Community mental health nurses' experiences of decentralised and integrated psychiatric-mental health care services in Botswana

M.Cur.Community mental health nurses working in mental health units attached to general health facilities, like all trained psychiatric care providers in the mental health care services, have hopes and expectations about a well-running decentralised and integrated mental health care service. Their hopes and expectations will be seen to have been realised when general health care workers at all levels, cooperate and show a positive attitude towards mental health and mental health services by being involved in mental health services. Unfortunately the situation is probably the opposite, such that a number of community mental health nurses have left mental health services since the beginning of integration, to join other health sectors or other institutions. They probably could not cope with the decentralization and integration of mental health services into the general health care delivery system. This led to the researcher developing an interest to undertake a research study on the community mental health nurses' experience of decentralised and integrated psychiatric-mental health care services. A qualitative, exploratory, descriptive and contextual research design was undertaken to find out what the community mental health nurses are experiencing due to decentralization and integration of the psychiatric-mental health care services into the general health care delivery system. Permission was obtained from the gatekeepers. A pilot phenomenological interview was conducted with a community mental health nurse who met the selection criteria, to test and refine the interview question. The phenomenological in-depth interviews were conducted with twelve community mental health nurses who were purposively selected. Ethical measures were adhered to. Steps were taken to ensure trustworthiness of results. Data were analysed following methods suggested by Tesch (in Creswell, 1994:155). Follow-up interviews were conducted with one group of community mental health nurses. A literature control was undertaken to compare the findings. The results demonstrated that community mental health nurses working in mental health units attached to general health facilities are frustrated, discouraged, disappointed, unhappy, demoralised, have lost interest in mental health work and confused, because of uncooperativeness, lack of being appreciated, lack of interest, lack of support, rejection of mental health responsibility and generally a negative attitude of general health care workers (general nurse, medical practitioner, nursing management, immediate supervisors, administrators and higher authorities) towards mental health, mental health services and personnel. Guidelines for the advanced psychiatric nurse to assist community mental health nurses to cope with decentralization and integration of psychiatric-mental health care services have been described. The recommendation and application of the results of the research in nursing practice, nursing education and nursing research have been highlighted. Community mental health nurses working in the decentralised and integrated mental health care services need support from advanced psychiatric nurses in order to facilitate the promotion, maintenance and restoration of their mental health as an integral part of health. This will influence their ability to facilitate the promotion of patients' health