Metrics details. In low-and middle-income countries, integration of mental health into primary care is recommended to reduce the treatment gap. In this study we explored barriers to initial and ongoing engagement of people with severe mental disorders SMD in rural Ethiopia after implementing integrated primary mental healthcare services.
A qualitative approach was employed. Two focus group discussions were conducted with community health workers 10 per group. Thematic analysis was used. Most respondents reported improved access to care, usually equated with medication, and were motivated to remain engaged due to experienced benefits of care.
However, four main barriers to engagement emerged. In those who never engaged, geographical inaccessibility was an important barrier. Alternative cultural explanations for illness were only mentioned as a barrier only by two of the respondents. Economic interventions may be needed to support ongoing engagement in care for people with SMD.
Systems of care for chronic illness need to be strengthened in combination with legal frameworks. Expanded options for affordable and effective medication and psychosocial interventions are required for person-centred care. Supporting recovery in a person with a severe mental disorder SMD; referring to psychotic and affective disorders associated with enduring disability requires prompt and ongoing access to medical, psychological and social services.
In high-income countries, one in three people with SMD who have accessed evidence-based mental healthcare drop out of care prematurely [ 1 ]. Discontinuation of mental healthcare in such settings has been associated with younger age, male gender, lack of insight, expectations of cure and the presence of co-morbid alcohol and substance use disorders [ 1 ]. In LMICs, specialist mental healthcare providers and services are scarce. Thus, integration of mental healthcare into primary health care PHC through task sharing is a recommended approach to improve access to care [ 3 , 4 ].
