Original Research

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

Lucy Maconick, Louis S. Jenkins, Henriette Fisher, Anthony Petrie, Lynnie Boon, Hermann Reuter
African Journal of Primary Health Care & Family Medicine | Vol 10, No 1 | a1660 | DOI: https://doi.org/10.4102/phcfm.v10i1.1660 | © 2018 Lucy Maconick, Louis S. Jenkins, Henriette Fisher, Anthony Petrie, Lynnie Boon, Hermann Reuter | This work is licensed under CC Attribution 4.0
Submitted: 22 October 2017 | Published: 24 May 2018

About the author(s)

Lucy Maconick, Improving Global Health, NHS Thames Valley and Wessex Leadership Academy, United Kingdom
Louis S. Jenkins, Department of Family and Emergency Medicine, Faculty of Health Sciences, University of Stellenbosch, South Africa; Department of Family Medicine, George Provincial Hospital, George, South Africa
Henriette Fisher, Conville Community Health Clinic, Eden district, Western Cape Department of Health, South Africa
Anthony Petrie, Western Cape Department of Health, George Provincial Hospital, South Africa
Lynnie Boon, Department of Psychiatry, Karoo GSA Mental Health, South Africa, George Provincial Hospital, George, South Africa
Hermann Reuter, Division of Primary Health Care, University of Cape Town, South Africa, George Provincial Hospital, George, South Africa


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 fromspecialists 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 staff to 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 staff to 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 staff had benefits to the integration of mental health into primary care. This approach could be relevant to similar contexts elsewhere.


primary health care; mental health; training; rural; nurses; integrated


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