PDF(Pubmed)
Abstract：
BACKGROUND: Mental health workers (MHWs) are exposed to conflicts of competence daily when performing tasks related to the provision of mental health services. This may be linked to a lack of understanding of their tasks as caregivers and providers. Furthermore, in most low-income settings, it is unclear how the available services are organized and coordinated to provide mental health care. To understand the above, this study aimed to identify the current mix of services for mental health care in the urban Democratic Republic of the Congo (DRC).
METHODS: A qualitative descriptive study was carried out in Lubumbashi from February to April 2021. We conducted 7 focus group discussions (FGDs) with 74 key informants (family members, primary care physicians, etc.) and 13 in-depth interviews (IDIs) with key informants (traditional healers, psychiatrists, etc.). We performed a qualitative content analysis, guided by an analytical framework, that led to the development of a comprehensive inventory of MHWs from the household level to specialized facilities, exploring their tasks in care delivery, identifying existing services, and defining their current organization.
RESULTS: Analysis of transcripts from the FGDs and IDIs showed that traditional healers and family caregivers are the leading providers in Lubumbashi. The exploration of the tasks performed by MHWs revealed that lifestyle, traditional therapies, psychotherapy, and medication are the main types of care offered/advised to patients. Active informal caregivers do not currently provide care corresponding to their competencies. The rare mental health specialists available do not presently recognize the tasks of primary care providers and informal caregivers in care delivery, and their contribution is considered marginal. We identified five types of services: informal services, traditional therapy services, social services, primary care services, and psychiatric services. Analyses pointed out an inversion of the ideal mix of these services.
CONCLUSIONS: Our findings show a suboptimal mix of services for mental health and point to a clear lack of collaboration between MHWs. There is an urgent need to clearly define the tasks of MHWs, build the capacity of nonspecialists, shift mental health-related tasks to them, and raise awareness about collaborative care approaches.
METHODS: A qualitative descriptive study was carried out in Lubumbashi from February to April 2021. We conducted 7 focus group discussions (FGDs) with 74 key informants (family members, primary care physicians, etc.) and 13 in-depth interviews (IDIs) with key informants (traditional healers, psychiatrists, etc.). We performed a qualitative content analysis, guided by an analytical framework, that led to the development of a comprehensive inventory of MHWs from the household level to specialized facilities, exploring their tasks in care delivery, identifying existing services, and defining their current organization.
RESULTS: Analysis of transcripts from the FGDs and IDIs showed that traditional healers and family caregivers are the leading providers in Lubumbashi. The exploration of the tasks performed by MHWs revealed that lifestyle, traditional therapies, psychotherapy, and medication are the main types of care offered/advised to patients. Active informal caregivers do not currently provide care corresponding to their competencies. The rare mental health specialists available do not presently recognize the tasks of primary care providers and informal caregivers in care delivery, and their contribution is considered marginal. We identified five types of services: informal services, traditional therapy services, social services, primary care services, and psychiatric services. Analyses pointed out an inversion of the ideal mix of these services.
CONCLUSIONS: Our findings show a suboptimal mix of services for mental health and point to a clear lack of collaboration between MHWs. There is an urgent need to clearly define the tasks of MHWs, build the capacity of nonspecialists, shift mental health-related tasks to them, and raise awareness about collaborative care approaches.
摘要：
背景：精神卫生工作者（MHW）在执行与提供精神卫生服务有关的任务时，每天都会面临能力冲突。这可能与缺乏对他们作为护理人员和提供者的任务的理解有关。此外，在大多数低收入环境中，目前尚不清楚如何组织和协调现有服务以提供精神卫生保健.为了理解上述内容，本研究旨在确定刚果民主共和国(DRC)城市地区目前的精神卫生保健服务组合.
方法：于2021年2月至4月在卢本巴希进行了一项定性的描述性研究。我们与74名关键线人(家庭成员，初级保健医生，等。)和13次与关键线人(传统治疗师，精神病医生,等。).我们进行了定性的内容分析，在分析框架的指导下，这导致了从家庭层面到专门设施的全面MHW清单的发展，探索他们在护理交付中的任务，识别现有服务，并定义他们当前的组织。
结果：对FGD和IDI转录本的分析表明，传统的治疗师和家庭护理人员是卢本巴希的主要提供者。对MHW执行的任务的探索揭示了生活方式，传统疗法,心理治疗,和药物是向患者提供/建议的主要护理类型。活跃的非正式护理人员目前不提供与其能力相对应的护理。现有的罕见精神卫生专家目前不承认初级保健提供者和非正式护理人员在护理提供中的任务，他们的贡献被认为是微不足道的。我们确定了五种类型的服务：非正式服务，传统治疗服务，社会服务,初级保健服务，和精神病服务。分析指出了这些服务的理想组合的倒置。
结论：我们的研究结果表明，心理健康服务的组合并不理想，并指出MHW之间明显缺乏合作。迫切需要明确定义MHW的任务，建立非专业人士的能力，将心理健康相关的任务转移给他们，并提高对协作护理方法的认识。
方法：于2021年2月至4月在卢本巴希进行了一项定性的描述性研究。我们与74名关键线人(家庭成员，初级保健医生，等。)和13次与关键线人(传统治疗师，精神病医生,等。).我们进行了定性的内容分析，在分析框架的指导下，这导致了从家庭层面到专门设施的全面MHW清单的发展，探索他们在护理交付中的任务，识别现有服务，并定义他们当前的组织。
结果：对FGD和IDI转录本的分析表明，传统的治疗师和家庭护理人员是卢本巴希的主要提供者。对MHW执行的任务的探索揭示了生活方式，传统疗法,心理治疗,和药物是向患者提供/建议的主要护理类型。活跃的非正式护理人员目前不提供与其能力相对应的护理。现有的罕见精神卫生专家目前不承认初级保健提供者和非正式护理人员在护理提供中的任务，他们的贡献被认为是微不足道的。我们确定了五种类型的服务：非正式服务，传统治疗服务，社会服务,初级保健服务，和精神病服务。分析指出了这些服务的理想组合的倒置。
结论：我们的研究结果表明，心理健康服务的组合并不理想，并指出MHW之间明显缺乏合作。迫切需要明确定义MHW的任务，建立非专业人士的能力，将心理健康相关的任务转移给他们，并提高对协作护理方法的认识。
