Integrating Mental Health Services in Primary Health Care: Nairobi County, Kenya
Study Aim: Map services, assess existing mental health care, and identify barriers/facilitators for integration, focusing on adolescents and peripartum populations.
Setting & Participants:
Facilities: Kangemi & Kariobangi Health Centers
Participants: 12 Health Care Workers (6 nurses, 2 clinical officers, 1 psychiatric clinical officer, 2 CHAs, 1 mentor mother)
Services Provided:
Outpatient services 5 days/week; psychiatric clinics once/week
TB, antenatal care, family planning, child welfare, HIV testing, nutrition, immunization, non-communicable disease clinics
Limited maternity (Kangemi only) and youth-friendly services
Psychiatric care provided via external NGOs (Kamili Organization, Mathari Hospital)
Staff shortages and high patient loads cause burnout
Key Barriers to Integration:
Systemic: Lack of integrated services, limited infrastructure, insufficient funding
Social: Stigma, cultural beliefs, preference for prayer/traditional healing
Individual: Limited HCW training (only 3 with psychiatric training), attitudinal challenges, lack of privacy
Facilitators & Opportunities:
Strong support from community health volunteers and partner organizations
HCWs aware of need for integration
Potential to scale training, supervision, and collaborative care models
Recommendations:
Training: Enhance HCW knowledge in mental health, early identification, and psychosocial support
Integration: Embed mental health into all service points
Resources: Improve staffing, infrastructure, and funding
Policy: Develop protocols, confidentiality measures, and evidence-based guidelines
Community Engagement: Address stigma and cultural barriers
Conclusion:
Integration of mental health into primary care is feasible but requires systemic support, funding, training, and culturally sensitive approaches. Focus on adolescents and peripartum populations is critical to reduce the mental health treatment gap.