Primary health care nurses' perceptions of the socio-ecology of mental illness among patients: An exploratory study

The de-institutionalisation of the health care system in South Africa had implications for the dissemination of resources from tertiary facilities to primary health care (PHC) clinics. Since there are little to no psychological or psychiatric services available at the PHC level, nurses serve the function of screening, assessing, and treating patients with mental health problems. We explored how primary health care nurses perceive the aetiology and socio-ecology of mental health problems as presented by their patients. Informants were eight nurses from three PHC facilities in the Ekurhuleni Metropolitan Area of Johannesburg, South Africa. They responded to a semi-structured interview that explored their perceptions of mental illness and psychological disorders. Thematic analysis yielded themes suggesting that nurses attribute mental illness and psychological disorders to community socio-ecological factors of (i) cultural beliefs; and (ii) fear of violent behaviours. The nurses acknowledged that the socio-cultural setting greatly impacted how symptoms associated with mental illness were interpreted. Additionally, a lack of training in mental health care provision hinders the ability of nurses to provide quality care to mental health care users at PHC facilities.