Prerpints.org logo
Preprint
Article

Mental Health Challenges during COVID-19 Pandemic: Experiences of Primary Healthcare Nurses in Durban, South Africa

Altmetrics

Downloads

150

Views

46

Comments

0

A peer-reviewed article of this preprint also exists.

This version is not peer-reviewed

Preprints on COVID-19 and SARS-CoV-2

Submitted:

05 August 2023

Posted:

07 August 2023

You are already at the latest version

Alerts
Abstract
The COVID-19 pandemic had a significant impact on the mental health of individuals globally, and primary healthcare (PHC) nurses play a critical role in providing mental healthcare services. However, limited research has explored the experiences of PHC nurses in providing mental healthcare services during the COVID-19 pandemic. This study explored the experiences of PHC nurses in providing mental healthcare services during the pandemic in Durban, South Africa. The aim was to identify the challenges faced by healthcare providers and the potential for innovative approaches to improve access to care. A qualitative, exploratory design guided the study, and data were collected through in-depth interviews with twelve PHC nurses purposively selected. Thematic analysis was used to analyse the data. Findings from interviews with primary healthcare nurses reveal that the pandemic exacerbated existing challenges, including medication adherence issues, fear and uncertainty among patients, vaccine hesitancy, decreased clinic visits, and the mental and emotional toll on both patients and healthcare workers. PHC nurses adapted their services by increasing outreach efforts, prioritising patient care, and utilising technology and non-governmental organisations’ (NGO) support. Challenges included reduced patient visits, complexities in healthcare provision, and lack of adequate support. Positive changes observed include increased mental health awareness among healthcare professionals and younger generations. Recommendations include implementing outreach and awareness campaigns, providing accurate information about COVID-19 and vaccinations, and promoting cultural sensitivity in mental healthcare provision.
Keywords: 
Subject: Public Health and Healthcare  -   Public Health and Health Services

1. Introduction

Mental health is an essential component of overall health and well-being. However, mental health services in many low- and middle-income countries (LMIC), particularly in Sub-Saharan Africa (SSA), are often limited [1,2]. In South Africa, mental health promotion, prevention of mental disorders and provision of mental health care are basic services that are provided in primary health care (PHC) clinics [3]. About 23% of people attending PHC clinics suffer from mental health disorders [4]. Despite the high number of people with mental health conditions, mental health has a low priority in South Africa and people with mental health disorders do not receive the care they require in PHC clinics [4]. People with mental illness often experience greater difficulty accessing mental health services due to different attitudinal and structural barriers [6]. To narrow the treatment gap, many countries including South Africa, adopted the initiative of integrating mental health services into primary healthcare [7,8]. The Policy on Integration of Mental Health Care into PHC in South Africa was promulgated in 1997. According to this policy, mental health care users should receive treatment at the clinic, near to where they live and mental health care services must be integrated into general care at PHC [9]. Despite the efforts to increase the accessibility of mental health services, treatment rates for mental illness remain low in LMIC. The COVID-19 pandemic had a significant impact on mental health globally, with reports of increased anxiety, depression, and other mental health problems [10,11,12]. The pandemic disrupted many aspects of life, including economic activities, education, and social interactions [13,14]. These disruptions resulted in increased stress, anxiety, and depression, which contributed to the overall increase in mental health disorders [14,15,16].
SSA is a region that is particularly vulnerable to the mental health impacts of the COVID-19 pandemic [17]. The region has a high burden of mental health disorders, with an estimated 13.5% of the population experiencing a mental health disorder at any given time [18]. According to the 2019 global burden of disease estimate, more than 970 million people live with mental illness which indicates a 48.1% increase since 1990. Of all people with mental illness, 66.7% reside in low and middle Sustainable Development Index (SDI) countries [19]. Furthermore, the pandemic has had a significant impact on the mental health of individuals in the continent, with reports of increased anxiety, depression, and other mental health problems [17,20]. Due to the COVID-19 pandemic, mental illness has posed a great concern with a 25% worldwide increase in the prevalence of depression and anxiety [2]. South Africa is no exception as it was severely impacted by the COVID-19 pandemic, with one of the highest numbers of reported cases and deaths on the African continent [21].
Studies have reported that the major and sustained disease outbreaks such as COVID-19 has caused physical, mental and psychological distress on society as a whole and may be attributed to increased risk for depression, anxiety, panic attacks, somatic symptoms, posttraumatic stress disorder (PTSD), psychosis, suicidal ideation and a low quality of life [22,23]. PHC nurses play a critical role in providing mental healthcare services in South Africa [24]. However, South Africa like other countries in SSA, faces significant challenges in providing adequate mental healthcare services, including a shortage of mental healthcare workers, limited access to mental healthcare services, and stigma associated with mental health problems [17,20,25]. The COVID-19 pandemic has further exacerbated these challenges, with PHC nurses facing increased workload and limited access to personal protective equipment (PPE) while providing mental healthcare services [26]. Prioritising the physical health of society, with little attention to the mental strain that the pandemic has caused, will likely increase the risk of experiencing another ‘pandemic’ linked to the development of mental disorders [27].
While PHC nurses play a critical role in providing mental healthcare services in SSA, little is known about their experiences during the pandemic in Durban, South Africa. The purpose of the study was to explore the experiences of PHC nurses in providing mental healthcare services during the COVID-19 pandemic in Durban, South Africa. The study aims to identify the challenges faced by PHC nurses in providing mental healthcare services during the pandemic, as well as the potential for innovative approaches to improving access to care. The study findings thus contribute to the broader effort to improve the provision of mental healthcare services during the COVID-19 pandemic in SSA.

2. Materials and Methods

2.1. Research Design

The study used a qualitative, exploratory design, which is appropriate for gathering rich, in-depth data on the experiences and perspectives of PHC nurses. According to Blumberg, et al. [28], the qualitative research approach follows the interpretivist research paradigm that is premised on how people make sense of the world around them by sharing their experiences with others through the medium of language.

2.2. Sampling and Participants

The study used purposive sampling to identify participants who are PHC nurses providing mental healthcare services in Durban, South Africa. Twelve PHC nurses were recruited from public and private healthcare facilities, including clinics and hospitals with a vast experience in mental healthcare.

2.3. Data Collection

Data of the study was collected through semi-structured interviews with PHC nurses, between April and May 2023. The interviews were conducted in-person and were audio-recorded with the participant’s permission. The interview guide was developed based on the research questions and sub-questions and pilot tested with a small group of participants to ensure clarity and relevance. To establish the views of PHC nurses, the following main questions were asked:
What are the challenges faced by PHC nurses in providing mental healthcare services and the innovative approaches used to address these challenges during the COVID-19 pandemic in Durban, South Africa?
What changes have PHC nurses observed in the mental health status of their patients during the COVID-19 pandemic in Durban, South Africa?
What are the barriers to providing mental healthcare services during the COVID-19 pandemic in Durban, South Africa?
What are the facilitators to providing mental healthcare services during the COVID-19 pandemic in Durban, South Africa?
What strategies have PHC nurses used to adapt their mental healthcare services to the COVID-19 pandemic in Durban, South Africa?
What are the perceptions of PHC nurses regarding the effectiveness of their mental healthcare services during the COVID-19 pandemic in Durban, South Africa?

2.4. Data Analysis

The audio recordings of the interviews were transcribed verbatim and analysed using thematic analysis with the aid of NVivo software. This approach involves coding the data to identify patterns, themes, and categories that emerge from the data [29]. The analysis was conducted iteratively, with the researchers reviewing the data to refine and revise the themes and categories until a coherent and comprehensive understanding of the data is achieved.

2.5. Trustworthiness and Credibility

The trustworthiness and credibility of the study was ensured through a rigorous and transparent research design, data collection, and data analysis process.

2.6. Ethical Considerations

The study was conducted in accordance with ethical principles, including obtaining informed consent from participants, protecting participant confidentiality, and ensuring that the research does not cause harm to participants or others. The study was approved by the relevant institutional review board(s) before data collection begins (RDI/06/2023).

3. Results

The findings of this study are presented in this section.

3.1. Theme 1: Impact of COVID-19 on mental healthcare provision

Five sub-themes have been highlighted under the impact of COVID-19 on mental healthcare provision, which are medical adherence challenges, fear and uncertainty, reluctance to vaccination, decrease in clinic visits, and mental and emotional toll.

3.1.1. Medication adherence challenges

Participant 1 observed that medication adherence was already a challenge, but the COVID-19 pandemic made it worse. Many patients couldn’t come to the clinic due to transportation issues caused by lockdowns and restrictions. This resulted in difficulties for patients to access their chronic medications, leading to a decline in medication adherence rates during the pandemic.
“What I noticed was I think adherence to medication, we are struggling with patients adhering to medication already, but I think it made it worse in terms of people who couldn’t come to the clinic because of the transportation.”
[Participant 1]

3.1.2. Fear and uncertainty

Participant 3 highlighted that the COVID-19 pandemic had a significant impact on people’s mental health due to fear and uncertainty. The fear of the unknown and witnessing the high number of deaths caused distress and mental disturbance among many individuals. The lack of understanding about the virus and its consequences added to the anxiety and uncertainty experienced by people during the pandemic.
“I think it had a great impact because people were scared, they didn’t know what it is, and a lot of people were dying. So, I think a lot of people got disturbed mentally as well because they didn’t really know what to expect.”
[Participant 3]

3.1.3. Reluctance to vaccination

Participant 4 mentioned that there was a noticeable reluctance among some individuals to take the COVID-19 vaccines. This hesitancy was attributed to reports of adverse effects experienced by some vaccinated individuals, leading others to fear potential negative outcomes. As a result, vaccine hesitancy affected the willingness of certain people to get vaccinated during the pandemic.
“They are now very reluctant to take vaccines. Because some of them they experience sort of like more of the illnesses when they took it than when they were not, so they didn’t do good, and it did worse instead of good.”
[Participant 4]

3.1.4. Decrease in clinic visits

Participant 4 noted that there was a significant decrease in the number of patients visiting the clinic during the COVID-19 pandemic. Many people were afraid to come to healthcare facilities due to the fear of exposure to the virus. As a result, the clinic experienced a decline in patient attendance, which affected the delivery of healthcare services during the pandemic.
“Yeah, there were. They were even afraid to come to the facility, to the polls, that’s where they were meeting more people, than when they were. So, they felt safer. So, we experience like a drop of people coming to the clinic.”
[Participant 4]

3.1.5. Mental and emotional toll

Participant 2 expressed that the impact of the COVID-19 pandemic on patients’ mental health was profound. The phrase “they were all flat” suggests a sense of emotional and psychological heaviness or lack of energy among the patients. Furthermore, Participant 2 indicated that the pandemic had a widespread effect on both patients and healthcare workers, indicating the significant toll it took on the mental well-being of individuals during this challenging time.
“They were all flat. We were all affected.”
[Participant 2]

3.2. Theme 2: Adaptation of mental healthcare services

Three key strategies were of mental healthcare services were uncovered from the interview discussion, namely increased outreach and support, prioritising patients care, and the use of digital technologies and intervention from Non-Governmental Organisation (NGOs).

3.2.1. Increased outreach and support

Participant 1 mentioned that during the COVID-19 pandemic, there was an increased effort to provide outreach and support to patients. Healthcare workers took the initiative to reach out to patients, allaying their anxiety and offering reassurance. The focus shifted from patients having to come to the clinic to receive care to healthcare workers proactively reaching out to provide the needed support, including medication assistance and emotional reassurance. This adaptation aimed to address the challenges posed by restrictions and transportation issues during the pandemic.
“Just by allaying anxiety to patients assuring them, and us as healthcare workers reaching out to them more than them coming to us for their medication.”
[Participant 1]

3.2.2. Prioritizing patients’ care

Participant 5 highlighted the importance of prioritizing patients’ care during the COVID-19 pandemic. The focus was on fast-tracking the treatment of patients with major cases and chronic conditions to avoid any potential security burden or complications. By ensuring timely and prioritized care for patients, healthcare workers aimed to address their needs promptly and effectively, despite the challenges posed by the pandemic.
“The major cases are obviously those on treatment. Don’t let them wait too long time because they can be a security burden and can trigger anything with them, so try to fast-track and make them priority.”
[Participant 5]

3.2.3. Use of technology and NGOs

Participant 5 mentioned the use of technology and NGOs to provide mental healthcare services during the COVID-19 pandemic. They utilised digital means to locate patients and offer support, addressing their fears and needs promptly. This adaptation involved utilizing technology in mental healthcare, which might not have been extensively used before. Additionally, NGOs played a role in providing staffing and support, extending their services to include mental healthcare during the pandemic.
“Yeah, we do. We do have our digital dreams that go out here and try and locate patients. They don’t come on time and try to address their fears and really help them by taking whatever they need to their and things like that. So, we did try and adapt using NGOs as our staffing.”
[Participant 5]
While the technology and NGO involvement were not entirely new, they were modified to cater to mental healthcare needs, especially during the challenging circumstances of the pandemic.
“It was always there, but not so much mental health uses, more with chronic uses and CD’s, so we try to talk with everybody.”
[Participant 5]
Participant 1 acknowledged the significant role of technology, particularly social media and the internet, in delivering mental healthcare services during the COVID-19 pandemic. The accessibility of information through digital platforms allowed healthcare providers to stay updated and informed about the latest developments, guidelines, and mental health resources. These digital tools facilitated the dissemination of mental health-related information, creating awareness, and providing support to both healthcare workers and the general public during the challenging times of the pandemic.
“Yeah, I think it did play a role because mostly we were being updated by the social media, the Internet yeah, I think it is.”
[Participant 1]

3.3. Theme 3: Challenges in Providing Mental Healthcare Services

Three key challenges were uncovered from the interview discussion, namely reduced number of patients, complexity of healthcare provision during the pandemic, and lack of adequate support.

3.3.1. Reduce number of patients

Participant 1 pointed out that one of the challenges in providing mental healthcare services during the pandemic was the reduced number of patients visiting the clinic. The lack of patients limited the opportunity for healthcare providers to teach and educate about mental health as they would typically do. This decrease in patient visits impacted the delivery of mental health education and support.
“Challenges, I think there were challenges because we couldn’t get people coming into the clinic. So, we couldn’t teach about mental health as we would because there were no patients coming in.”
[Participant 1]

3.3.2. Complexity of healthcare provision during the pandemic

Participant 2 mentioned the challenges faced in providing mental healthcare services while simultaneously dealing with the demands of COVID-19 testing. The clinic was running out of testing kits at times, leading to stress and pressure on healthcare workers. Juggling both mental health counselling and COVID-19 testing added to the complexity of healthcare provision during the pandemic.
“They want to challenge you. We had to counsel the patient and inspect the patient every morning, that could help to relieve the stress It will meet. The challenges were when we were running out of these kits because we were doing COVID-19 testing in our site, so sometimes we do run out of stock and right.”
[Participant 2]

3.3.3. Lack of adequate support

Participant 5 shared a coping mechanism during the COVID-19 pandemic, emphasizing the significance of support from family. They found strength in the support they received from their family members on a daily basis, which helped them cope with the challenges of their work as a healthcare provider during the pandemic. The family’s support acted as a source of motivation and resilience, enabling Participant 5 to continue providing care and support to patients despite facing difficulties during this time.
“Well, the support from your family comes most, so you know every day while you’re coming to work and when you’re doing it, it makes you stronger.”
[Participant 5]

3.4. Theme 4: Positive changes from providing mental healthcare services during the pandemic

Two positive changes from providing mental healthcare services during the pandemic were uncovered from the interview discussion, namely awareness of mental health and community acceptance of mental health.

3.4.1. Awareness of mental health

Participant 1 mentioned that a positive change observed during the pandemic was an increased awareness of mental health among healthcare professionals like themselves. They recognized the importance of mental healthcare and were educated on the subject. However, in their community, the general awareness about mental health was still limited, with only educated individuals and teenagers being more informed about it due to mental health education at schools. This highlights the need for further efforts to raise awareness about mental health among the broader population, including the elderly and less educated individuals.
“Yeah, I think, but as I am saying in my community as much as we are aware of it be-cause we’re professional nurses, but the community is not so much aware about the mental health situation. It’s only the people that are educated and mostly the teenagers that are still in school because it is taught at schools, but not the elderly people.”
[Participant 1]

3.4.2. Community acceptance of mental health

Participant 1 shared insights into perceptions of mental health in their community, particularly in rural areas. They mentioned that in such communities, mental health is sometimes perceived through a traditional lens and viewed differently based on the level of education. This highlights the importance of cultural and educational factors in shaping people’s attitudes towards mental health. There may be varying levels of acceptance and awareness of mental health issues, influenced by cultural beliefs and educational backgrounds. It indicates the need for targeted awareness and education programs to address misconceptions and improve mental health acceptance in such communities.
“Some of them because in the community that I live in. I live in the rural areas; so, some-times mental health is perceived as traditional. It is viewed differently; it depends on the level of education.”
[Participant 1]
Participant 1 mentioned that in their community, mental health awareness is higher among educated individuals and mostly teenagers who receive education about mental health at schools. However, there seems to be a lack of awareness about mental health among the elderly and the broader community. This observation highlights the potential positive change of mental health education being integrated into schools, enabling younger generations to be more aware and informed about mental health issues. However, there is still a need to improve mental health awareness among other segments of the community, particularly the elderly population, to promote better mental healthcare provision during the pandemic and beyond. apologies for the confusion earlier.
“Yeah, I think, but as I am saying in my community as much as we are aware of it be-cause we’re professional nurses, but the community is not so much aware about the mental health situation. It’s only the people that are educated and mostly the teenagers that are still in school because it is taught at schools, but not the elderly people.”
[Participant 1]

3.5. Theme 5: Suggestions for improving mental healthcare services

Two suggestions were offered by the PHC nurses on how to improve mental healthcare services. This includes outreach and awareness campaign and positive accurate information.

3.5.1. Outreach and awareness campaign

Participant 3 suggested that improving mental healthcare services could be achieved through increased outreach efforts and awareness campaigns. They emphasised the importance of talking openly about mental health conditions to make people aware that it is okay to have such issues and that life can continue positively despite facing mental health challenges. The goal is to reduce stigma and promote acceptance, fostering a supportive environment for individuals experiencing mental health issues.
“Having more outreach and talking about the mental health condition and making people aware of them and that they are ok, and life does continue even though you do have the mental issue.”
[Participant 3]

3.5.2. Providing accurate information.

Participant 4 highlighted the importance of providing accurate information to the public about COVID-19 and vaccinations. They expressed concern that insufficient information led to misconceptions and fear about vaccines, resulting in reluctance to get vaccinated. Participant 4 stressed the need to educate individuals about the virus, vaccine benefits, and potential side effects, allowing them to make informed decisions. By offering comprehensive information, healthcare providers can dispel myths and build trust, encouraging more people to get vaccinated and promoting public health during the pandemic.
“Giving them the vaccine than giving them the information. But the virus is all about the dangers and all what to expect, so people were ending up using what happened to somebody taking as what exactly is happening then experimenting like things on their own. Like if somebody passed on, they say the vaccine has caused somebody to die. But if we can give more information to people so that they can have the choice, more informed and make decisions.”
[Participant 4]

4. Discussion

The COVID-19 pandemic has had significant impacts on mental healthcare services in SSA, where mental healthcare services are already under-resourced. The purpose of the study is to explore the experiences of PHC nurses in providing mental healthcare services during the COVID-19 pandemic in Durban, South Africa. The study aims to identify the challenges faced by PHC nurses in providing mental healthcare services during the pandemic, as well as the potential for innovative approaches to improving access to care.

4.1. Impact of COVID-19 on mental healthcare provision

The finding of the study suggests that the impact of the COVID-19 pandemic on mental healthcare provision is multi-faceted. It was found that the COVID-19 pandemic exacerbated existing challenges related to medication adherence. With transportation issues caused by lockdowns and restrictions, many patients couldn’t access their chronic medications, leading to a decline in adherence rates. This can have serious consequences for patients with chronic mental health conditions, as interrupted or inconsistent medication use may result in symptom exacerbation and a higher risk of relapse [30]. From a practical perspective, healthcare providers need to find alternative ways to support patients’ medication adherence during crises or periods of restricted mobility. Telemedicine and home delivery services for medications could be viable solutions to address this issue [31]. Moreover, the finding highlights the importance of providing patients with sufficient medication supplies to sustain them through emergencies.
Equally, the fear of the unknown and the high mortality rates caused distress and mental disturbance among individuals during the pandemic. It was uncovered that the lack of understanding about the virus and its consequences added to the anxiety and uncertainty experienced by people. Given this concern, mental health services should prioritise providing support and resources to help individuals cope with fear and uncertainty during pandemics [32]. Psychoeducation about the virus and its transmission, as well as information on coping strategies, can be valuable in reducing anxiety [33]. Thus, timely dissemination of accurate information and addressing misconceptions is crucial in mitigating the mental health impact of fear and uncertainty.
Furthermore, it occurred that vaccine hesitancy among certain individuals was a challenge during the COVID-19 pandemic. It was found that the reports of adverse effects experienced by some vaccinated individuals contributed to vaccine hesitancy. Addressing vaccine hesitancy requires a multi-faceted approach involving healthcare providers, community leaders, and public health authorities. Transparent communication about vaccine safety, effectiveness, and benefits is essential in building trust and increasing vaccination rates [34]. In this, mental health professionals can play a role in addressing vaccine-related anxieties and helping individuals make informed decisions [35].
The fear of exposure to the virus led to a significant decrease in clinic visits during the pandemic. It was uncovered that reduced patient attendance impacted the delivery of healthcare services. Given this concern, telehealth and virtual care options should be expanded and promoted to ensure continuous access to mental healthcare during crises. Telehealth services have been found effective in providing mental health support during the pandemic, enabling remote consultations, and reducing exposure risks [36]. To achieve this, healthcare providers should implement safety measures and communicate them effectively to alleviate patient concerns about visiting healthcare facilities [37].
More so, it was found that the pandemic had a profound impact on patients’ mental health, as well as healthcare workers. Both groups experienced emotional and psychological challenges during this time. Healthcare workers’ mental health should be a priority, as they play a crucial role in providing care and support to patients [24]. Adequate support systems, such as counselling services and mental health check-ins, should be implemented for healthcare professionals [38]. Additionally, integrating mental health support into overall healthcare services can help address the emotional toll experienced by patients during pandemics [32].

4.2. Adaptation of mental healthcare services

During the pandemic, healthcare workers took a proactive approach by reaching out to patients to offer support and reassurance. This shift in focus from patients coming to the clinic to healthcare workers reaching out aimed to address challenges such as restrictions and transportation issues. The finding suggests that the increased outreach and patient support approach should be integrated into regular mental healthcare practices beyond the pandemic. Telemedicine and remote consultations can be incorporated to maintain continuous communication with patients [39]. Regular check-ins and proactive mental health support can help enhance patient engagement and adherence to treatment plans.
Also, recognising the importance of timely care, it was found that healthcare workers prioritised patients with major cases and chronic conditions to avoid potential complications. This was achieved by Fast-tracking treatment aimed to address patients’ needs promptly despite the challenges posed by the pandemic. Hence, prioritisation of patients’ care should remain a fundamental principle in mental healthcare provision during emergencies or crisis situations [40]. To achieve this, healthcare systems need to develop protocols to ensure efficient triaging and prompt care for patients with severe mental health conditions [41]. Clear guidelines and collaboration between mental health professionals and other healthcare providers can help streamline patient care during challenging times. This is particularly important in light of the report by Kohn, et al. [42] that collaboration and information flows between healthcare professionals and persons with severe mental illness are troublesome. According to the authors, modifying these aspects will improve the quality of somatic healthcare for vulnerable patients [42].
Of interest, the pandemic led to the increased use of technology to provide mental health services. Digital means, including social media and digital platforms, facilitated communication, patient location, and information dissemination. NGOs also played a role in providing staffing and support for mental healthcare services during the pandemic. The integration of technology and NGO support in mental healthcare delivery should be continued and expanded upon. Healthcare systems can invest in telehealth infrastructure and training for mental health professionals to utilise technology effectively in service delivery [43]. Additionally, collaborating with NGOs and community-based organisations can help extend mental health services to underserved populations, even during normal times. This is consistent with Ojagbemi and Gureje [44] that collaboration between faith-based mental healthcare and health practitioners may help to bridge the large treatment gap for mental health conditions on the African continent.

4.3. The challenges faced in providing mental healthcare services during the COVID-19 pandemic

Equally relevant, it was found that the challenges in providing mental healthcare services during the COVID-19 pandemic call for a multifaceted approach. For instance, it was uncovered that the reduced number of patients visiting the clinic during the pandemic posed a challenge in delivering mental health education and support. With fewer patients, healthcare providers had limited opportunities to engage with individuals and raise awareness about mental health. It is therefore necessary that healthcare systems explore alternative ways to reach out to individuals and provide mental health education and support beyond clinic visits. Telehealth platforms and digital outreach can be effective in disseminating mental health information to a broader audience [45,46]. Additionally, community-based mental health campaigns and public awareness initiatives can play a vital role in promoting mental health education [47].
Furthermore, it was uncovered that the COVID-19 pandemic brought the challenge of juggling mental healthcare services with the demands of COVID-19 testing. It was found that healthcare workers faced stress and pressure while managing both aspects of care provision. During public health crises, it is advisable that healthcare systems ensure adequate resources and support to manage the complexities of multiple healthcare services [48]. This may involve enhancing staffing, training, and logistics to handle the dual responsibilities efficiently. Equally important, flexibility in adapting healthcare workflows during pandemics can help healthcare providers maintain quality mental healthcare alongside other essential services.

4.4. Positive changes from providing mental healthcare services during the pandemic

From the study finding, there was some positive changes observed during the pandemic in the context of mental healthcare provision. It was found that healthcare professionals experienced a positive change in increased awareness of mental health during the pandemic. They recognised the importance of mental healthcare and were educated on the subject. However, some of the healthcare practitioners points out that the general awareness about mental health in the broader community, particularly among the elderly and less educated individuals, was still limited. Efforts to raise awareness about mental health should be prioritised and extended to reach all segments of the community, especially those with limited access to mental health education. Community-based awareness campaigns, outreach programs, and public health initiatives can play a vital role in improving mental health literacy and promoting destigmatisation [49]. Additionally, integrating mental health education into schools can continue to be beneficial in fostering a mentally informed and aware younger generation [50].
The influence of cultural and educational factors in shaping perceptions of mental health in their community, particularly in rural areas was also highlighted. Mental health was sometimes perceived through a traditional lens, with varying levels of acceptance based on educational backgrounds. According to Moleiro, et al. [51], cultural competence and sensitivity are crucial when providing mental healthcare services in diverse communities. Thus, mental health programs should be tailored to address specific cultural beliefs and values to improve acceptance and engagement with mental health services [42]. Given the significance of culture, one could rightly infer that collaborating with community leaders and involving community members in mental health initiatives can help bridge cultural gaps and ensure that services are responsive to the needs of the population.

4.5. Suggestions for improving mental healthcare services

From the study findings, it was suggested that increasing outreach efforts and conducting awareness campaigns can improve mental healthcare services. According to Hampson, et al. [53], openly discussing mental health conditions can help reduce stigma and promote acceptance. Thus, by raising awareness, individuals experiencing mental health challenges can feel supported and encouraged to seek help. This may be achieved through mental health awareness campaigns that is designed to reach diverse populations, including vulnerable communities and remote areas. According to Gopalkrishnan and Babacan [54], ethno-specific approaches to mental health that incorporate traditional and community-based systems can provide new avenues for working with culturally diverse populations. As such, healthcare providers, community leaders, and mental health organisations can collaborate to design culturally sensitive campaigns to address specific cultural beliefs and barriers to mental healthcare. Moreover, incorporating peer support and testimonies from individuals who have successfully managed mental health challenges can make awareness efforts more relatable and impactful [55].

5. Summary, practical implications, and recommendations of the study

The impact of the COVID-19 pandemic on mental healthcare provision is extensive and requires a comprehensive response. Integrating telehealth, expanding psychoeducation efforts, addressing vaccine hesitancy, and prioritising mental health support for both patients and healthcare workers are crucial steps in ensuring effective mental healthcare provision during crises. The lessons learned from the COVID-19 pandemic underscore the importance of adaptability and innovation in mental healthcare provision. Strategies such as increased outreach, prioritising patients’ care, and utilising technology and NGO support should be incorporated into standard mental healthcare practices. In doing so, healthcare systems can better address challenges during emergencies, improve patient outcomes, and enhance mental health support in both normal and crisis situations. The positive changes observed during the pandemic in terms of increased mental health awareness among healthcare professionals and younger generations are promising. However, challenges remain in enhancing awareness and acceptance of mental health among the broader community, including the elderly and less educated individuals. Targeted mental health education programs, community-based initiatives, and cultural sensitivity are essential in promoting mental health acceptance and improving mental healthcare provision in diverse communities.
Overall, the findings of this study offer valuable insights into enhancing mental healthcare services and public health response during the COVID-19 pandemic. Arguably, we proposed that by implementing outreach and awareness campaigns, mental health services can become more accessible and accepted. Additionally, providing accurate information about COVID-19 and vaccinations is crucial in building trust and encouraging vaccine acceptance. In summary, this study conclusively suggests that by adopting the strategies highlighted, healthcare systems can promote better mental health outcomes and contribute to successful pandemic management. This is very vital as the world prepares for another kind of pandemic in the near future.

6. Conclusions

The impact of the COVID-19 pandemic on mental healthcare provision has been significant, bringing forth both challenges and positive changes. The challenges of reduced patient visits, the complexity of healthcare provision, and lack of adequate support have underscored the need for adaptability and resilience in mental health services. On a positive note, increased awareness of mental health among healthcare professionals and younger generations has been observed during the pandemic. However, there is still work to be done in raising awareness among the broader community, especially the elderly and less educated individuals.
To improve mental healthcare services, it is crucial to focus on outreach efforts, conduct awareness campaigns, and provide accurate information about mental health and COVID-19. Addressing stigma, promoting acceptance, and fostering a supportive environment are key to empowering individuals to seek help and support their mental well-being.
Additionally, cultural sensitivity and community engagement are essential to bridge gaps and address varying perceptions of mental health in diverse communities. Transparent communication about COVID-19 and vaccines is vital in building public trust and encouraging vaccine acceptance, thus contributing to better pandemic management.

Author Contributions

Conceptualization, S.C.O. and M.S.N.; methodology, S.C.O.; data analysis, S.C.O., M.U.M. and M.N.S.; writing—original draft preparation, S.C.O., M.U.M. and M.N.S.; writing review and editing, S.C.O. and M.N.S.; supervision and project administration. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Research Ethics Committee of the Mangosuthu University of Technology (Ethics Reference Number RDI/06/2023). Approval was also granted by the Institutional Research Ethics Committee of the Durban University of Technology.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study are available upon request from the corresponding author. The data are not publicly available due to privacy restriction.

Acknowledgments

We would like to thank the research participants for their contribution towards the success of this study.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Godman, B.; Grobler, C.; Van-De-Lisle, M.; Wale, J.; Barbosa, W.B.; Massele, A.; Opondo, P.; Petrova, G.; Tachkov, K.; Sefah, I. Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries. Expert Opinion on Pharmacotherapy 2019, 20, 2237–2255. [Google Scholar] [CrossRef] [PubMed]
  2. Mekonen, T.; Chan, G.C.K.; Belete, T.; Menberu, M.; Davidson, L.; Hides, L.; et al. Mental health service utilization in a low resource setting: A qualitative study on perspectives of health professionals in Northwest Ethiopia. PLoS One 2022, 17, 0278106. [Google Scholar] [CrossRef] [PubMed]
  3. Dube, F.; Uys, L.N. Integrating mental health care services in primary health care clinics: a survey of primary health care nurses’ knowledge, attitudes and beliefs. South African Family Practice 2016, 1, 1–7. [Google Scholar] [CrossRef]
  4. Grandes, G.; Montoya, I.; Arietaleanizbeaskoa, M.S.; et al. The burden of mental disorders in primary care. Eur Psychiatry 2011, 26, 428–435. [Google Scholar] [CrossRef]
  5. Draper, C.E.; Lund, C.; Kleintjes, S.; et al. Mental health policy in South Africa: development process and content. Health Policy and Plan 2009, 24, 342–356. [Google Scholar] [CrossRef] [PubMed]
  6. Roberts, T.; Miguel Esponda, G.; Krupchanka, D.; Shidhaye, R.; Patel, V.; Rathod, S. Factors associated with health service utilisation for common mental disorders: a systematic review. BMC Psychiatry 2018, 18, 262. [Google Scholar] [CrossRef]
  7. World Health Organization. The World Health Report 2001—Mental health: new understanding, new hope. Bull World Health Organ. 2001, 79, 1085. [Google Scholar]
  8. World Health Organization. mhGAP: Mental Health Gap Action Programme: scaling up care for mental, neurological and substance use disorders. World Health Organization: Geneva, 2008. [Google Scholar]
  9. Hlongwa, E.N. and Sibiya, M.N. A practice framework to enhance the implementation of the Policy on Integration of Mental Health Care into Primary Health Care in KwaZulu-Natal Province. African Journal of Primary Health Care & Family Medicine 2019, 11, 1–8. [Google Scholar] [CrossRef]
  10. de Miranda, D.M.; da Silva Athanasio, B.; Oliveira, A.C.S.; Simoes-e-Silva, A.C. How is COVID-19 pandemic impacting mental health of children and adolescents? International Journal of Disaster Risk Reduction 2020, 51, 101845. [Google Scholar] [CrossRef]
  11. Jiang, N.; Yan-Li, S.; Pamanee, K.; Sriyanto, J. Depression, anxiety, and stress during the COVID-19 pandemic: Comparison among higher education students in four countries in the Asia-Pacific region. Journal of Population and Social Studies 2021, 29, 370–383. [Google Scholar] [CrossRef]
  12. Hossain, M.M.; Tasnim, S.; Sultana, A.; Faizah, F.; Mazumder, H.; Zou, L.; McKyer, E.L.J.; Ahmed, H.U.; Ma, P. Epidemiology of mental health problems in COVID-19: a review. F1000Research 2020, 9, 636. [Google Scholar] [CrossRef] [PubMed]
  13. Echegaray, F. What post-COVID-19 lifestyles may look like? Identifying scenarios and their implications for sustainability. Sustainable Production and Consumption 2021, 27, 567–574. [Google Scholar] [CrossRef] [PubMed]
  14. Shek, D.T. COVID-19 and quality of life: Twelve reflections. Applied Research in Quality of Life 2021, 16, 1–11. [Google Scholar] [CrossRef] [PubMed]
  15. Moura, A.A.M.d.; Bassoli, I.R.; Silveira, B.V.d.; Diehl, A.; Santos, M.A.d.; Santos, R.A.d.; Wagstaff, C.; Pillon, S.C. Is social isolation during the COVID-19 pandemic a risk factor for depression? Revista Brasileira de Enfermagem 2022, 75. [Google Scholar] [CrossRef] [PubMed]
  16. McBride, O.; Murphy, J.; Shevlin, M.; Gibson-Miller, J.; Hartman, T.K.; Hyland, P.; Levita, L.; Mason, L.; Martinez, A.P.; McKay, R. Monitoring the psychological, social, and economic impact of the COVID-19 pandemic in the population: Context, design and conduct of the longitudinal COVID-19 psychological research consortium (C19PRC) study. International Journal of Methods in Psychiatric Research. 2021, 30, e1861. [Google Scholar] [CrossRef]
  17. Semo, B.-W.; Frissa, S.M. The mental health impact of the COVID-19 pandemic: implications for sub-Saharan Africa. Psychology Research and Behavior Management. 2020, 713–720. [Google Scholar] [CrossRef]
  18. Jörns-Presentati, A.; Napp, A.-K.; Dessauvagie, A.S.; Stein, D.J.; Jonker, D.; Breet, E.; Charles, W.; Swart, R.L.; Lahti, M.; Suliman, S. The prevalence of mental health problems in sub-Saharan adolescents: A systematic review. Plos One 2021, 16, e0251689. [Google Scholar] [CrossRef]
  19. GBD 2019 Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry 2022, 9, 137–150. [Google Scholar] [CrossRef]
  20. Mabrouk, A.; Mbithi, G.; Chongwo, E.; Too, E.; Sarki, A.; Namuguzi, M.; Atukwatse, J.; Ssewanyana, D.; Abubakar, A. Mental health interventions for adolescents in sub-Saharan Africa: A scoping review. Frontiers in Psychiatry 2022, 13, 1696. [Google Scholar] [CrossRef]
  21. de Jong, T.R. Rapid review: perceptions of COVID-19 vaccines in South Africa. Social Science in Humanitarian Action Platform 2021, 1–20. [Google Scholar] [CrossRef]
  22. Stojanov, J.; Malobabic, M.; Stanojevic, G.; Stevic, M.; Milosevic, V.; Stojanov, A. Quality of sleep and health-related quality of life among health care professionals treating patients with coronavirus disease-19. International Journal of Social Psychiatry 2021, 67, 175–181. [Google Scholar] [CrossRef] [PubMed]
  23. Suryavanshi, N.; Kadam, A.; Dhumal, G.; Nimkar, S.; Mave, V.; Gupta, A. Mental health and quality of life among healthcare professionals during the COVID-19 pandemic in India. Brain Behav. 2020, 10, e01837. [Google Scholar] [CrossRef]
  24. Petersen, I.; Fairall, L.; Bhana, A.; Kathree, T.; Selohilwe, O.; Brooke-Sumner, C.; Faris, G.; Breuer, E.; Sibanyoni, N.; Lund, C. Integrating mental health into chronic care in South Africa: the development of a district mental healthcare plan. The British Journal of Psychiatry 2016, 208, s29–s39. [Google Scholar] [CrossRef] [PubMed]
  25. Nxumalo, C.T.; Mchunu, G.G. Exploring the stigma related experiences of family members of persons with mental illness in a selected community in the iLembe district, KwaZulu-Natal. Health SA Gesondheid. 2017, 22, 202–212. [Google Scholar] [CrossRef]
  26. Robertson, L.; Maposa, I.; Somaroo, H.; Johnson, O. Mental health of healthcare workers during the COVID-19 outbreak: A rapid scoping review to inform provincial guidelines in South Africa. South African Medical Journal. 2020, 110, 1010–1019. [Google Scholar] [CrossRef] [PubMed]
  27. Giorgi, G.; Lecca, L.I.; Alessio, F.; Finstad, G.L.; Bondanini, G.; Lulli, L.G.; Arcangeli, G.; Mucci, N. COVID-19-related mental health effects in the workplace: a narrative review. International Journal of Environmental Research and Public Health 2020, 17, 7857. [Google Scholar] [CrossRef]
  28. Blumberg, B.; Cooper, D.; Schindler, P. Business Research Methods, 4th ed.; McGraw Hill: London, UK, 2014. [Google Scholar]
  29. Saldaña, J. The coding manual for qualitative researchers. Sage Publication: USA, 2021; ISBN 978-1529731743. [Google Scholar]
  30. Lewis, G.; Marston, L.; Duffy, L.; Freemantle, N.; Gilbody, S.; Hunter, R.; Kendrick, T.; Kessler, D.; Mangin, D.; King, M. Maintenance or discontinuation of antidepressants in primary care. New England Journal of Medicine 2021, 385, 1257–1267. [Google Scholar] [CrossRef]
  31. Gillespie, S.M.; Moser, A.L.; Gokula, M.; Edmondson, T.; Rees, J.; Nelson, D.; Handler, S.M. Standards for the use of telemedicine for evaluation and management of resident change of condition in the nursing home. Journal of the American Medical Directors Association 2019, 20, 115–122. [Google Scholar] [CrossRef]
  32. Ardebili, M.E.; Naserbakht, M.; Bernstein, C.; Alazmani-Noodeh, F.; Hakimi, H.; Ranjbar, H. Healthcare providers experience of working during the COVID-19 pandemic: a qualitative study. American Journal of Infection Control 2021, 49, 547–554. [Google Scholar] [CrossRef]
  33. Holmes, E.A.; O’Connor, R.C.; Perry, V.H.; Tracey, I.; Wessely, S.; Arseneault, L.; Ballard, C.; Christensen, H.; Silver, R.C.; Everall, I. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. The Lancet Psychiatry 2020, 7, 547–560. [Google Scholar] [CrossRef]
  34. Lin, C.; Tu, P.; Beitsch, L.M. Confidence and receptivity for COVID-19 vaccines: a rapid systematic review. Vaccines 2020, 9, 16. [Google Scholar] [CrossRef] [PubMed]
  35. Borthwick, C.; O’Connor, R.; Kennedy, L. Predicting and understanding seasonal influenza vaccination behaviour among forensic mental health inpatients. Psychology & Health 2021, 36, 1235–1259. [Google Scholar] [CrossRef]
  36. Rajkumar, R.P. COVID-19 and mental health: A review of the existing literature. Asian Journal of Psychiatry 2020, 52, 102066. [Google Scholar] [CrossRef] [PubMed]
  37. Lin, Y.S.; Lin, Y.C.; Lou, M.F. Concept analysis of safety climate in healthcare providers. Journal of Clinical Nursing 2017, 26, 1737–1747. [Google Scholar] [CrossRef]
  38. Greenberg, N.; Docherty, M.; Gnanapragasam, S.; Wessely, S. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ 2020, 368. [Google Scholar] [CrossRef] [PubMed]
  39. Bokolo Jnr, A. Use of telemedicine and virtual care for remote treatment in response to COVID-19 pandemic. Journal of Medical Systems 2020, 44, 132. [Google Scholar] [CrossRef]
  40. Imran, N.; Zeshan, M.; Pervaiz, Z. Mental health considerations for children & adolescents in COVID-19 Pandemic. Pakistan Journal of Medical Sciences 2020, 36, S67–S72. [Google Scholar] [CrossRef]
  41. Pappa, S.; Ntella, V.; Giannakas, T.; Giannakoulis, V.G.; Papoutsi, E.; Katsaounou, P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain, Behavior, and Immunity 2020, 88, 901–907. [Google Scholar] [CrossRef]
  42. Kohn, L.; Christiaens, W.; Detraux, J.; De Lepeleire, J.; De Hert, M.; Gillain, B.; Delaunoit, B.; Savoye, I.; Mistiaen, P.; Jespers, V. Barriers to somatic health care for persons with severe mental illness in Belgium: a qualitative study of patients’ and healthcare professionals’ perspectives. Frontiers in Psychiatry 2022, 12, 798530. [Google Scholar] [CrossRef]
  43. Min, J.J.; Choi, S.; Park, H. Associations between accessibility to health care service, social support, and Korean Americans’ mental health status amid the COVID-19 pandemic. BMC Public Health 2021, 21, 1–10. [Google Scholar] [CrossRef]
  44. Ojagbemi, A.; Gureje, O. The importance of faith-based mental healthcare in African urbanized sites. Current Opinion in Psychiatry 2020, 33, 271–277. [Google Scholar] [CrossRef] [PubMed]
  45. Abraham, A.; Jithesh, A.; Doraiswamy, S.; Al-Khawaga, N.; Mamtani, R.; Cheema, S. Telemental health use in the COVID-19 pandemic: A scoping review and evidence gap mapping. Frontiers in Psychiatry 2021, 12, 748069. [Google Scholar] [CrossRef] [PubMed]
  46. Garfin, D.R. Technology as a coping tool during the coronavirus disease 2019 (COVID-19) pandemic: Implications and recommendations. Stress and Health 2020, 36, 555. [Google Scholar] [CrossRef] [PubMed]
  47. Fuhr, D.; Acarturk, C.; McGrath, M.; Ilkkursun, Z.; Sondorp, E.; Sijbrandij, M.; Ventevogel, P.; Cuijpers, P.; McKee, M.; Roberts, B. Treatment gap and mental health service use among Syrian refugees in Sultanbeyli, Istanbul: a cross-sectional survey. Epidemiology and Psychiatric Sciences 2020, 29, e70. [Google Scholar] [CrossRef] [PubMed]
  48. Loan, L.A.; Parnell, T.A.; Stichler, J.F.; Boyle, D.K.; Allen, P.; VanFosson, C.A.; Barton, A.J. Call for action: Nurses must play a critical role to enhance health literacy. Nursing Outlook 2018, 66, 97–100. [Google Scholar] [CrossRef]
  49. Thornicroft, G.; Mehta, N.; Clement, S.; Evans-Lacko, S.; Doherty, M.; Rose, D.; Koschorke, M.; Shidhaye, R.; O’Reilly, C.; Henderson, C. Evidence for effective interventions to reduce mental-health-related stigma and discrimination. The Lancet 2016, 387, 1123–1132. [Google Scholar] [CrossRef]
  50. Yamaguchi, S.; Ojio, Y.; Foo, J.C.; Michigami, E.; Usami, S.; Fuyama, T.; Onuma, K.; Oshima, N.; Ando, S.; Togo, F. A quasi-cluster randomized controlled trial of a classroom-based mental health literacy educational intervention to promote knowledge and help-seeking/helping behavior in adolescents. Journal of Adolescence 2020, 82, 58–66. [Google Scholar] [CrossRef]
  51. Moleiro, C.; Freire, J.; Pinto, N.; Roberto, S. Integrating diversity into therapy processes: The role of individual and cultural diversity competences in promoting equality of care. Counselling and Psychotherapy Research 2018, 18, 190–198. [Google Scholar] [CrossRef]
  52. Lee, S.; Laiewski, L.; Choi, S. Racial-ethnic variation in US mental health service use among Latino and Asian non-US citizens. Psychiatric Services 2014, 65, 68–74. [Google Scholar] [CrossRef]
  53. Hampson, M.E.; Watt, B.D.; Hicks, R.E.; Bode, A.; Hampson, E.J. Changing hearts and minds: The importance of formal education in reducing stigma associated with mental health conditions. Health Education Journal 2018, 77, 198–211. [Google Scholar] [CrossRef]
  54. Gopalkrishnan, N.; Babacan, H. Cultural diversity and mental health. Australasian Psychiatry 2015, 23, 6–8. [Google Scholar] [CrossRef] [PubMed]
  55. Chinman, M.; George, P.; Dougherty, R.H.; Daniels, A.S.; Ghose, S.S.; Swift, A.; Delphin-Rittmon, M.E. Peer support services for individuals with serious mental illnesses: assessing the evidence. Psychiatric Services 2014, 65, 429–441. [Google Scholar] [CrossRef] [PubMed]
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.
Copyright: This open access article is published under a Creative Commons CC BY 4.0 license, which permit the free download, distribution, and reuse, provided that the author and preprint are cited in any reuse.
Prerpints.org logo

Preprints.org is a free preprint server supported by MDPI in Basel, Switzerland.

facebook logotwitter logolinkedin logo
MDPI Initiatives
Important Links
Subscribe

Disclaimer

Terms of Use

Privacy Policy

© 2024 MDPI (Basel, Switzerland) unless otherwise stated