The era of primary healthcare solely focused on physical health is long gone. Today, it is universally acknowledged that health encompasses both physical and mental aspects. To substantiate this, one can look at how the World Health Organization (WHO) defines health: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Yet, to think of mental health in the realm of primary health care is still a distant dream for many.
Primary healthcare aims to deliver high-quality, comprehensive care for people throughout their lives. As outlined by the World Health Organization (WHO), it involves three main elements: integrating health services to address diverse health needs, tackling the broader determinants of health through coordinated policy and action, and empowering individuals, families and communities to take control of their health.
The Alma Ata Declaration established primary health care as crucial for achieving health for all people. In fact, as an extension of the same, in recent years, there has been growing recognition of the critical role that primary healthcare plays in strengthening community mental health. Since it is at the foundational level of a country’s healthcare system, primary healthcare is uniquely positioned to address mental health issues early, integrate mental healthcare with general health services, and foster a supportive environment for mental well-being.
Several studies suggest that by leveraging the strengths of primary health care, communities can achieve more comprehensive, accessible, and equitable mental health support.
Integration of mental health into primary healthcare
An article in the Mental Health in Family Medicine journal recommends that one of the most significant ways primary healthcare can strengthen community mental health is by integrating mental health services into general healthcare settings. Traditionally, mental health care has been siloed, with specialised services separate from primary health care. Still, this fragmentation often leads to gaps in care and stigma, eventually discouraging individuals from seeking help.
Integrating mental health services into primary healthcare settings—such as family practices, community health centres and clinics—ensures that mental health is addressed as part of routine care. This integration can then allow for early detection and treatment of mental health issues. Mental health conditions frequently present as physical symptoms or occur alongside other physical health issues.
For example, individuals with chronic conditions such as diabetes or hypertension may also experience depression or anxiety. Integrating mental health care into primary healthcare is crucial for providing comprehensive and effective treatment. By integrating mental health into primary healthcare, we aim to enhance access to care and health outcomes. The World Health Organization (WHO) recommends several key strategies to achieve this: securing a formal commitment from the highest levels of government, incorporating mental health training into medical and paramedical curricula, reinforcing this training through on-the-job education and ensuring adequate supervision of primary care staff to support sustainable integration.
What is the other aspect?
Another essential aspect of strengthening primary healthcare to improve access to mental health services is addressing the stigma associated with mental health, which is particularly prevalent in rural areas. Integrating mental health services into primary care can help normalise conversations about mental health.
Incorporating mental health care into regular health check-ups becomes a standard part of overall well-being. Primary healthcare settings are often more accessible than specialised mental health facilities. Therefore, by providing mental health services within these familiar and accessible primary care environments, barriers such as transportation, cost and long wait times can be significantly reduced, improving overall access to care.
Community support to advance mental health policies
An approach to effect this is by promoting community-based approaches and support networks. This usually involves working with local organisations, schools, workplaces and community leaders to create supportive environments that promote mental well-being and provide resources for needy individuals.
A great example of how primary healthcare can strengthen community mental health is Bhutan’s Mental Health Integration Program, which started in July 1997. While mental health issues were traditionally inaccessible to many people, the programme attempts to integrate mental health services into the primary healthcare system. This was done through a three-part process. Training and capacity building of primary health care providers for mental health diagnosis and treatment through which they can identify common mental health disorders and understand how to provide essential mental health interventions. They then leveraged community-based approaches including building local health centers, allowing individuals to access mental health care alongside other health services and running awareness campaigns to educate the public about mental health and encourage individuals to seek help. Lastly, regular supervision and support from mental health specialists was enforced to ensure they were delivering effective and appropriate care.
In turn, the programme enhanced access to care, improved health outcomes and reduced stigma, proving that mental health is addressed as part of overall health care, leading to more comprehensive and practical support for community mental health. A similar approach was implemented in Sehore, Madhya Pradesh, where the government adopted the World Health Organization’s Mental Health Gap Action Plan. This plan advocated for a collaborative care model to effectively address the challenges faced in implementing mental health services.
Better Community, Better Nation
In conclusion, strengthening community mental health through primary healthcare is certainly a multifaceted approach that includes integrating mental health services into general care settings, enhancing access, reducing stigma and building provider capacity, among other measures. By leveraging the strengths of primary healthcare– an area where Smile Foundation works extensively in, countries can achieve a more holistic and accessible mental health support system, fostering healthier, more resilient communities.
