Integrating mental health into primary care for post-conflict populations: a pilot study

Chesmal Siriwardhana, Anushka Adikari, Kaushalya Jayaweera, Buddhika Abeyrathna, Athula Sumathipala

Mental health care in post-conflict settings is often not prioritized, despite its important public health role. There is a salient gap in integrating mental health into primary care, especially in post-conflict settings. In the post-conflict Northern province of Sri Lanka, a pilot study was conducted to explore the feasibility of integrating mental health into primary care through a mhGAP-based training intervention. Using the mhGAP training intervention modules, a 24 h training programme was held over 3 days for primary care practitioners serving post-conflict populations (including internally displaced people and returnees). mhGAP intervention guide and video material was used in the training. Pre/post knowledge increase was measured. A qualitative study was also nested within the training programme to explore views, attitudes and perceptions of primary care practitioners on integrating mental health into primary care in the region. In-depth interviews were conducted. Twelve primary care practitioners participated. The average service duration of the group was 7.6 years. The mean pre- and post-test scores of the PCP group were 72.8 and 77.2 % respectively. All 12 took part in the qualitative component. Participants highlighted their experiences of conflict and displacement, discussed the health profiles/needs of post-conflict populations in the region and provided insight into mental health care and training needs at primary care level. Participants also provided feedback on the mhGAP-based training; the cultural and contextual relevance of training material and content. This study was planned as a local demonstrative project to explore the feasibility of training primary care practitioners to promote the integration of mental health into primary care for post-conflict populations. To our knowledge, this is the first such attempt in Sri Lanka. Findings highlight the practical, operational and attitudinal barriers to integrate mental health into primary care, especially in resource-poor, post-conflict settings. Important feedback on mhGAP intervention guide, its implementation and training material was gained.