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Table 1 Summary of participants’ concerns and recommendations on integrating mental health services into primary care

From: Recommendations from primary care providers for integrating mental health in a primary care system in rural Nepal

Concerns Recommendations
Integration of counselors into the primary care clinic
1. Workplace hierarchies 1. Train current PCPs as counselora
2. Lack of true collaboration between counselor and PCP 2. Co-manage patients between PCPs and counselors
3. Current clinic space may not provide privacy for counselor encounters 3. Create private space for mental health evaluations
4. Staff turnover and continuity of care 4. Recruit a senior and a junior counselor. If the senior person cannot be retained, the junior counselor will have received mentorship.
5. Use manualized therapy so a new counselor can take over care using the same principles of treatment.
5. High patient load for counselor 6. Consider group therapy rather than one-on-one therapy.
Consultation from an off-site psychiatrist
6. Reliability of off-site psychiatrist 7. Prioritize recruiting academic psychiatrists, who may have a flexible schedule and be reliable.
7. High number of patients for case review 8. Discuss amongst on-site clinicians first to decide which patients to discuss
9. Develop a priority order (e.g. by severity) and discuss those patients first, rather than trying to discuss all patients.
8. Consultation questions may not wait until the weekly review meeting 10. Allow urgent consultation throughout the week, in coordination with the PCP and counselor.
Training and Support for PCPs
9. PCPs may not be able to appropriately screen patients for mental illness 11. Train and support PCPs in screening, diagnosis and treatment of mental illness
12. Integrate screening tools into the medical records system
10. PCPs may not have the requisite clinical skills to follow the psychiatrist’s recommendations 13. Provide on-site training on clinical skills by a visiting psychiatrist
11. Risk of abuse of psychiatric medications. 14. (No recommendation)
  1. aCounselor: Psychosocial Counselor