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BMC Health Services Research
Published in: BMC Health Services Research 1/2016

Open Access 01-12-2016 | Research article

Perceptions of health managers and professionals about mental health and primary care integration in Rio de Janeiro: a mixed methods study

Authors: Karen Athié, Alice Lopes do Amaral Menezes, Angela Machado da Silva, Monica Campos, Pedro Gabriel Delgado, Sandra Fortes, Christopher Dowrick

Published in: BMC Health Services Research | Issue 1/2016

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Abstract

Background

Community-based primary mental health care is recommended in low and middle-income countries. The Brazilian Health System has been restructuring primary care by expanding its Family Health Strategy. Due to mental health problems, psychosocial vulnerability and accessibility, Matrix Support teams are being set up to broaden the professional scope of primary care. This paper aims to analyse the perceptions of health professionals and managers about the integration of primary care and mental health.

Method

In this mixed-method study 18 health managers and 24 professionals were interviewed from different primary and mental health care services in Rio de Janeiro. A semi-structured survey was conducted with 185 closed questions ranging from 1 to 5 and one open-ended question, to evaluate: access, gateway, trust, family focus, primary mental health interventions, mental health records, mental health problems, team collaboration, integration with community resources and primary mental health education. Two comparisons were made: health managers and professionals’ (Mann-Whitney non-parametric test) and health managers’ perceptions (Kruskall-Wallis non parametric-test) in 4 service designs (General Traditional Outpatients, Mental Health Specialised Outpatients, Psychosocial Community Centre and Family Health Strategy)(SPSS version 17.0). Qualitative data were subjected to Framework Analysis.

Results

Firstly, health managers and professionals’ perceptions converged in all components, except the health record system. Secondly, managers’ perceptions in traditional services contrasted with managers’ perceptions in community-based services in components such as mental health interventions and team collaboration, and converged in gateway, trust, record system and primary mental health education. Qualitative data revealed an acceptance of mental health and primary care integration, but a lack of communication between institutions. The Mixed Method demonstrated that interviewees consider mental health and primary care integration as a requirement of the system, while their perceptions and the model of work produced by the institutional culture are inextricably linked.

Conclusion

There is a gap between health managers’ and professionals’ understanding of community-based primary mental health care. The integration of different processes of work entails both rethinking workforce actions and institutional support to help make changes.
Appendix
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Footnotes
1
From this explanation on referred to the Brazilian National Health Service simply as SUS.
 
2
Grupo Interdisciplinar de Pesquisa em Atenção Primária à Saúde—CNPq (Conselho Nacional de Desenvolvimento Científico) (http://​dgp.​cnpq.​br/​dgp/​espelhogrupo/​9879901048555185​).
 
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Metadata
Title
Perceptions of health managers and professionals about mental health and primary care integration in Rio de Janeiro: a mixed methods study
Authors
Karen Athié
Alice Lopes do Amaral Menezes
Angela Machado da Silva
Monica Campos
Pedro Gabriel Delgado
Sandra Fortes
Christopher Dowrick
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1740-8

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