ABSTRACT:
South Africa has implemented a nation-wide community health worker (CHW) programme, responsible for general preventative and promotive care, in which CHWs identify those who need assistance, refer them to the local health services and support treatment adherence. Efforts to strengthen community-based mental health care by integrating mental health care into primary health care (PHC)1 has come with an expectation that CHWs will play an integral role. The CHW training manual stipulates their role in identifying and referring cases of common mental disorders, gender-based violence, drug, alcohol, and child abuse. However, little training is provided on the skills needed to support people living with serious mental illness (PLSMI). This study aimed co-produce a service model for the involvement of CHWs in detecting and providing support for the health and social care of PLSMI. Focus group discussions were conducted with representatives from non-governmental organisations, traditional healers/faith-based organisations, CHWs and people with lived experience of mental illness in the Sedibeng District. Experiences of mental health in the community were explored, while perceptions on the role and capacity of CHWs to support PLSMI were examined. Thematic content analysis was conducted to analyze the qualitative data. Participants expressed challenges in accessing mental health care services; CHWs have limited knowledge and capacity to support PLSMI, and there are unclear referral pathways and shortage of mental health professionals in PHC facilities. Recommendations to strengthen the role of CHWs included support by mental health professionals during home visits, improved skills and enhanced communication amongst multidisciplinary mental health cadres. Communities experience mental health challenges with limited access to care, while CHWs experience multiple barriers to provide care for PLSMI. Efforts to strengthen the role of CHWs in supporting PLSMI requires improved training and enhanced support from a multidisciplinary mental health team to improve communication and referral pathways.