**4. Skills and training of nurses in mental health care management of mental health care disorders within the primary health care setting**

Currently, no studies reported training of nurses in mental health care management of rape survivors diagnosed with PTSD and depression. Instead, studies have documented both lack of skills and training of nurses in mental health care

#### *Perspective Chapter: Integrating Follow-up Care Management for Assessment and Management… DOI: http://dx.doi.org/10.5772/intechopen.107499*

management of mental health disorders. One study reported a lack of training and supervision by hospital mental health teams, resulting in a lack of knowledge in managing patients with mental disorders [34]. It was further stated that this practice has a negative impact on the integration of mental health care into primary health care [35]. Furthermore, the World Health Organization (WHO) found that most health care workers in primary health care settings do not receive adequate mental health care training [34]. Again, nurses' lack of knowledge in managing patients with mental health disorders has resulted in the underdiagnosis of most mental health conditions in primary health care [36]. The study found that primary health care nurses managing patients at the clinic were not adequately qualified to provide all of the services that are provided in clinics that use a one-stop-shop approach [37]. In addition, it was revealed that some mental health patients are treated by registered nurses who do not have Psychiatric Nursing Science qualifications. This practice may result in mental health patients being misdiagnosed, leading to mental illness relapse [18]. Although the lack of skills and training of nurses in relation to mental health care management of patients diagnosed with mental health disorders is argued from a general overview of the literature review, it may impact the decentralization and integration of rape survivors diagnosed with PTSD and depression consulting in PHC settings.

Despite this, some studies have reported that nurses are trained to provide mental health care management among patients. The nurses that register for a 4-year degree or diploma are taught psychiatric nursing, and when they complete their courses, they are placed either in the hospital or primary health care to care for the patients consulting in these settings. Furthermore, the literature review illustrated that to ensure that mental health conditions are appropriately identified and managed, primary health care clinics must have psychiatric-trained nurses on staff [15]. Furthermore, most nurses have a 4-year Diploma in Nursing, indicating that psychiatric nursing training is well represented in primary health care clinics [15]. Despite this, nurses with a 4-year diploma or degree do not have adequate skills and knowledge to manage patients presenting with mental health disorders in primary health care settings [15, 38]. These findings indicate a need for capacitating these nurses to provide mental health care among patients consulting in primary health care, considering that they were trained to provide mental health nursing. In support of this, Bowlers [39] reported that for disseminating information and guidelines and practice-based education, continuing education is required for nurses. This will aid in improving diagnostic skills and psychological therapy for psychiatric patients [39].

In addition, nurses reported that they require in-service training for empowerment, quality care, and increasing staff motivation when providing mental health care management to patients [40]. In South Africa, some nurses are trained for an advanced diploma in psychiatric nursing. However, placing nurses with advanced psychiatric nursing is uncommon in primary health care settings because they are placed in mental health care institutions when they complete their studies. Therefore, we suggest that nurses who have completed advanced psychiatry in nursing must also be placed in primary health care mainly to render mental health care services among clients reporting mental health disorders, including rape survivors diagnosed with PTSD and depression.

In addition, mental health care management of rape survivors must be done by nurses studying for a postgraduate diploma in forensic nursing. Currently, South Africa's postgraduate diploma in forensic nursing is not accredited [41]. Again, most nursing universities are re-curriculating their postgraduate courses to ensure that

forensic nursing is one of the postgraduate diplomas that the South African Nursing Council accredits. Therefore, it will be imperative to include mental health care management for rape survivors in their curriculum, such as placing them in primary health care settings to offer the management of rape survivors diagnosed with PTSD and depression and working in collaboration with those that are trained for mental health care at the undergraduate and postgraduate levels, thus, improving mental health care services for rape survivors in South Africa.
