Low and middle income countries face many challenges in meeting mental health needs in their regions. Treatment of patients with mental disorders is inadequate in most of these countries and majority of individuals with severe mental disorders remain untreated. The bad news is that mental health problems in these countries are on the rise due to socioeconomic challenges being faced. Regardless of guidelines and directives provided by WHO for organizing mental health services, these countries continue to face many challenges in the effort to cater for mental health needs. Such challenges include lack of human resource for mental health especially at primary health care level, inadequate training of human resource for mental health, misplacement of human resource for mental health, lack of drugs, wrong priorities, problematic insurance coverage for mental disorders, and stigma. This study aimed at exploring mental health care and delivery system at Temeke district hospital, and how services were organized to meet the increasing mental health needs of its population.
A qualitative study was conducted at Temeke hospital in Dar es Salaam, involving 7 in-depth interviews with mental health care providers, 7 in-depth interviews with mentally ill patients, and 2 focus group discussions with caregivers. A convenient sampling procedure was used to select participants for the study. All interviews were audio-recorded in Kiswahili and transcribed. A qualitative Content Analysis was used to analyze data after translation with the aid of Nvivo 10 software.
Three main themes were identified. These were resource challenges, environmental/system challenges, and satisfaction with mental health services. Temeke health facility faced resource and environmental/system challenges, and there were mixed feelings on satisfaction with services. Funding and priority issues were found to mainly affect delivery of appropriate services to clients.
Health facilities that provide mental health services in the community need to be well equipped with necessary resources to meet the vast needs of people they serve. Having a political will, improving the health systems governance for mental health, and priority setting, are necessary to address the challenges experienced in the delivery of mental health services.
World Health Organization. Investing in mental health [Internet]. Geneva: World Health Organization; 2003 [cited. Feb 15. 2017; Available from: http://www.who.int/mental_health/media/investing_mnh.pdf].
Funk M, Drew N, Knapp M. Mental health, poverty and development. J Public Ment Health. 2012;11(4):166–85. CrossRef
Organizzazione mondiale della sanità. Organization on services for mental health. Geneva: World health organization; 2003.
Hanlon C, Luitel NP, Kathree T, Murhar V, Shrivasta S, Medhin G, et al. Challenges and Opportunities for Implementing Integrated Mental Health Care: A District Level Situation Analysis from Five Low- and Middle-Income Countries. Montazeri A, editor. PLoS ONE. 2014;9(2):e88437.
World Health Organization, editor. Mental health atlas 2014. Geneva: World Health Organization; 2015. p. 67.
Bos ER, Jamison DT, Bainga F, Feacham RGA, Makgoba M, Hofman KJ, et al., editors. Disease and Mortality in Sub-Saharan Africa: Second Edition [Internet]. The World Bank; 2006 [cited 2017 Feb 16] Available from: http://elibrary.worldbank.org/doi/book/10.1596/978-0-8213-6397-3.
Hill A, Lindner C. Land-use modelling to support strategic urban planning-the case of Dar es Salaam, Tanzania. In: 45th ISOCARP Congress [Internet]. 2010 [cited 2016 Nov 17]. p. 1–12. Available from: http://isocarp.net/Data/case_studies/1820.pdf.
IFPRI / CARE-Tanzania Urban Livelihood Survey, 1998. UNPD World Urbanization Prospects; 2001.
Kuruvilla A, Jacob KS, et al. Poverty, social stress & mental health. Indian J Med Res. 2007;126(4):273. PubMed
World Health Organization, Funk M, Saraceno B, Pathare S. The mental health context [Internet]. Geneva: WHO; 2003 [cited. Sep 10. 2014; Available from: http://www.who.int/mental_health/policy/services/3_context_WEB_07.pdf].
Campbell-Hall V, Petersen I, Bhana A, Mjadu S, Hosegood V, Flisher AJ, et al. Collaboration between traditional practitioners and primary health care staff in South Africa: developing a workable Partnership for Community Mental Health Services. Transl Psychiatry. 2010;47(4):610–28. CrossRef
Mental health systems in selected low- and middle-income countries: a WHO-AIMS cross-national analysis. [Internet]. Geneva: World Health Organization; 2009 [cited. Nov 1. 2016; Available from: http://www.who.int/mental_health/evidence/who_aims_report_final.pdf].
Semrau M, Evans-Lacko S, Alem A, Ayuso-Mateos JL, Chisholm D, Gureje O, et al. Strengthening mental health systems in low- and middle-income countries: the Emerald programme. BMC Med [Internet]. 2015 Dec [cited 2017 Feb 17];13(1) Available from: http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0309-4.
Medina CO, Kullgren G, Dahlblom K. A qualitative study on primary health care professionals’ perceptions of mental health, suicidal problems and help-seeking among young people in Nicaragua. BMC Fam Pract. 2014;15(1):1. CrossRef
World Health Organization. Mental Health Atlass 2011. 2011.
Abdelgadir E. Exploring Barriers to the Utilization of Mental Health Services at the Policy and Facility Levels in Khartoum State, Sudan [Internet]. University of Washington; 2012 [cited 2016 Oct 21] Available from: https://dlib.lib.washington.edu/researchworks/handle/1773/20682.
World Health Organization, World Organization of National Colleges A and Academic Associations of General Practitioners/Family Physicians. Integrating mental health into primary health care: a global perspective. [Internet]. Geneva, Switzerland; London: World Health Organization; Wonca; 2008 [cited. Dec 20. 2016; Available from: http://www.who.int/mental_health/resources/mentalhealth_PHC_2008.pdf].
Evans GW. The built environment and mental health. J Urban Health. 2003;80(4):536–555.
Tsai C-Y, Wang M-C, Liao W-T, Lu J-H, Sun P, Lin BY-J, et al. Hospital outpatient perceptions of the physical environment of waiting areas: the role of patient characteristics on atmospherics in one academic medical center. BMC Health Services Research [Internet]. 2007 Dec [cited 2017 Feb 17];7(1). Available from: http://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-7-198.
Kim JI, Kim B, Kim B-N, Hong S-B, Lee DW, Chung J-Y, et al. Prevalence of psychiatric disorders, comorbidity patterns, and repeat offending among male juvenile detainees in South Korea: a cross-sectional study. Child and Adolescent Psychiatry and Mental Health [Internet]. 2017 Dec [cited 2017 Feb 20];11(1). Available from: http://capmh.biomedcentral.com/articles/10.1186/s13034-017-0143-x.
Maj M. “Psychiatric comorbidity”: an artefact of current diagnostic systems? [Internet]. RCP; 2005 [cited 2017 Feb 20]. Available from: http://bjp.rcpsych.org/content/186/3/182.full-text.pdf%2Bhtml.
Caccavale J, Reeves JL, Wiggins J. The Impact of Psychiatric Shortage on Patient Care and Mental Health Policy: The Silent Shortage that Can No Longer Be Ignored. Report prepared for the American Board of Behavioural Healthcare Practice [Internet]. 2012 [cited 2017 Feb 20]; Available from: http://ww.abbhp.org/survey.pdf.
Luitel NP, Jordans M, Adhikari A, Upadhaya N, Hanlon C, Lund C, et al. Mental health care in Nepal: current situation and challenges for development of a district mental health care plan. Confl Heal. 2015;9(1):3. CrossRef
Totman J, Hundt GL, Wearn E, Paul M, Johnson S. Factors affecting staff morale on inpatient mental health wards in England: a qualitative investigation. BMC psychiatry. 2011;11(1).
Svensson B, Hansson L. Satisfaction with mental health services. A user participation Ruud Tapproach. Nordic J Psychiatry. 2006;60(5):365–71. CrossRef
Aarre TF, Boeskov B, Husevåg PS, Klepp R, Kristiansen SA, et al. Satisfaction with primary care and mental health care among individuals with severe mental illness in a rural area: a seven-year follow-up study of a clinical cohort. International Journal of Mental Health Systems [Internet]. 2016 Dec [cited 2016 Nov 9];10(1). Available from: http://ijmhs.biomedcentral.com/articles/10.1186/s13033-016-0064-8.
Gani N, Saeed K, Minhas FA, Anjuman N, Waleed M, Fatima G. Assessment of patient satisfaction with mental health services in a tertiary care setting. J Ayub Med Coll Abbottabad. 2011;23(1):43–6. PubMed
Conner-Spady BL, Sanmartin C, Johnston GH, McGurran JJ, Kehler M, Noseworthy TW. The importance of patient expectations as a determinant of satisfaction with waiting times for hip and knee replacement surgery. Health Policy. 101(3):245–52.
- Mental health care and delivery system at Temeke hospital in Dar es Salaam, Tanzania
Joel Seme Ambikile
Masunga K. Iseselo
- BioMed Central
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