Table 1.

Bottlenecks identified in pilot study, reasons and modifications to the mental healthcare plan (MHCP) and implementation tools

Bottleneck and reasons	Modifications to MHCP and implementation tools
Paucity of referrals for depression to lay counsellors by primary healthcare nurses and minimal identification of alcohol use disorders
Organisational
High patient loads	Change management for district/facility managers and service providers
Limited time and space for consultation needed to identify symptoms	Inclusion of depression on chronic care form
Weak information system for mental health	Facility target for identification of depression/alcohol use disorders
Primary healthcare providers
Biomedical orientation	Alcohol use disorders PC101+ guidelines strengthened
Unattended personal issues	Strengthened employee assistance programme
Psychiatric stigma
Perception of depression/alcohol use disorders as a social problem     requiring referral to a social worker
Patients
Low mental health literacy	Waiting room educational talks
Defensiveness in divulging alcohol consumption	Information leaflets
Low follow-up of counselling referrals by counsellors
Organisational
Unclear role clarification of lay counsellor roles	Inclusion of primary healthcare nurse as case managers
Marginalised status
Primary healthcare providers
Low self-esteem	Role clarification of primary healthcare nurses and lay counsellors in PC101+ training
Lay counsellors
Unattended personal issues	Role clarification and stress management in lay counsellor training
Poor suitability to counselling role	Selection of dedicated lay counsellors
Patients
Low mental health literacy	Waiting room educational talks
	Information leaflets
High rate of defaulting on follow-up medication
Organisational
ICDM (no dedicated queue or nurse for psychiatric patients)	Strengthened role of community health workers in tracking patients with mental disorders
Poor tracking of defaulters
Primary healthcare providers
Psychiatric stigma	Strengthened orientation to mental health in PC101 +
Poor understanding of severe mental illness
Patients
Low mental health literacy	Psychosocial rehabilitation intervention
	Information leaflets
Low uptake of psychosocial rehabilitation intervention by caregivers
Organisational
Poor community outreach to families	Strengthened role of community outreach to provide psychoeducation
Primary healthcare providers
Poor understanding of the need to provide psychoeducation to families	Strengthened PC101+ training
Caregivers
Low mental health literacy	Focused engagement of caregivers by community outreach teams prior to programme
Psychiatric stigma

PC101, Primary Care 101; ICDM, integrated chronic disease management.