**10. Examples of success of treating mental health disorders at PHC level**

A number of countries have successfully integrated mental health services to mainstream primary health care services, with tremendous gains for both the country health system and the patients who receive such care. In Zimbabwe, the primary health care services for mental disorders include the use of lay health workers, which is advantageous for resource-constrained countries. The services they offer include screening for mental health disorders and administering primary care-based problem solving therapy with education and support for the clients [40]. *The Need to Strengthen Primary Health Care Services to Improve Mental Health Care Services… DOI: http://dx.doi.org/10.5772/intechopen.99781*

In India, a similar program has been used for several years, and it has been found to be not only cost-effective, but also cost-saving [41]. The use of a lower cadre of health workers require task-shifting which, if properly utilized with effective training of the workers, can substantially reduce the number of high level health professionals, and thus close the mental health service gaps at primary health care level in South Africa at a minimal cost [42, 43].

#### **10.1 Status of PHC services for mental health**

Despite the high prevalence of mental health disorders in South Africa, mental health services at primary health care level are not prioritized. With the high level of stigmatization of mental illness, the health-seeking behaviors are compromised, despite the high prevalence of such disorders. This low prioritization also contributes to poor capacity planning and implementation of mental health care plans, scarcity of trained generalists in mental health care, poor integration of mental health into integrated care, and lack of dedicated mental health budget [44]. Specifically, the resource limitations need to be addressed, by allocation of more funding for PHC services and to upgrade mental health legislation and policies [45].

In order for primary care providers to diagnose substance abuse and mental illness among clinic attendees, they need to receive specific training, specifically in the use of self-reported screening tools which are easy to administer and efficient to make a substance abuse diagnosis in primary care settings. Early diagnosis and a brief behavioral change counseling are effective in managing substance abuse before it develops into dependency.

The acknowledgement of increasing prevalence of mental disorders which include substance abuse in South Africa, renders them to be a priority in the offering of primary health care services, and literature has reported that mental health care can be effectively integrated into primary health care [46]. However, in order to do this, governance should be improved [44]. This improved governance is what this chapter regards as a major intervention to improve PHC services and to set them to adequately address mental health matters.

#### **10.2 Integrating mental health into mainstream primary health care services**

Integration of mental health services into mainstream services has been recommended globally [47], and this has been found to be both effective for intended treatment outcomes, as well as economically cost-effective [21, 48]. While treatment effectiveness benefits the patients, cost-effectiveness has a direct benefit on the health system and an indirect benefit to the patients as the quality of treatment can be improved as more resources are available. Although compared to other African countries, South Africa is reported to be doing better in offering mental health services [49], a lot still needs to be done to implement integration of mental health services to reap envisaged health system benefits. With the high prevalence of mental disorders, which are ranked third as contributors to disability-adjusted life-years [50], integration of mental health into primary health care remains incomplete, which contributes to inconsistent care and difficulties such as unidentified symptoms, defaulting treatment and the revolving-door phenomenon [47, 51].

The integration of mental health services requires a vision contained in the South African Mental Health Policy and Strategy Plan, whose implementation can make a difference to the quality of services required by mental health care users [52]. Additionally, strong political will can assist in providing the resources required.
