Perceptions of stakeholders regarding integration mental health into primary health care in Pakistan

A considerable world population (450 million people) is suffering from some form of mental health (MH) disorder. The gap between individuals who get diagnosed and those who are treated, impose considerable productivity loss to the society. The financial constrains in Low and Middle Income Countries (LMIC) further exaggerates the issue. In Pakistan the prevalence of mental health diseases is comparatively higher in rural areas than urban setting. There are few institutions which are providing mental health care and their density is mostly around cities. There are only 5 mental health hospitals in the country and they are located in urban areas. To provide accessible mental health care it is important to integrate mental health into primary care. The World Health Organization (WHO) has also emphasized the integration of mental health in primary health care (PHC). Significantly, some of the LMIC have integrated mental health services with primary health care. Aim of study: The aim of this study is to inform the policy and implementation level gaps, by exploring the perception of stakeholders for integration of mental health into primary health care. Methodology: An exploratory qualitative study design was used. Using self-developed study guide, in-depth interviews were conducted to collect data from policy decision making and implementation level stakeholders. Purposive sampling was used for selection of participants. Analysis was done using NVivo version 10. Findings: All stakeholders considered mental health as integral part of health and felt the need of mental health integration into primary health care. The findings showed that although there is a general willingness among all stakeholders for integration, there are some underlying reservations. Firstly, there is lack of support from the system in terms of resource allocation and acceptance from community. Secondly, there is lack of human resource in the field of mental health. in addition, there is resistance at primary care level as they are already burdened with other services. Strong political commitment, adequate human and financial resources and strong advocacy are needed for integration of mental health into primary health care in Pakistan. Conclusion: The study findings revealed that MH is considered an important component of health by both decision making and implementation level stakeholders. The importance of MH at individual, community and national level was acknowledged. The study also showed that there are many flaws in the current MH services in Pakistan due to which MIT issues are not properly addressed in the Country. The stakeholders recommended that MH should be integrated into PHC in order to improve the MN situation, but there is a dire need of strong political commitment, human and financial resources, mass level awareness and strong advocacy. Furthermore, there needs to be modifications in the current 131-IC setup before MH can be integrated into PHC