Attitudes towards mental health and the integration of mental health services into primary health care: a cross-sectional survey among health-care workers in Lvea Em District, Cambodia

Abstract

Background: Cambodia is a country where the resources for treating mental health disorders are far from sufficient. One strategy to narrow the treatment gap is to integrate mental health into primary health care (PHC). Understanding the knowledge and attitudes towards mental health integration that health-care workers have is important for assessing the challenges and opportunities when planning a potential integration project.Objective: The aim of this study was to assess these basic conditions in Lvea Em District, Cambodia.Design: A structured self-reporting questionnaire regarding attitudes and knowledge about mental health and its integration into PHC was collected from 75 health-care workers in Lvea Em District, Cambodia in October 2015. Firstly, descriptive analyses were carried out, and secondly, linear regression analyses to assess the relationship between attitudes and socio-demographic variables were conducted.Results: There was clear support towards integrating mental health services into PHC among these participants as 81.3% were interested in personally delivering mental health care at their units. Respondents who reported having received some kind of mental health-care training tended to have a more positive attitude towards mentally ill people (p = 0.005) and those who thought there was a high need for mental health care had a more favourable attitude towards the integration of mental health services (p = 0.007).Conclusions: The most important finding from this survey was the willingness and the acceptance of the need for integration of mental health care. This enhances the feasibility of integrating mental health services at the PHC level. Improving the competence of mental health care in these settings will likely help to reduce the treatment gap for mental, neurological and substance use disorders in Cambodia.

Mental health knowledge, attitudes, and self-efficacy among primary care physicians working in the Greater Tunis area of Tunisia

“…More specifically, most PCPs in our sample did not answer the following questions favorably: (1) people with mental illness are dangerous more often than not; and (2) the public does not need to be protected from people with mental illness. This fear, an effect of stigmatization common in other low-resource settings [ 12 , 27 – 30 ], may help explain, in part, why most PCPs in our sample (91.8%) reported feeling very confident in their capability to refer patients to more specialized care, which, in Tunisia, is frequently remote from the homes and communities of patients [ 23 , 58 ]. Confidence in referral to specialized care also seems to be concretely translated into self-reported practice; per week, PCPs refer most people consulting for mental health issues to specialized resources (55.6; SD = 30.8; Q1 = 30.0, Q2 = 50.0, Q3 = 80.0).…”

“…These negative experiences within the healthcare system are attributable in part to healthcare professionals’ stigma against mental illness. For example, studies show how common it is for healthcare workers to believe that people with mental illness are “violent” and “dangerous” [ 12 , 27 – 30 ]. Studies also show that stigmatizing views against mental illness encourage healthcare professionals to associate mental illness with personal, moral faults or weakness [ 13 , 14 , 31 ] and describe people consulting for mental health conditions with derogatory terms, such as “crazy” and “mad” [ 32 ].…”

Mental health in primary health care in a rural district of Cambodia: a situational analysis

“…In India it was found that primary care doctors described integration programmes of mental health into PHC as valuable and that they became more involved in the integration due to observed benefits of patients’ clinical outcomes and positive feedback from the patients [ 37 ]. Interviews with health care workers in Lvea Em District also show support of the integration of mental health services into PHC and most of them were willing to personally deliver mental health care [ 38 ].…”

Barriers and facilitators to the integration of depression services in primary care in Vietnam: a mixed methods study

“…Neimi et al identified low levels of knowledge of depression among health workers in northern Vietnam [ 30 ]. Low levels of knowledge about mental illness among PHPs has also been identified in other contexts, in both high-income [ 33 ] and low-income settings [ 34 , 35 ].…”