Integrating mental health care services in primary health care clinics: a survey of primary health care nurses’ knowledge, attitudes and beliefs

Figures & data

Table 1: WHO’s 10 principles of integration

Principle	What it entails
1. Policy and plans need to be incorporated into primary care for mental health	There must be commitment from the government to integrate mental health care that must be guided by policy and legislation
2. Advocacy is required to shift attitudes and behaviour	Information can be used strategically to influence behaviour change
3. Adequate training of primary care workers is required	Continuous in-service training of primary health care workers is essential for mental health integration
4. Primary care tasks must be limited and doable	Primary health care workers’ functions must be limited and doable so that they function at their optimal level
5. Specialist mental health professionals and facilities must be available to support primary care	Integration of mental health care into primary health care must be accompanied by secondary care to which primary health care workers can refer
6. Patients must have access to essential psychotropic medication in primary care	Availability of essential psychotropic medications is essential for the successful integration of mental health into primary care
7. Integration is a process, not an event	Integration takes time and involves a series of developments
8. A mental health service coordinator is crucial	A mental health coordinator is essential in facilitating the integration process
9. Collaboration with other government non-health sectors, nongovernmental organisations, village and community health workers, and volunteers is required	Collaboration with government and non-governmental sectors can help patients become more functional and decrease their need for hospitalisation
10. Financial and human resources are needed	Financial resources are required to establish and maintain the service

Table 2: Description of sample

Clinic	Service hours	Number and type of staff	Number of staff with PHC*** training
A	24 -hour service	5 RN*	4
		3 EN**
B	24-hour service	3 RN*	3
		3 EN**
C	8-hour service	3 RN*	1
		2 EN**
D	8-hour service	3 RN*	1
		3 EN**	1
E	8-hour service	3 RN*	1
		3 EN**
F	8-hour service	3 RN*	3
		2 EN**

Key: *Registered Nurse.

**Enrolled Nurse.

***Clinical diagnosis, assessment, treatment and care.

Table 3: Demographic characteristics of respondents (n = 36)

Item	Attribute	Frequency	Percentage
Age	21–30	6	17
	31–40	11	30
	41–50	14	39
	51–60	5	14
Gender	Male	3	8
	Female	33	92
Nursing qualification	Four-year diploma in nursing (i.e. general nursing, midwifery, community health and psychiatric nursing)	24	66
	Three-year diploma in General Nursing only	5	14
	Three-year diploma in General Nursing and one-year qualification in psychiatric nursing	6	17
	Enrolled Nurse	1	3
Years of practice	0–1 year	2	5
	2–5 years	10	28
	6–10 years	15	42
	11–15+ years	9	25
Past experience working in psychiatric nursing	None	7	19
	2 years	8	22
	5 years	13	36
	More than 10 years	8	22
Know someone other than patient with psychiatric condition?	Yes	28	78
	No	8	22

Table 4: Scores for attitudes and knowledge

Number	Item	n	Mean
1	I just learn about mental health when I have to and would not bother reading additional material	36	2.6389
2	People with mental illness can never recover enough to have a good quality of life	36	2.9167
3	People with mental illness are dangerous^R	36	2.8056
4	It is important for any health professional supporting a person with mental illness to also ensure that their physical health is assessed	36	1.4722
5	PHC nurses should not be expected to complete a thorough assessment for people with psychiatric symptoms because they have been referred to the psychiatrist^R	36	2.8056
6	I have a responsibility to identify patients with mental health problems	36	1.4444
7	For the majority of mental health conditions, counselling is a waste of effort	36	2.9444
8	I have a responsibility to intervene with patients who have mental health-related problems	36	1.5833
	Average for attitudes 2.326
9	I do not have enough clinical skills to care for psychiatric patients^R	36	2.5833
10	I do not have enough clinical skills to care for patients’ psychotropic drugs’ side effects^R	36	3.2222
11	I include a detailed mental health history in my psychiatric patients’ nursing assessment	36	1.7778
12	I provide information about mental health to patients	36	1.8333
13	I assess my patients for physical problems related to psychotropic drug use	36	1.8611
14	I assess my patients for psycho-social problems	36	1.6667
15	People with mental illness tend to improve with treatment	36	1.5
	Average for knowledge 2.8

Note: R = reverse-scored items.

Table 5: Characteristics associated with nurses’ knowledge, attitudes and beliefs towards mental illness

Number	Item	n	Mean (SE)	F	p-value
1	I have a responsibility to identify patients with mental health problems	36
	Health qualification		4.027	7.113	0.003
2	For the majority of mental health conditions, counselling is a waste of effort	36
	Health qualification		4.027	7.113	0.003
3	I do not have enough clinical skills to care for psychiatric patients^R	36
	Health qualification		5.879	12.879	0
4	I do not have enough clinical skills to care for patients’ psychotropic drugs’ side effects^R	36
	Past experience of working with psychiatric patients		82.479	3.689	0.022
5	I assess my patients for physical problems related to psychotropic drug use	36
	Age		4.803	7.409	0.002
	Health qualification		4.371	8.024	0.001
6	I assess my patients for psycho-social problems	36
	Health qualification		3.474	6.837	0.001

Note: R = reverse-scored items.