Should mental health be integrated in primary health care? Issues and prospects in selected rural health units in Batangas, Philippines

Abstract

The World Health Organization recommends the integration of mental health services in primary health care. This is due to the fact that the global burden of disease due to mental illness is on the rise and that the impact on individual quality of life and economic productivity can be enormous (Murray and Lopez, 2013). Moreover, psychological factors are known to be risk factors, and have indubitable effects on the development and progression of various forms of diseases and other physical illnesses. This study aimed to explore the feasibility of incorporating mental health services in government-run Rural Health Units (RHUs) through the identification of the various factors that facilitate or impede the offering of these services to the general population. A facility based survey of 262 patients and 247 health care providers was conducted in four RHUs in the province of Batangas. The Self-Reporting Questionnaire-20 (SRQ-20) developed by the World Health Organization (1994) was administered to patients to determine the presence of mental disorders as defined by the Diagnostic and Statistical Manual, version 5 (DSM-5). A structured questionnaire dealing with mental health training and competencies, knowledge and attitudes toward mental disorders and the provision of mental health care in the RHUs, was also administered to health care providers. This was followed by semi-structured interviews with the heads of the RHUs and a focus group discussion with selected patients for more in-depth understanding of the issue. Descriptive statistics and thematic analysis of qualitative responses including quotable quotes were used to analyze the data. The results show that 17.2 percent of the patients consulting in the RHUs exhibited common mental disorders (CMDs) such as depression, anxiety, and somatic disorders. Only 3.2 percent of the health care providers had mental health training, which significantly resulted in an overall low mental health knowledge, ambivalent attitudes toward integration, and inadequate competencies. The overall RHU structure and health system showed lack of routine screening procedures, absence of mental health specialist supervision, and lack of policies and budget for mental health. These findings indicate that the psychological aspects of health care are largely neglected despite its crucial role in improving overall health outcomes. This study therefore, recommends the development and prioritization of policies and programs on mental health, provision of more intensive mental health training of health care providers, inclusion of behavioral health specialists as regular staff in local health centers, and intensification of patient and community education and information dissemination in order to significantly improve the mental health status of Filipinos.