Public healthcare personnel’s experiences and opinions on access and readiness to provide mental health care in a remote rural area in South Africa

Introduction: The WHO encourages decentralising mental health care away from the tertiary locus of care into lower levels of care so as to reform mental health worldwide. More recently, attempts have been made to facilitate the integration of public mental health care into general health care systems in South Africa. It is well established that the country’s public health care system faces numerous multi-faceted challenges – including very limited human, structural and material resources needed to accommodate and treat patients. We studied the experiences and opinions of public health care workers at primary health care clinics and the associated referral hospitals, focusing mainly on exploring their views on the ability and readiness for access to and provision of mental health to state health patients.
Methods: The Mental Health Knowledge Schedule (MAKS), the Mental Illness: Clinicians’ Attitudes Scale (MICA-4), and a purpose-made questionnaire were used for data collection.  The data from the MAKS and MICA-4 were imported into IBM SPSS Statistics Software (Version 29.0.0.0 [241]) to yield descriptive information, and Spearman correlations were performed between the measures. The purpose-made questionnaire produced descriptive quantitative data and qualitative data that were analysed through conventional content analysis.
Results: Results from the MAKS suggest participants experience gaps in mental health knowledge and fair level of familiarity and ability to recognise different mental health conditions. Results from the MICA-4 suggest that participants in our study generally displayed a positive attitude towards people with mental illness and aspects involving psychiatry. Quantitative results from the purpose-made questionnaire describe aspects around mental health services, training, resources, and care. Qualitative findings suggest health workers wish for more mental health specific resources and contact with the health care system facilitate interventions and care.
Conclusion: This research presents possible solutions to the challenges faced in public mental health care. Some of these solutions are within workers’ control, while many of the solutions to the successful integration of more comprehensive basic care are out of their ambit of control, remaining locked up in policy and implementation rather than in field-level practice.
Keywords: integrated mental health care, public mental health care, rural mental health care, South Africa, task-shifting.