Understanding the mix of services for mental health care in urban DR Congo: a qualitative descriptive study

Abstract

Background Mental health workers (MHWs) are exposed to conflicts of competence daily when performing tasks related to the provision of mental health services. This may be linked to a lack of understanding of their tasks as caregivers and providers. Furthermore, in most low-income settings, it is unclear how the available services are organized and coordinated to provide mental health care. To understand the above, this study aimed to identify the current mix of services for mental health care in the urban Democratic Republic of the Congo (DRC). Methods A qualitative descriptive study was carried out in Lubumbashi from February to April 2021. We conducted 7 focus group discussions (FGDs) with 74 key informants (family members, primary care physicians, etc.) and 13 in-depth interviews (IDIs) with key informants (traditional healers, psychiatrists, etc.). We performed a qualitative content analysis, guided by an analytical framework, that led to the development of a comprehensive inventory of MHWs from the household level to specialized facilities, exploring their tasks in care delivery, identifying existing services, and defining their current organization. Results Analysis of transcripts from the FGDs and IDIs showed that traditional healers and family caregivers are the leading providers in Lubumbashi. The exploration of the tasks performed by MHWs revealed that lifestyle, traditional therapies, psychotherapy, and medication are the main types of care offered/advised to patients. Active informal caregivers do not currently provide care corresponding to their competencies. The rare mental health specialists available do not presently recognize the tasks of primary care providers and informal caregivers in care delivery, and their contribution is considered marginal. We identified five types of services: informal services, traditional therapy services, social services, primary care services, and psychiatric services. Analyses pointed out an inversion of the ideal mix of these services. Conclusions Our findings show a suboptimal mix of services for mental health and point to a clear lack of collaboration between MHWs. There is an urgent need to clearly define the tasks of MHWs, build the capacity of nonspecialists, shift mental health-related tasks to them, and raise awareness about collaborative care approaches.

Health system facilitators and barriers to the integration of mental health services into primary care in the Democratic Republic of the Congo: a multimethod study

“…This may be due, in particular, to the low proportion of providers who have received in-service training in mental health and to the lack of supervision and/or nonsupervision of primary care facilities. It is essential to encourage mental health workers to work primarily in multidisciplinary teams and to promote collaborative approaches to care [ 15 ].…”

“…For the mental health sector, this resulted in only six recognized psychiatric hospitals, with a capacity of 500 hospital beds, i.e., 1 bed per 190,000 inhabitants, and a few private mental health centers [ 14 ]. In practice, due to the lack of formal mental health provisions in the primary healthcare system, traditional medicine and spiritual healing have, until recently, been the main sources of care for mental health problems [ 15 ]. To fill this treatment gap, the first well-documented program to effectively integrate mental health into primary care was officially launched in 2011 in the health district of Lubero, North Kivu Province [ 16 ], a rural area characterized by recurrent armed conflicts.…”