney non-parametric test) and health managers’ perceptions (Kruskall-Wallis non parametric-test) in 4 service designs (General Traditional Outpatients, Mental Health Specialised Outpatients, Psychosocial Community Centre and Family Health Strategy)(SPSS version 17.0). Qualitative data were subjected to Framework Analysis.ResultsFirstly, health managers and professionals’ perceptions converged in all components, except the health record system. Secondly, managers’ perceptions in traditional services contrasted with managers’ perceptions in community-based services in components such as mental health interventions and team collaboration, and converged in gateway, trust, record system and primary mental health education. Qualitative data revealed an acceptance of mental health and primary care integration, but a lack of communication between institutions. The Mixed Method demonstrated that interviewees consider mental health and primary care integration as a requirement of the system, while their perceptions and the model of work produced by the institutional culture are inextricably linked.ConclusionThere is a gap between health managers’ and professionals’ understanding of community-based primary mental health care. The integration of different processes of work entails both rethinking workforce actions and institutional support to help make changes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1740-8) contains supplementary material, which is available to authorized users.

A Carteira de Serviços de Saúde do Município do Rio de Janeiro e as ações em saúde na Atenção Primária no Brasil

“…For example, considering the lines of women's health care, chronic diseases and mental health (a NCD), despite advantages, it can be difficult to address users whose health needs are covered by different lines of care. Hence, different authors [11][12][13] point to hardships faced by teams in addressing mental health cases, which include diagnostic difficulties and insufficient training, highlighting the shortcomings in the understanding that mental health is a cross-cutting theme in all strategic areas, when understanding health in a comprehensive way.…”

Health Professionals’ Perceptions of the Integration of Mental Health Into HIV Services

“…This is important and will help medical professionals to go beyond the customary means of managing mental health conditions, thus leading to proper patient care delivery. Also, this will give them the sense of being stakeholders in achieving integration (Athié et al, 2016).…”

“…It involves the interplay of several factors: policy makers and the frontline health care professionals need to work together to achieve this as this is more than just the sharing of a physical working environment (Athié et al, 2016;Knowles et al, 2013;Lawn, Lloyd, King, Sweet, & Gum, 2014). Determining the perceptions of frontline medical professionals concerning the integration of medical services will be important in the formulation of policies for proper planning by policy makers as well as in undertaking research to improve patient care (Athié et al, 2016). Also, this will help health care professionals to be aware of the need to advance their knowledge and to reassess their perceptions concerning the integration of services (Athié et al, 2016).…”

“…Determining the perceptions of frontline medical professionals concerning the integration of medical services will be important in the formulation of policies for proper planning by policy makers as well as in undertaking research to improve patient care (Athié et al, 2016). Also, this will help health care professionals to be aware of the need to advance their knowledge and to reassess their perceptions concerning the integration of services (Athié et al, 2016).…”

Impasses e desafios para consolidação e efetividade do apoio matricial em saúde mental no Brasil

“…Entre os fatores contributivos para o estabelecimento desse cenário, destacamse a baixa integração das redes de saúde e a falta de profissionais preparados para providenciar cuidados adequados em saúde mental na Atenção Primária 3,4 . Como desdobramentos desse cenário, há uma baixa capacidade de identificação e manejo dos casos nos níveis primários de atenção, sobrecarga dos serviços especializados, e consequentemente, dificuldade de acesso aos serviços de saúde mental em tempo oportuno [5][6][7][8] .…”