A Review of Mental Health Practices in Primary Care

In this post we will be reviewing an article written by de Sá Cartana and colleagues that was published in The International Journal of Advanced Engineering Research and Science in July of 2019. The study was carried out in Brazil, and the article is titled “Practices in Mental Health in Primary Care: An Integrative Review.”

What did they do?

The authors of this review paper identified 22 studies that focused on the subject of mental health in primary care settings. They then categorized those studies into 4 main themes: (1) matrix support; (2) biomedical model; (3) importance of community health agent (CHA); (4) implementation of public policies in mental health, and examined how different structures contributed to the movement of integrating mental health care into primary care in Brazil.

Why did they do it?

In the introduction of this article, the authors highlight the movement in Brazil to integrate mental health care into primary care. The idea behind this movement is to develop a care strategy where the patients with mental health disorders could be supported. The authors explain that primary care is recognized as the gateway to any health service offered to society, and they make it clear that individuals with mental health difficulties should be included in the primary care model. This study was put together to better understand the different approaches in which behavioral healthcare can be embedded into a primary care setting.

How did they do it?

For the purposes of this review, two online databases were used to collect research: (1) A Scientific Electronic Library Online (SciELO), an electronic library that covers a selected collection of Brazilian scientific journals; (2) Latin American and Caribbean Literature in Health Sciences (LILACS). The results of the literature search were analyzed based on the categories previously mentioned.

What did they find?

Nearly all of the included 22 articles revealed that mental health policies are not accurately being implemented into practice in primary care. 22% of the articles explicitly explained the issues with mental health in primary care. Some of these issues at large include lack of assistance coverage for individuals with mental health issues, a disconnect between primary care services and other areas of attention related to mental health services, a lack of implementation of mental health public policy at the state level, and stereotyped views on mental disorders.

The matrix support category, which includes articles focused on integration in such a way that the emphasis is placed on the joint relationship between professionals from different professional backgrounds, was concluded to be fundamentally important. Many articles in the biomedical category cited problems with integration such that this model is focused primarily on the use of drug intervention as a means of treatment, which is not inclusive enough to be successful. Category 3 included articles focused on the involvement of a community agent. The main driving point here was that there is a professional, who is a part of the community, who is in regular contact with patients. A primary problem with this integration model was the unpreparedness of the professionals involved. The public policy category presented a primary concern regarding the difficulty for healthcare units to meet the demands of patients with mental health difficulties. This inability to meet such demands was attributed mainly to a lack of preparation of the team involved.

What does it all mean (our take)?

Behavioral health integration into a primary care setting is critical, and we have presented a summary of this particular article to demonstrate that this is not a problem that exists only in the United States, but the integration of behavioral health and primary care is actually a global effort. This article importantly demonstrates that all of the categories of integration (examined within this review) are flawed in unique ways. However, knowledge about areas of weakness is crucial in helping our continued efforts to build a system that connects the highly related worlds of mental and physical health.

We feel that when integration is eventually successful (and we do believe that this will happen), it will be the outcome of leveraging technology that most smoothly bridges the existing gaps between mental and physical health care. Continued innovation is important - as is some degree of change acceptance and risk taking on the end of primary care facilities.