Perceptions of primary mental health care in a semi-rural setting in the Eastern Cape of South Africa: a qualitative inquiry

Abstract

Despite extensive global efforts to prioritise and improve primary mental health care, challenges and opportunities within resource-constrained settings, particularly in low- and middle-income countries (LMICs) such as South Africa, persist. The study explored the barriers and opportunities in primary mental health care in a resourced-constrained setting in the Eastern Cape, South Africa. Moreover, and based on the rationale, the study explored how staff and patients within a low-resource community experience and perceive mental health care at a primary health level. Using a qualitative method, semi-structured interviews were conducted with 24 participants (patients = 11, staff = 13), recruited using purposive sampling. Thematic analysis of the data revealed three overarching themes: (1) Challenges and opportunities, (2) Medication and admission, and (3) Mental health is misunderstood. The findings suggest that patient experiences of mental health care in primary health clinics are complex, approaches to mental health care are predominantly pharmacological and that mental health stigma persists. The findings indicate the need for integrative approaches to mental health care and improved mental health literacy in communities. They also align with the key action areas outlined in the National Mental Health Policy Framework and Strategic Plan (2023-2030). However, decisive governmental investment, implementation, and leadership are necessary. Future research, through systems approaches and implementation science, should focus on enhancing primary health clinic experiences, expanding mental health care provision through various community-based implementation strategies, such as task-sharing, low-intensity psychological interventions, and implementing mental health literacy initiatives to mitigate the impact of mental health stigma.