The outcomes of implementing the Department of Health mental health clinical guidelines for the management of psychiatric patients at primary health care clinics.

Abstract

Background: The South African (SA) government recognizes that the first step towards improving mental health and wellbeing of the people is to develop effective guidelines .After guidelines have been developed, there is a need for transferring them to the implementing settings. It has been noted that mental health guidelines are important tools for enhancing framework of the mental health system. Objectives: The objectives for the study were: (1) To analyse the process inherent in the implementation of the guidelines in PHC settings in KZN based on action research; (2) To analyze the awareness, knowledge, perceptions and implementation practices of Primary Health Care Nurses of the treatment guidelines for common mental health conditions in their primary health care practice; and (3) To evaluate the readiness for a change management programme for the sustainable implementation of appropriate clinical guidelines in selected primary health care practice contexts. Method: A survey was conducted amongst nurses working in PHC clinics in order to determine the outcomes of implementing the Department of Health mental health clinical guidelines for the management of psychiatric patients at primary health care clinics. Qualitative and quantitative methods were used. Results: The study found that quality of care was compromised when the implementation of a mental health policy was flawed in all seven major implementation themes. Services for psychiatric patients were only available daily in four of the sites (66.7%). Patients attending the other two sites (33.3%) were seen by a psychiatrically trained nurse on a dedicated day once a month. PHC nurse’s attitudes and beliefs toward people with mental illness were positive, but did not have adequate knowledge to manage psychiatric patients. Conclusion: The identified a number of gaps in the implementation of Standard Treatment Guidelines for Common Mental Health conditions in primary health care settings as an example of the policy implementation process in rural areas.