Table 1 Mapping stakeholder perspectives on what matters most in relation to mental health services in primary care

Equality in health services

Emphasized the importance of being treated by HCPs equally to people with physical health conditions.

Highlighted the importance of maintaining professionalism and treating all PWLE equally regardless of their condition.

Policymakers reinforced the importance of integrating mental health into primary care, aiming to provide equal treatment for mental health disorders and physical disorders.

During training, the shared goal to be highlighted: Equality is important to PWLE experiences, to demonstrate professionalism of providers, and to care systems by policymakers.

Support/ compassion

Underscored that their experiences were improved when HCPs adopted compassionate and responsive approaches, regardless of their mental health conditions.

Expanding their roles to establish a supportive environment for PWLE, noting that staff attitudes and support may vary.

The attitudes of healthcare managers were mixed, and managers were reluctant to support PWLE in distress.

In training sessions, emphasize the common goal by acknowledging compassionate and responsive approaches, incorporating role-playing exercises to hone compassion-building skills and focus on de-escalation techniques.

Confidentiality

Assuring that confidentiality regarding their condition will be maintained by HCPs.

Building trust and assuring confidentiality helps PWLE to disclose about their condition and treatment needs.

While proactive measures are implemented in certain PHCs to safeguard the confidentiality of SU, there is a need for improvement in the structural facilities of other centres.

This could be addressed by structural changes in providing private physical spaces and confidential record keeping in addition to strict policies.

Competency and time

Emphasized that while HCPs were perceived as competent, there was a need for an increased allocation of time to address their concerns and needs effectively.

Having protected time devoted to mental health care. Having adequate training and continuous supervision provided by MOPH to ensure competency.

Policymakers underscored the need for competent HCPs, for more time, and training to be offered for them. Policymakers raised concerns about staff turnover in mhGAP-trained personnel and discontinuity of support and supervision.

Setting up systems that allow for more time for providers to get training, supervision, and deliver MH services which require more allocation of funding.

Willingness

Hesitancy to offer mental health treatment due to concerns about expanding their main responsibility. Preferred to refer mental health issues to specialized professionals and institutions.

Limited management willingness to adjust job descriptions for mental healthcare indicated reluctance to make structural changes and integrate mental healthcare within the PHC.

Collaborative engagement between specialists and primary care workers is crucial, along with policy changes to reinforce the delivery of mental healthcare by HCPs.

Burnout/ Self-care

Burnout was a common occurrence due to long work hours, dealing with PWLE and other stresses like high workloads and poor support.

Some managers challenged the burnout claims validity, believing that working hours are sufficient while acknowledging external and personal stressors. Other managers advocated for increased staff numbers to alleviate the burden on team dynamics.

The need for a comprehensive approach through self-care and support to manage employee burnout, considering variables like staffing, communication, and patient education.

Resource sustainability

Financial barriers to accessing care (e.g., transportation costs, medications cost when out of stock, etc.).

HCPs should be compensated for providing mental health care. Training attendance days should be compensated.

Policymakers emphasized the need for sustainable funding by addressing human resources sustainability, the integration of MH into PHCs.

Ensuring access to care through PHCs as a solution, adequate funding is needed for staffing, integrating mental health, training, medication sustainable provision, the establishment of community mental health services, referral systems, and enhancing overall access to care.

Stigma

Reduced discrimination from HCPs, frontliners and centre management.

Acknowledged that PWLE experienced stigma and discrimination.

PHC Managers displaying stigma towards PWLE contributed to their resistance in integrating mental health services.

Stigma reduction interventions for HCPs must include addressing stigmatizing beliefs and the negative societal attitudes prevalent in the community significantly impacting PWLE’s willingness to seek mental health care.

Misconceptions

Misunderstandings about seeking mental healthcare and using medication for mental health disorders.

Certain behaviours were inherent to a person’s personality rather than symptoms of a mental disorder.

Cultural and religious beliefs as per HCPs often contributed to myths and stigma surrounding mental health, connecting them to faith and discouraging professional help.

Training HCPs to engage in myth-dispelling conversations with PWLE and their families by providing educational materials to counter common misconceptions.