Healthcare providers' experiences of community-based collaborative care for serious mental illness: a qualitative study in two integrated clinics in South Africa.

Abstract

Community-based collaborative care (CBCC) is an internationally recognised model of integrated care that emphasises multidisciplinary teamwork and care coordination. In South Africa, community psychiatry has been integrated into some primary healthcare (PHC) facilities. This study examines healthcare providers' perceptions of collaboration and its challenges in various integrated care settings. Three main components of CBCC (multidisciplinary teams, communication and case management) were explored through qualitative interviews with 29 staff members in 2 clinics. In Clinic-1, community psychiatry services operate independently in an outbuilding behind the main PHC clinic ("co-located"). In Clinic-2, these services are fully integrated within the PHC clinic ("physically integrated"). Both clinics had multidisciplinary teams, with various staff members conducting case management functions on an ad hoc basis. The physically integrated clinic (due to shared files, physical proximity and a facility manager with mental health experience) had greater levels of communication between the multidisciplinary team. In contrast, the co-located clinic struggled with poor management, unclear reporting structures and reinforced traditional hierarchies, limiting collaboration between the staff members. Integration does not guarantee collaboration. Improving collaboration between mental health and PHC staff requires clear roles, competent managers, CBCC endorsement from PHC clinicians, sufficient human resources and systematic communication channels, such as case review meetings.