Barriesr to the Utilisation of Mental Health Services in Zambia

Abstract

Globally, mental health is recognised as an important component of health. However, it is one of the most neglected areas in the health sector. Poor mental health has been linked to low socioeconomic status. With many Zambians living in poverty, susceptibility to these conditions is high. While Lusaka has better mental health services than any other province, under-utilisation has been reported. The situation can only be much worse in other provinces and rural areas with limited access to services at primary level. The aim of this study was to explore the barriers to the utilisation of mental health services in Zambia at policy, facility and individual level. A concurrent triangulation study was done in 2015; comprising a household survey of 270 participants from Chilenje Township in Lusaka and a qualitative case study of 12 participants including health workers, patients’ family members and policy makers. The case study was conducted in 2 secondary health facilities, a tertiary mental health facility and the Ministry of Health. Data was collected using questionnaires and interview guides. Proportions and logistic regression were used to analyse survey data while thematic analysis was used to analyse qualitative data. Inadequate financing to mental health services was observed as the main barrier to utilisation of services across the different levels investigated. Late detection of mental health conditions was attributed to little knowledge and low awareness about conditions, sometimes leading to relapse. Those knowledgeable about mental health conditions were over 3 times more likely to utilise services than those who were not (OR 3.1 95% CI, p=0.006). Knowledge could have led to utilisation or vice versa. Stigma from the community and health care providers and visits to traditional healers were also reported. There was a strong association between utilisation of services and stigma from health care personnel (OR 13.6 95% CI p< 0.001). A weak referral system was reported as well as lack of services at primary level. This was attributed to few health workers trained in managing mental health conditions despite undergoing basic training. The existing referral system and low levels of awareness in the community were also linked to overcrowding in secondary facilities. Overall, mental health services are hindered by inadequate financing, stigma and low prioritisation at facility level. As such, there is lack of services at primary level creating a pattern of utilisation that begins at secondary level. There is need to improve financing for mental health as well as strengthen efforts to educate the community about mental health and mental health conditions. Also, the stipulated referral system needs to be reinforced so as to strengthen service provision at primary level. Most health care providers have basic knowledge that allows them to do so. Key words: mental health services, barriers, health service utilisation, utilization, Zambia, community stigma, health care provider stigma