Screening intake |
1. Mistrust of informal health providers |
Patients tend to have negative biases towards healers |
40 |
1.1 Belief system |
Patients’ belief systems are in opposition to those of healers |
14 |
1.2 Secondary gain |
Patients assume that healers make some form of material gain |
7 |
1.3 Mental health credentials |
Patients believe healers lack the necessary credentials |
11 |
1.4 Suggestions |
Informal Health Providers (IHPs) made suggestions as to how to break these biases |
10 |
2. Cultural misunderstanding and stigma of mental health |
General misunderstandings and often negative associations about mental health |
37 |
2.1 Lack of knowledge |
No knowledge about mental health |
12 |
2.2 Stigma around mental disorders |
Negative beliefs about mental illness |
7 |
2.3 Social support |
Partly because of stigma, families and friends do not support the mentally ill |
16 |
2.4 Fear of treatment |
Fears about the hospital testing and procedures for mental disorders |
5 |
2.5 Suggestions |
IHPs provided opportunities that can be used to reduce these negative perceptions |
12 |
Between screening and treatment |
3. Resource barriers |
Lack necessary resources (financial, time, etc.) to travel to hospital for treatment |
61 |
3.1 Patient resources |
Patients lack funds to pay for public transport to the hospital, or for food (requiring work at time of appointment) |
38 |
3.2 IHP resource barriers |
IHPs lack resources for themselves and for supporting their patients |
33 |
3.3 Suggestions |
IHPs suggest ways of dealing with the above barriers |
10 |
4. Resistance to treatment |
Patients resist treatment in multiple ways (e.g. illness denial, refusal to go to hospital, substance addiction) |
25 |
4.1 Suggestions |
IHPs identify ways of strengthening the willingness of patient referral for those suffering from mental illnesses |
11 |
5. Limitations of the referral system |
Lack of recognition on the limit of IHPs’ role in the task-sharing model, resulting in responsibilities outside their role as referrers |
25 |
5.1 Suggestions |
IHPs emphasized the need for specialized training such as counselling to know how to motivate patients who have lost hope, to seek further treatment without being accompanied by IHPs |
5 |
During treatment |
6. Treatment infrastructure issues |
Many logistical challenges are faced upon arrival to the hospital |
39 |
6.1 Procedural issues |
Some untrained hospital staff often do not recognize referral forms |
24 |
6.2 Drug availability |
Drugs are often unavailable at the hospital and patients are forced to purchase elsewhere |
9 |
6.3 Limited medical staff |
There are often limited medical staff and long queues at the health facilities |
6 |
6.4 Suggestions |
IHPs suggested how to improve infrastructure issues |
5 |