Primary healthcare is meeting the needs of the population (each person, family and community) by providing medical services at the first contact with the health system, comprehensive services close to the place of residence and work. Primary health care is currently defined as the zone of the first contact of the population with health services as the first stage of public health protection. The provision of primary health care is one of the guarantees of medical and social assistance.
Improving primary healthcare is one of the priority tasks of national healthcare. The development of primary healthcare will increase the availability of this type of care for the population and, consequently, the satisfaction of patients with the quality of medical care. An important role in the organization of primary health care is played by specialists with nursing education, who are currently given the opportunity to independently solve a number of medical and social problems when serving patients within their competence.
Mental health services may be defined as a method of treatment based on the interaction of two or more people. Psychotherapeutic treatment consists in the fact that a person talks with a psychotherapist or, for example, with members of a therapeutic group about those problems for the solution of which he needs therapy. For instance, through conversation, a person can sort out difficult experiences and find a solution to his problems. These services are based on interpersonal interaction; Mental health services are a treatment that has clear goals. Specialists try to relieve or overcome the suffering caused by a mental disorder or other life problems through conversation. Studies have shown that psychotherapy is an effective remedy for, for example, depression.
Evidence-based practice is a practice in which decisions about health care must be based on the best available, current, correct and relevant evidence. These decisions must be made by patients in healthcare settings based on the implicit and explicit knowledge of healthcare providers, as well as taking into account the number of resources available (Dang & Dearholt, 2017). Here, it seems rational to state that primary health care and mental health services should be integrated in order to ensure society’s well-being and solid psychological state. Below, through the lens of evidence-based practice, the appropriacy of this integration will be discussed.
The modern development of society imposes on health systems, as the main structural units, requirements for a more effective response to the contemporary challenges of the changing world caused by the processes of globalization, socio-economic development. People are increasingly intolerant of the fact that health services cannot provide levels of national coverage that meet the stated demand and changing needs and that the quality of the services offered does not meet their expectations (Ahmad et al., 2017). The solution to these problems, according to the conclusions of the international expert community, is possible with the effective development of primary health care.
Primary health care is a type of medical care that includes measures for the prevention, diagnosis, treatment of diseases and conditions, the formation of a healthy lifestyle and sanitary and hygienic education of the population, is provided on an outpatient basis and in a hospital. The results of the analysis indicate a significant decrease in mortality from all causes (Ahmad et al., 2017). These include mortality from diseases of the circulatory system with an increase in the volume of outpatient care, the amount of funding for outpatient care, and the provision of medical personnel in the provision of outpatient care.
An increase in the volume of outpatient care leads to a decrease in the incidence of diseases of the circulatory system, but at the same time, an increase in spending on this type of medical care does not entail a decrease in the number of cases, which indicates the expenditure of funds, in most cases, on the treatment of an already arisen disease, and not on preventive measures to prevent the occurrence of conditions in the population (Ahmad et al., 2017). The priority development of the organization of primary health care creates conditions for the formation of a holistic approach to the health of the population to strengthen the preventive direction in work. The creation of conditions for the walking accessibility of primary health care to the people, the development of the provision of medical care by mobile teams is necessary for the implementation of the principle of the availability of this type of care.
Integration of Primary Healthcare and Mental Health Services
Mental disorders are one of the main problems of our time, as evidenced by their prevalence and the resulting burden of disease and disability. Mental illnesses are common among the most vulnerable and disadvantaged groups of the population. Life expectancy for people with mental disorders is many years less than for the general population in the same age and gender groups, which is due to comorbidities and the relationship between cognitive and somatic health disorders. According to the WHO, persons with mental disorders account for a disproportionately higher proportion of disabilities and deaths (Xiang, et al., 2018). People with major depression and schizophrenia are 40-60% more likely to die prematurely than those without disabilities due to suicide and often overlooked physical health problems (e.g., cancer, HIV).
Suicide is the second common cause of death for young people worldwide. Taken together, substance use mental disorders have a powerful impact on public health, accounting for 13% of the global burden of disease, with depression alone accounting for 4%; social groups may be at significantly higher risk of developing mental health problems (Xiang, et al., 2018). These vulnerable groups can include people of low economic status, people with chronic illnesses, natural disasters or other humanitarian disasters.
Monitoring the state of mental health, prevention and treatment of mental disorders with the subsequent rehabilitation of patients are the most important prerequisites for protecting and improving the quality of life, well-being and productive activities of citizens and their families. Thus, the stability of society against external negative influences is achieved (Xiang, et al., 2018). The development of mental health care is moving towards the provision of medical and social services for mental health care outside the hospital. However, the progress made in this direction is not so obvious. It is unanimously recognized that in large psychiatric hospitals, patients are often not given the necessary attention, which leads to the risk of developing the so-called hospitalism syndrome.
Increasing the role of primary health care is becoming urgent, and one must work in close partnership with multidisciplinary mental health groups in community settings. Modern methods of therapy for mental disorders can effectively treat many mental illnesses. With timely treatment, social deterioration and suicide can be prevented (Simpson et al., 2020). However, many people with mental disorders do not receive modern medicine in a timely manner and in full. Citizens with mental disabilities often do not seek medical care due to fear of stigma and discrimination, as well as because of negative experiences of previous treatment.
Mental health development strategies involve structural reform of the delivery of health and social services with an emphasis on quality, which ultimately should ensure the provision of effective forms of treatment and social support. The need to develop programs for the primary prevention of mental disorders in mentally healthy people is also obvious (Xiang, et al., 2018). At the same time, the primary prevention of mental disorders, and those suffering from mental illnesses, requires a complex interdisciplinary and interdepartmental approach based on coordinated actions on the part of both specialists employed in psychiatry and specialists from other areas of practical knowledge, representatives of the state, culture, media, business, and other spheres of society.
Currently, the executive bodies of state power are faced with the need to solve problems of a very different nature, including the issues of improving the quality of life of the population in general and rendering assistance to persons with mental health problems, in particular. Solving these problems requires consistent actions at the system level. Interdepartmental interaction of executive authorities, institutions of state and other forms of ownership, as well as public organizations, is gaining great importance. Each government and non-government agency and institution has a role to play in this area. Sustainable financing of health and social policies is a prerequisite for achieving mental health goals. The availability of psychiatric care and social support largely depends on the economic well-being of the region.
Integration of Primary Healthcare and Mental Health Services From the Community-Based Approach
In developed countries, traditional psychiatric hospitals have been replaced by small dormitories for people with severe mental disorders and day centers for patients for various therapeutic activities (in fact, outpatient supervision). There is also a clear work of community services, whose activities are focused on providing therapy in the patient’s place of residence, treatment at the initial stages of disease development, crisis services and supportive treatment (Nadeau et al., 2017). Finally, the number of staff was increased, in particular social workers, occupational therapists, and the possibility of training employees in new working conditions was provided.
Of course, the priorities and goals of reform in each specific country largely depend on financial support. Low-resource countries are encouraged to focus their efforts on establishing and improving mental health services in primary healthcare settings and using specialized services as a backup. This is due to the fact that the maintenance of traditional psychiatric hospitals is much more expensive than outpatient services or community services (Nadeau et al., 2017). At the same time, the effectiveness of alternative forms of providing psychiatric care is quite high. Medium-income countries should strive to develop well-developed outpatient services, community-based services such as long-term accommodation and vocational rehabilitation, and short-term emergency services. Many of these tasks can be solved in our country today. For example, in the face of another reduction in bed capacity, the current alternative is the development of community mental health services that can organically complement the existing system. These services provide assistance to patients with a psychiatric profile who live in a certain area, and the main principle of their work is the integration of such patients into society.
Community services provide patients and their families with information on self-help methods; treats the most common mental illnesses. Their competence also includes prevention, treatment and rehabilitation of patients with severe disorders at the place of residence, hospitalization in local institutions (health centers or central district hospitals); support for the staff of residential homes for people with chronic mental health problems; other types of services, including forensic psychiatric examination.
The recommended population size of the community is 100-150 thousand people. The content and scope of care are determined individually, depending on the needs of each patient and the resources of the team (Nadeau et al., 2017). The specialists involved in the work of such brigades are motivated to actively train in the field of organizing assistance to people who find themselves in a zone of military conflict or political provocations. And one can be sure that it is in these regions that the best practices for providing emergency psychiatric and psychological assistance will soon be accumulated, especially for people who find themselves in emergency situations. International experience demonstrates not only the clinical but also the cost-effectiveness of community mental health services. Moreover, this type of care is preferred by the patients themselves.
The following organizational models have been proposed. The first is represented by a specialized medical center for mental health, which includes a psychiatric hospital with dispensary observation, a day hospital, and mobile community mental health teams. The Psychiatric Hospital provides specialized inpatient care for residents of the hospital district with mental health problems, in particular those developed as a result of the use of psychoactive substances. In addition, the mental hospital provides counseling services to all health care facilities in the hospital district.
The second organizational model is represented by the dispensary department, day hospital, mobile community teams, which are a structural subdivision of the hospital of planned treatment. Dispensary specialists provide advice to all medical institutions in the district. Inpatient psychiatric treatment in a hospital district under this model can be provided either in a psychiatric unit within the structure of a general hospital or in an inter-hospital psychiatric hospital. The third model is represented by an inter-hospital specialized mental health center, which serves the population of two or three hospital districts (Nadeau et al., 2017). This would include a psychiatric hospital with a dispensary department, a day hospital, and mobile community teams. Such a center provides advisory assistance to all medical institutions in these hospital districts. Thus, it seems apparent that the integration of primary healthcare and mental health services is achievable if to adhere to the community-based approach.
To conclude, a number of essential issues related to the themes of mental health services and primary healthcare were discussed. It was found that the mentioned concepts demonstrate a great degree of correlation and may positively affect the well-being of society as a whole. Through the perspective of evidence-based practice, it was shown that the integration of primary healthcare and mental health services could be achieved by coherent and consistent actions of the authorities, which may address a number of pressing issues of today. It is crucial to promote programs that would take into account the mentioned integrative approach – this can benefit a plethora of stakeholders and improve the reputation of a healthcare system.
Then, according to another critical section of the research, community-based mental health services can be considered as an appropriate option to implement and even as a perspective through which primary healthcare and mental health services can be integrated. After analyzing a number of reliable scholarly publications, three organizational ways of the community approach – within the scope of the topic – were identified. Hence, there are many strategies that can be followed in order to achieve the necessary extent of integration of primary healthcare and mental health services. Such a state of affairs allows assuming that further research is required to elaborate on the topic even more. For instance, researchers can view the issue from the angle of the diversity of communities and the related problem of developing a unified approach.
Mental health may be defined as the absence of psychiatric disorders, as well as the presence of crucial inner prerequisites of an individual to address possible issues related to his or her mental state. Mental health interventions are aimed at assisting a person in dealing with factors that may negatively affect – or has already affected – his or her psychological state. The mental health system in the future should be founded on evidence-based practices, as well as appealing to a significant community approach as discussed above.
It should be noted that the warning signs of a mental health illness include the following – feeling sad, reduced capabilities to concentrate, problems with sleeping, excessive fears. Withdrawal from friends and considerable mood changes may also be mentioned, among other of these warnings. Such an impressive list of signs implies that an individual should be cared for constantly. In this vein, it seems reasonable to stress that mental health nurses help in the promotion and support of people’s recoveries, as well as enable them to possess a significant extent of control over their conditions.
The profession connects nurses with contingents of patients, differing in somatic status, socio-demographic characteristics and the degree of connection with relatives and legal representatives. The variability of procedural practices and communication spaces gives rise to the specific nature of the professional activity, specializes, narrows professional courses and is reflected in additional specialized ethical norms.
An important part of patient care is the organization of his lifestyle, contributing to his or her speedy and final recovery. In mental healthcare, treatment regimes are organized, taking into account the need for the following. First, it is the prevention of socially dangerous acts of patients, escapes, suicidal and accidents. Secondly, it is the minimization of the isolation of patients from society with the maximum non-constraint of patients. Thus, the supervisory functions of the staff, the deviant behavior of patients, the high degree of closeness of psychiatric treatment and prevention institutions create the prerequisites for the specialization of the professional group of nurses in psychiatry. It should also be emphasized the need for the formation in the professional field of this community of special mechanisms for maintaining tolerance towards patients.
As evident from the above discussion, there are many factors that can contribute to mental disorders. It should be stressed that the psychological state of a person cannot be considered as a static phenomenon that can be isolated from these factors. In contrast, they rather form and shape the mentioned state and tend to press even more in the modern era of biological and environmental issues. Moreover, given free access to the Internet from almost every point in the world, an individual is also continuously affected by enormous flows of information that, at times, may result in psychological pressure. The diversity of the described factors, again, implies the importance of the integration of primary health care and mental health services.
Ahmad, B. A., Khairatul, K., & Farnaza, A. (2017). An assessment of patient waiting and consultation time in a primary healthcare clinic. Malaysian Family Physician, 12(1), 14–21.
Dang, D., & Dearholt, S. L. (2017). Johns Hopkins nursing evidence-based practice (3rd ed.). Sigma Theta Tau International.
Nadeau, L., Jaimes, A., Johnson-Lafleur, J., & Rousseau. (2017). Perspectives of migrant youth, parents and clinicians on community-based mental health services: Negotiating safe pathways. Journal of Child and Family Studies, 26(1), 1936–1948.
Simpson, S. A., Dumas, A., McDowell, A. K., & Westmoreland, P. (2020). Novel Coronavirus and related public health interventions are negatively impacting mental health services. Psychosomatics, 61(5), 568–571.
Xiang, Y. T., Ng, C. H., Yu, X., & Wang, G. (2018). Rethinking progress and challenges of mental health care in China. World Psychiatry, 17(2), 231–232.