Mental health in primary care: Integration through in-service training in a South African rural clinic

Background: Integrating mental health into primary care is a global priority. It is proposed to 'task-share' the screening, diagnosis and treatment of common mental disorders from specialists to primary care workers. Key to facilitating this is training primary care workers to deliver mental health care. Mental health training in Africa shows a predominance of short-term, externally driven training programmes. Locally, a more sustainable delivery system was needed. Aim: The aim of the study was to develop and evaluate a locally delivered, long-term, inservice training programme to facilitate mental health care in primary care. Methods: This was a quasi-experimental study using mixed methods. The in-service training programme was delivered in weekly 1-h sessions by local psychiatry staffto 20 primary care nurses at the clinic over 5 months. The training was evaluated using quantitative data from participant questionnaires and analysis of the referrals from primary to specialist care. Qualitative data were collected via semi-structured interviews and 14 observed training sessions. Results: The training was feasible and well received. Referrals to the mental health nurse increased in quality and participants' self-rated competence improved. Additional benefits included the development of supervision skills of mental health nurses and providing a forum for staffto discuss service improvement. The programme acted as a vehicle to pilot integration in one clinic and identify unanticipated barriers prior to rollout. Conclusions: Long-term, in-service training, using existing local staffhad benefits to the integration of mental health into primary care. This approach could be relevant to similar contexts elsewhere.