Barriers to mental health services at public health centers: Providers’ perspectives

Abstract

Background and purpose: The disparity between the increasing prevalence of mental health (MH) illness and the availability of treatment in Indonesia remains high, despite the campaign to provide MH services at public health centers (PHCs) initiated by the government in 2014. This study explored barriers to provide MH services at PHCs in Denpasar, Bali, Indonesia in order to identify priorities to improve the services.Methods: This qualitative study was conducted from March to December 2015 and employed in-depth interviews and focus group discussions (FGDs). In-depth interviews were conducted with the Head of Denpasar City Health Office to explore the barriers of MH services provision at PHCs in the scope of policy and services management. Interviews with general practitioners (GPs) from 4 PHCs in Denpasar were conducted in order to explore the experiences and barriers of MH services in the PHC clinics. To explore further the MH services implementation in the community, two FGDs were conducted with the MH program managers and community health workers (CHWs). The interviews and FGDs were recorded, and the verbatim transcripts were analyzed using a thematic framework analyses.Results: Barriers to MH service provision identified in our study are poor dissemination of the national policy to the local government and PHCs; low prioritization of MH issues; organization workforce issues; funding concerns; poor coordination and supervision; poor management and recording system; scarcity of ancillary facilities and other resources such as psychotropic medicines.Conclusion: The findings of this study highlight the importance of national policy dissemination and collaboration between local government, health providers and CHWs to overcome the barriers in providing MH services at PHC level.