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Health system preparedness for integration of mental health services in rural Liberia.

Publication ,  Journal Article
Gwaikolo, WS; Kohrt, BA; Cooper, JL
Published in: BMC Health Serv Res
July 27, 2017

BACKGROUND: There are increasing efforts and attention focused on the delivery of mental health services in primary care in low resource settings (e.g., mental health Gap Action Programme, mhGAP). However, less attention is devoted to systematic approaches that identify and address barriers to the development and uptake of mental health services within primary care in low-resource settings. Our objective was to prepare for optimal uptake by identifying barriers in rural Liberia. The country's need for mental health services is compounded by a 14-year history of political violence and the largest Ebola virus disease outbreak in history. Both events have immediate and lasting mental health effects. METHODS: A mixed-methods approach was employed, consisting of qualitative interviews with 22 key informants and six focus group discussions. Additional qualitative data as well as quantitative data were collected through semi-structured assessments of 19 rural primary care health facilities. Data were collected from March 2013 to March 2014. RESULTS: Potential barriers to development and uptake of mental health services included lack of mental health knowledge among primary health care staff; high workload for primary health care workers precluding addition of mental health responsibilities; lack of mental health drugs; poor physical infrastructure of health facilities including lack of space for confidential consultation; poor communication support including lack of electricity and mobile phone networks that prevent referrals and phone consultation with supervisors; absence of transportation for patients to facilitate referrals; negative attitudes and stigma towards people with severe mental disorders and their family members; and stigma against mental health workers. CONCLUSIONS: To develop and facilitate effective primary care mental health services in a post-conflict, low resource setting will require (1) addressing the knowledge and clinical skills gap in the primary care workforce; (2) improving physical infrastructure of health facilities at care delivery points; and (3) implementing concurrent interventions designed to improve attitudes towards people with mental illness, their family members and mental health care providers.

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Published In

BMC Health Serv Res

DOI

EISSN

1472-6963

Publication Date

July 27, 2017

Volume

17

Issue

1

Start / End Page

508

Location

England

Related Subject Headings

  • Social Stigma
  • Rural Health Services
  • Referral and Consultation
  • Psychotropic Drugs
  • Primary Health Care
  • Mental Health Services
  • Mental Disorders
  • Medical Assistance
  • Liberia
  • Humans
 

Citation

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Gwaikolo, W. S., Kohrt, B. A., & Cooper, J. L. (2017). Health system preparedness for integration of mental health services in rural Liberia. BMC Health Serv Res, 17(1), 508. https://doi.org/10.1186/s12913-017-2447-1
Gwaikolo, Wilfred S., Brandon A. Kohrt, and Janice L. Cooper. “Health system preparedness for integration of mental health services in rural Liberia.BMC Health Serv Res 17, no. 1 (July 27, 2017): 508. https://doi.org/10.1186/s12913-017-2447-1.
Gwaikolo WS, Kohrt BA, Cooper JL. Health system preparedness for integration of mental health services in rural Liberia. BMC Health Serv Res. 2017 Jul 27;17(1):508.
Gwaikolo, Wilfred S., et al. “Health system preparedness for integration of mental health services in rural Liberia.BMC Health Serv Res, vol. 17, no. 1, July 2017, p. 508. Pubmed, doi:10.1186/s12913-017-2447-1.
Gwaikolo WS, Kohrt BA, Cooper JL. Health system preparedness for integration of mental health services in rural Liberia. BMC Health Serv Res. 2017 Jul 27;17(1):508.
Journal cover image

Published In

BMC Health Serv Res

DOI

EISSN

1472-6963

Publication Date

July 27, 2017

Volume

17

Issue

1

Start / End Page

508

Location

England

Related Subject Headings

  • Social Stigma
  • Rural Health Services
  • Referral and Consultation
  • Psychotropic Drugs
  • Primary Health Care
  • Mental Health Services
  • Mental Disorders
  • Medical Assistance
  • Liberia
  • Humans