Mental Health Policy Implementation As An Integral Part Of Primary Health Care Services In Oshana Region, Namibia

ABSTRACT

Despite the 1990 health system reforms in Namibia, mental health still receives low priority. Pressed with limited resources, health policies are directed at communicable and life-threatening diseases. On primary health care level, there is either an absence of or fragmented mental health services. As a result, when patients suffering from common mental disorders visit the curative health services, delays are experienced in the identification and diagnosis of their conditions, which in turn leads to poor treatment and rehabilitation outcomes that often result in permanent disability that places a heavy burden of care on the family. It is against this background that a descriptive study of the implementation of the mental health policy was launched in 2005 in the Oshana region of Namibia in order to assess the extent of the policy’s implementation.

The aim of the study was to explore and describe the extent to which the mental health policy has been implemented and to identify the challenges faced by nurses in primary health care settings. A quantitative, explorative, descriptive design was used, in terms of which a total population of sixty-four (64) nurses from (13) health facilities and (12) health programme administrators in the Oshana region were included in the study. Data were collected using open and closed-ended questions to policy implementers whereas health programme administrators answered an open-ended self-administered questionnaire only.

The results of the study showed that there is a lack of supervisory support by general health service managers at all levels, from facility managers to regional health managers; restrictions that prohibit primary care nurses from prescribing common psychotropic medications; a shortage of mental health professionals to provide ongoing supervision and support to Primary care practitioners; and lack of training among the policy implementers in the identification and management of mental disorders.

Hence, basic mental health services such as counselling, follow up and after care of discharged patients, including home visits are not available in 94% of health facilities in the region. This study found that although 77% of the research participants were trained in mental health; none of them expressed confidence with regard to delivering mental health services to their clients. These results were found to be consistent with those of previous similar studies conducted in South Africa, Zambia, and Uganda. The challenges to mental health policy implementation that were identified by the participants include conflicting policies and the lack of guidelines for identifying and managing mental health disorders.

The study recommends that, health care providers should be provided with additional in service training in mental health in order to enhance their knowledge and skills to enable them to provide mental health care to their patients. The study further recommends that further research can be done to explore the possibility of having a separate division at both regional and district levels be created to oversee mental health policy implementation in the region. These recommendations are crucial for addressing the challenges inherent in the implementation of Namibia’s mental health policy.