Assessing capability for implementing mental health counselling within primary care facilities in a middle-income country: A feasibility study.

ABSTRACT

WHAT IS ALREADY KNOWN ABOUT THIS TOPIC? Integrating mental health counselling into primary care services is a recommended strategy for reducing the mental health treatment gap in low- and middle-income countries. To support this strategy, potential barriers to counselling integration must be identified and addressed. Organizational preparedness for implementation may influence the extent to which the introduction of counselling is successful. Features of primary care facilities associated with preparedness for the implementation of mental health counselling have not been explored. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE? This study uses a novel approach to explore variations in preparedness of primary care services to implement counselling and factors potentially associated with these variations. Findings suggest there is considerable variation in the preparedness of facilities to implement counselling. Organizational factors such as resource availability, management style and facility environment are potentially associated with capability for implementing mental health counselling. WHAT ARE THE IMPLICATIONS FOR PRACTICE? Health planners could use this method to identify poorly functioning services that may benefit from additional interventions to build preparedness for counselling implementation. Future research should examine whether differences in facility preparedness impact on the implementation and outcomes of this service. Abstract Introduction Differences in primary care facilities' preparedness for implementing mental health counselling may affect the implementation process but have rarely been studied. Aim To assess the feasibility of using a novel methodological approach to explore variations in capability for implementing mental health counselling and factors potentially associated with this variation among primary care services in the Western Cape, South Africa. Methods Staff from 26 facilities participated in discussions about their facility's mental health implementation capability. Three researchers conducted observations of the facility's environment, staff-patient interactions and resources. We used qualitative comparative analysis to identify factors potentially associated with implementation capability. Results Facilities appeared to vary in their capability for implementing counselling services. The availability of person-centred health services, a therapeutic environment and sufficient human resources may be requirements for implementation preparedness. Other factors that seem to support preparedness include the availability of confidential space for counselling and an adequately managed facility. Discussion This study identified several features of well-functioning primary care facilities. Facilities with these features may be better prepared to implement a new counselling service. Implications for practice This method may identify facilities that are poorly prepared for implementation that could benefit from preparedness-building interventions. Whether differences in preparedness affect counselling outcomes is yet to be established.