Lessons from case studies of integrating mental health into primary health care in South Africa and Uganda
Open accessAbstract
BACKGROUND: While decentralized and integrated primary mental healthcare forms the core of mental health policies in many low- and middle-income countries (LMICs), implementation remains a challenge. The aim of this study was to understand how the use of a common implementation framework could assist in the integration of mental health into primary healthcare in Ugandan and South African district demonstration sites. The foci and form of the services developed differed across the country sites depending on the service gaps and resources available. South Africa focused on reducing the service gap for common mental disorders and Uganda, for severe mental disorders. METHOD: A qualitative post-intervention process evaluation using focus group and individual interviews with key stakeholders was undertaken in both sites. The emergent data was analyzed using framework analysis. RESULTS: Sensitization of district management authorities and the establishment of community collaborative multi-sectoral forums assisted in improving political will to strengthen mental health services in both countries. Task shifting using community health workers emerged as a promising strategy for improving access to services and help seeking behaviour in both countries. However, in Uganda, limited application of task shifting to identification and referral, as well as limited availability of psychotropic medication and specialist mental health personnel, resulted in a referral bottleneck. To varying degrees, community-based self-help groups showed potential for empowering service users and carers to become more self sufficient and less dependent on overstretched healthcare systems. They also showed potential for promoting social inclusion and addressing stigma, discrimination and human rights abuses of people with mental disorders in both country sites. CONCLUSIONS: A common implementation framework incorporating a community collaborative multi-sectoral, task shifting and self-help approach to integrating mental health into primary healthcare holds promise for closing the treatment gap for mental disorders in LMICs at district level. However, a minimum number of mental health specialists are still required to provide supervision of non-specialists as well as specialized referral treatment services.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Knowledge from low- and middle-income settings might not transfer to high-income countries because infrastructure differs.
“what is known in low and middle income settings may not apply to high income countries given differences in infrastructure across these settings.17”
From Task-sharing approaches to improve mental health care in rural and other low-resource settings: a systematic review (2018) · cites this paper as [17]
Scarce health care resources in low-income countries may account for difficulties in working with primary care.
“Limited health care resources in low income countries may explain challenges related to working with primary care.17”
From Task-sharing approaches to improve mental health care in rural and other low-resource settings: a systematic review (2018) · cites this paper as [17]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Qualitative data analysis for applied policy research
(2002) · Analyzing Qualitative Data · doi:10.4324/9780203413081-14 · Cited by 4,964 · see citing works
Gibbs, G. (2007) · doi:10.4135/9781849208574 · Cited by 4,299 · see citing works
No health without mental health
Prince, M. J., Patel, V., Saxena, S., Maj, M., Maselko, J., Phillips, M. R., & Rahman, A. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61238-0 · Cited by 3,835 · see citing works
The world health report 2001 - Mental health: new understanding, new hope
Sayers, J. (2001) · Europe PMC (PubMed Central) · doi:10.1590/s0042-96862001001100014 · Cited by 3,307 · see citing works
Treatment gap in mental health care.
Abramowitz, M. Z., Greenberg, D., & Levav, I. (2008) · PubMed · Cited by 1,482 · see citing works
The treatment gap in mental health care.
(2004) · Europe PMC (PubMed Central) · Cited by 1,419 · see citing works
Poverty and common mental disorders in low and middle income countries: A systematic review
Lund, C., Breen, A., Flisher, A. J., Kakuma, R., Corrigall, J., Joska, J. A., Swartz, L., & Patel, V. (2010) · Social Science & Medicine · doi:10.1016/j.socscimed.2010.04.027 · Cited by 1,375 · see citing works
Barriers to improvement of mental health services in low-income and middle-income countries
Saraceno, B., van Ommeren, M., Batniji, R., Cohen, A., Gureje, O., Mahoney, J., Sridhar, D., & Underhill, C. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61263-x · Cited by 1,088 · see citing works
Scale up services for mental disorders: a call for action
(2007) · The Lancet · doi:10.1016/s0140-6736(07)61242-2 · Cited by 835 · see citing works
Cohort Profile: Africa Centre Demographic Information System (ACDIS) and population-based HIV survey
Tanser, F. C., Hosegood, V., Bärnighausen, T., Herbst, K., Nyirenda, M., Muhwava, W., Newell, C., Viljoen, J., Mutevedzi, T., & Newell, M. (2007) · International Journal of Epidemiology · doi:10.1093/ije/dym211 · Cited by 403 · see citing works
Williams, D. R., HERMAN, A. A. B., Stein, D. J., Heeringa, S. G., Jackson, P. B., Moomal, H., & Kessler, R. C. (2007) · Psychological Medicine · doi:10.1017/s0033291707001420 · Cited by 302 · see citing works
Thornicroft, G., Alem, A., dos Santos, R. A., Barley, E. A., Drake, R. E., Gregório, G., Hanlon, C., Ito, H., Latimer, E. A., LAW, A., et al. (2010) · World Psychiatry · doi:10.1002/j.2051-5545.2010.tb00276.x · Cited by 289 · see citing works
Kigozi, F. N., Ssebunnya, J., Kizza, D., Cooper, S., Ndyanabangi, S., & the Mental Health and Poverty Project (2010) · International Journal of Mental Health Systems · doi:10.1186/1752-4458-4-1 · Cited by 254 · see citing works
Self-citationPatel, V., & Thornicroft, G. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000160 · Cited by 237 · see citing works
Lund, C., Kleintjes, S., Kakuma, R., & Flisher, A. J. (2009) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-009-0078-5 · Cited by 224 · see citing works
Mental Health Policy Development and Implementation in Four African Countries
Flisher, A. J., Lund, C., Funk, M., Banda, M., Bhana, A., Doku, V. C. K., Drew, N., Kigozi, F. N., Knapp, M. R. J., Omar, M., et al. (2007) · Journal of Health Psychology · doi:10.1177/1359105307076237 · Cited by 159 · see citing works
Self-citationPetersen, I., Lund, C., Bhana, A., Flisher, A. J., & the Mental Health and Poverty Research Programme Consortium (2012) · Health Policy and Planning · doi:10.1093/heapol/czr012 · Cited by 158 · see citing works
Self-citationLessons learned in developing community mental health care in Africa
Hanlon, C., Wondimagegn, D., & Alem, A. (2010) · World Psychiatry · doi:10.1002/j.2051-5545.2010.tb00308.x · Cited by 114 · see citing works
Petersen, I., Bhana, A., Campbell-Hall, V., Mjadu, S., Lund, C., Kleintjies, S., Hosegood, V., & Flisher, A. J. (2009) · Health Policy and Planning · doi:10.1093/heapol/czn049 · Cited by 108 · see citing works
Self-citationSeedat, S., Stein, D. J., HERMAN, A. A. B., Kessler, R. C., Sonnega, J. R., Heeringa, S. G., Williams, S. L., & Williams, D. R. (2008) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-008-0399-9 · Cited by 106 · see citing works
Lessons learned in developing community mental health care in Europe
Semrau, M., Barley, E. A., LAW, A., & Thornicroft, G. (2011) · World Psychiatry · doi:10.1002/j.2051-5545.2011.tb00060.x · Cited by 99 · see citing works
Mental Disorder in People Living with HIV/Aids in South Africa
Freeman, M. C., Nkomo, N., Kafaar, Z., & Kelly, K. (2008) · South African Journal of Psychology · doi:10.1177/008124630803800304 · Cited by 93 · see citing works
Schizophrenia: illness impact on family members in a traditional society - rural Ethiopia
Shibre, T., Kebede, D., Alem, A., Negash, A., Deyassa, N., Fekadu, A., Fekadu, D., Jacobsson, L. H., & Kullgren, G. (2003) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-003-0594-7 · Cited by 90 · see citing works
The power gap: Freedom, power and mental illness
Kelly, B. D. (2006) · Social Science & Medicine · doi:10.1016/j.socscimed.2006.05.015 · Cited by 75 · see citing works
Scaling up services for mental and neurological disorders in low-resource settings
Patel, V., Goel, D. S., & Desai, R. (2009) · International Health · doi:10.1016/j.inhe.2009.02.002 · Cited by 74 · see citing works
Mental health policy in South Africa: development process and content
Draper, C. E., Lund, C., Kleintjes, S., Funk, M., Omar, M. A., & Flisher, A. J. (2009) · Health Policy and Planning · doi:10.1093/heapol/czp027 · Cited by 66 · see citing works
Kleintjes, S., Lund, C., Swartz, L. M., Flisher, A. J., & The MHaPP Research Programme Consor (2010) · International Review of Psychiatry · doi:10.3109/09540261.2010.536153 · Cited by 51 · see citing works
Integration of Mental Health into Primary Health Care in a rural district in Uganda
Ssebunnya, J., Kigozi, F., Kizza, D., & Ndyanabangi, S. (2010) · African Journal of Psychiatry · doi:10.4314/ajpsy.v13i2.54359 · Cited by 48 · cited 2× · see citing works
“This focus emerged from the paucity of adequate treatment and care at the primary healthcare (PHC) level for these disorders, with most psychiatric patients seeking treatment directly from secondary or tertiary levels of care [10,14].”
BackgroundMethodSelf-citationKumar, S. M. (2011) · Journal of Health Management · doi:10.1177/097206341001300111 · Cited by 17 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- World Health Organization (WHO) Mental Health Gap Action Programme (mhGAP): Scaling up care for mental, neurological and substance abuse disorders 2008 Geneva: WHO 26290926
Cited by
Sorted by citations
Hoeft, T. J., Fortney, J. C., Patel, V., & Unützer, J. (2018) · The Journal of Rural Health · doi:10.1111/jrh.12229 · Cited by 619 · see citing works
Padmanathan, P., & De Silva, M. J. (2013) · Social Science & Medicine · doi:10.1016/j.socscimed.2013.08.004 · Cited by 278 · see citing works
Gureje, O., Abdulmalik, J., Kola, L., Musa, E., Yasamy, M. T., & Adebayo, K. (2015) · BMC Health Services Research · doi:10.1186/s12913-015-0911-3 · Cited by 188 · see citing works
Economic evaluation of a task-shifting intervention for common mental disorders in India
Buttorff, C., Hock, R., Weiss, H., Naik, S., Araya, R., Kirkwood, B., Chisholm, D., & Patel, V. (2012) · Bulletin of the World Health Organization · doi:10.2471/blt.12.104133 · Cited by 175 · see citing works
Javadi, D., Feldhaus, I., Mancuso, A., & Ghaffar, A. (2017) · Global Mental Health · doi:10.1017/gmh.2017.15 · Cited by 144 · see citing works
“Across these different contexts, community mental health programmes were variable in nature with some being more integrated into existing health systems (Patel et al. 2010b, 2011; Petersen et al. 2011; Mendenhall et al. 2014; Agyapong et al. 2015a, b; Nimgaonkar & Menon, 2015; Agyapong et al. 2016; Wright & Chiwandira…”
BackgroundMethodInfluentialAccuracy of proactive case finding for mental disorders by community informants in Nepal
Jordans, M. J. D., Kohrt, B. A., Luitel, N. P., Komproe, I. H., & Lund, C. (2015) · British Journal of Psychiatry · doi:10.1192/bjp.bp.113.141077 · Cited by 96 · see citing works
Mascayano, F., Toso-Salman, J., Ho, Y. C. S., Dev, S., Tapia, T., Thornicroft, G., Cabassa, L. J., Khenti, A., Sapag, J., Bobbili, S. J., et al. (2020) · Transcultural Psychiatry · doi:10.1177/1363461519890964 · Cited by 66 · see citing works
“…were focused on addressing stigma among healthcare professionals, para-professionals, and medical students (Altindag et al., 2006; Arkar & Eker, 1997; Fernandez et al., 2016; Makanjuola et al. 2012; Petersen et al., 2011; Premalatha Chinnayya et al., 1990; Reddy et al., 2005; Bayar et al. 2009).”
BackgroundAngdembe, M., Kohrt, B. A., Jordans, M., Rimal, D., & Luitel, N. P. (2017) · International Journal of Mental Health Systems · doi:10.1186/s13033-017-0176-9 · Cited by 39 · see citing works
Agyapong, V. I. O., Osei, A., Farren, C. K., & Mcauliffe, E. (2015) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzv058 · Cited by 15 · see citing works
- Authors
- Petersen, I., Ssebunnya, J., Bhana, A., Baillie, K., & MhaPP Research Programme Consortium
- Affiliations
- University of KwaZulu-Natal (ZA)
- Makerere University (UG)
- Human Sciences Research Council (ZA)
- Corresponding author
- Petersen, Inge
- Venue
- International Journal of Mental Health Systems
- Published
- 2011
- Volume
- 5
- Issue
- 1
- Pages
- 8
- ISSN
- 1752-4458 (ISSN-L)
- PMC
- PMC3096573
- OpenAlex
- W2104844578
- Cited by
- 125
- References
- 29
- Citations by year
- 2026: 4 · 2025: 13 · 2024: 5 · 2023: 10 · 2022: 7 · 2021: 9 · 2020: 7 · 2019: 12 · 2018: 11 · 2017: 15 · 2016: 10 · 2015: 7 · 2014: 8 · 2013: 4 · 2012: 3
- FWCI
- 6.53
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- International Journal of Mental Health Systems (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- World Health Organization
- Wellcome Trust (50534)
- University of Leeds
- Department for International Development
- Inyuvesi Yakwazulu-Natali
- University of Ghana
- University of Cape Town
- Ministry of Health, Uganda
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- mental health integration, primary care, implementation framework, task shifting, community health workers, mental health treatment gap, common mental disorders, severe mental illness, stigma and discrimination, social inclusion, political will, South Africa, Uganda
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
