‘Private practice was my second option’: exploring barriers and facilitators to the delivery of mental health care by registered counsellors in South Africa

Abstract

The category of registered counsellor was created to service the mental health care needs of the South African population at primary health care level. However, a lack of employment opportunities for registered counsellors within primary health care settings resulted in many opting to work within private practice. In this study, we explored barriers and facilitators to the delivery of mental health care by registered counsellors. We employed purposive and snowball sampling to recruit 15 participants, who were registered counsellors in private practice throughout South Africa, and registered with the Health Professions Council of South Africa. Semi-structured interviews were conducted online via Skype. The interviews were audio-recorded, transcribed, and analysed using thematic analysis. We used the Capability, Opportunity, Motivation model of behaviour and the Theoretical Domains Framework as conceptual frameworks in the study. We identified facilitators and barriers that registered counsellors experienced in their attempts to provide mental health care at a primary care level. We identified three themes and named them as follows: (1) registered counsellors feeling competent, capable, and motivated to engage in community work, (2) the registered counsellor as an unacknowledged mental health professional, and (3) limited alternatives to private practice. We regarded the first theme as a facilitator, and the other two as barriers to the provision of mental health care by registered counsellors in private practice. These findings suggest that registered counsellors felt motivated and capable of providing mental health care, but that structural barriers prevent them from doing so.