Mental, neurological, and substance-use (MNS) disorders are extremely common worldwide [1] [2] . Untreated mental diseases represent 13% of the worldwide disease burden, with the treatment gap being highest in poor and middle income nations [3] . Mental diseases also account for 7% of the global burden of disease assessed in disability-adjusted life-years (DALYs) and up to 19% of all years lived with disability [4] . As a result of the aforementioned, MNS are substantial contributors to disease, untimely death, and disability throughout the world [5] . They’re also regularly linked to social stigma and human rights violations, especially in low- and middle-income nations (LMICs).

Despite this, treatment care for MNS still lags behind LMICs, especially in Africa. According to the WHO’s World Mental Health Survey, the treatment gap for serious mental disorders in those climes has been estimated to be up to 75% [6] . According to Espinosa-Jovel, Toledano, Aledo-Serrano, García-Morales, and Gil-Nagel [7] , over 80% of people with epilepsy live in LMICs, and about 6 out of 10 do not receive any therapy. By 2050, “substantial population growth and aging are expected to result in an estimated 130 percent rise in the impact of mental and drug use disorders” in Sub-Saharan Africa [8] . The situation is even more alarming in a highly populated African country like Nigeria. Only 20% of patients with very common mental disorders in the country received treatment in the previous year, and even when they did, it was frequently below basic ethical and clinical standards [6] [9] .

No doubt, the society faces grave consequences from the lack of available mental health professionals especially doctors and nurses to render the needed services [10] . This emphasizes the need to expand mental health services, particularly in low- and middle-income countries (LMICs), to enhance access to care. On the other hand, efforts to expand mental health support in LMICs must struggle with a current scarcity of mental health specialists and health facilities capable of providing specialized care for mental, neurological, and substance use disorders (MNS).

As part of the global drive to scale up mental health services and eliminate the treatment gap, incorporating mental health services into primary health care has been identified as the most practicable strategy to enhance access [11] . Primary health care (PHC) is a community-based management method for providing healthcare services. Primary health care provides care at the point of contact for people with health problems, as well as comprehensive, continuous, and coordinated care and rapid referrals to higher levels of care. Various countries have made different amounts of progress in implementing the notion since it was first published in 1978 [12] .

However, in the majority of LMICs, this expectation is rarely met when it comes to MNS problems in primary care. The sophistication of PHCs in dealing with health care challenges at the grassroots level implies that mental health services could be delivered by health services providers close to them in the community rather than the tertiary approach that relies solely on professional psychiatrists. This way, the PHC model easily comes into play.

Primary healthcare is required to provide first contact and, in addition to providing comprehensive, ongoing, and coordinated treatment for people with health problems, it should also demonstrate the ability to refer patients to a higher level of care quickly. However, in the majority of LMICs, this expectation is rarely met when it comes to MNS problems in primary care. Although some reasons have been advanced, such as poor training of primary care providers, a lack of support and supervision, and uncoordinated referral pathway through the multiple levels of the health service, and policy neglect manifesting itself in the form of poor financing, infrequent supply of medications for MNS conditions, and weak health systems [13] . There is however a need for context-specific empirical evidence to inform policy and plan of action towards integration of mental healthcare into PHC. Therefore, the study aimed to determine the healthcare workers’ preparedness for the care of the mentally ill, the knowledge of the care of the mentally ill among health workers, the attitudes of health workers towards mentally ill patients, and the health workers’ perception of integrated mental healthcare.

Of 226 distributed questionnaires, two hundred and fifteen (215) were correctly completed giving a 95% return rate. The majority of the participants (46%) were in the age range of 50 years and above while the age 39 and below are the lowest in the population. Based on the highest academic qualification, a preponderant (48%) showed that the majority of the participants were Diploma holders. Those who had 16 years of working experience (32%) were higher than other categories.

As evidenced in the results of this study, less than 20% of the participants consented to the position that they had sufficient community-based child mental health care training, awareness of referral protocol for mentally ill patients, and assessment of mentally ill patients have been undertaken by them, identifying patients with mental health problems, adequacy of occupational mental health training skills, and preparedness for MHC. The findings also imply that there is a lack of awareness regarding mental health and the prejudice that comes with it. Within the context of this study and in line with the position of Abimbola [15] , there is still a pervasive belief system that mental illness is a form of retribution from the gods for one’s the wrong deed thus they try as much as possible to avoid contact with such person. The outcome of the work is in line with a study [16] in which health workers were observed to have very poor knowledge of depression. The work is equally in tandem with the work of Abera, Tesfaye, Belachew, and Hanlon [17] where the participants were found to have poor knowledge of mental illness (23.4%). Yet, this disagrees with realities found in other parts of the world like Australia [18] . The implication is that developed countries are more knowledgeable about mental illness.

Analysis revealed that the major source of the respondent’s knowledge of mental health was published educational articles, classroom lectures, social media networks, seminars and personal experience. Published educational articles are reliable means of circulating medical information. Classroom lectures and social media are equally other powerful means of circulating information which might be responsible for the study outcome. The result of the study is in line with the report by Gureje, Abdulmalik, Kola, Musa, Yasamy and Adebayo [3] where social media and published educational articles were found to be the major sources of awareness of mental health. The study is equally in line with related studies [19] [20] where seminars and manuals were reported as the major source of the respondent’s knowledge of mental illness respectively. The study thus indicates that such knowledge sources as in-service training are conspicuously missing.

A greater number of the study participants have favourable attitudes towards the mentally ill for instance 39% and 45% strongly agree and agree that they will not discriminate against the mentally ill. This might be a result of the awareness some have concerning mental illness. It might equally be a result of knowledge gained through experiences acquired over years of nursing practice. The findings are similar to a study that investigated attitudes regarding mental health and the incorporation of mental health support into primary health care in Cambodia’s Lave En District [21] . Approximately 81 percent of those polled said they were personally interested in providing mental health care in their units. Similar optimism was recorded among nurses rendering care to remote communities of Australia [22] . In a study that investigated the perceived barriers and opportunities associated with integrating mental health into primary care in south-west Ethiopia [17] , almost all PHC employees in their survey said mental health treatment was important in Ethiopia, and the proportion of the respondents said they wanted to give mental health care. Contemporaneously, a good number of study participants have negative attitudes toward the mentally ill and this will have a substantial effect on the care they will render irrespective of their knowledge base. As revealed, 39.5% and 33.4% strongly agreed and agreed that they’ll not be comfortable caring for the mentally ill while 22.7% and 28.5% affirmed that they are afraid of caring for the mentally ill.

It is general knowledge that lowering stigma and promoting human rights for persons with mental illnesses could go a long way toward improving the quality of life of those who suffer from mental illnesses. Yet study reveals that about a third to a half of the respondents still perceived that lack of community awareness and stigmatization of the mentally ill as a major barrier to the achievement of the successful integration of the mentally ill. Also, approximately half of the respondents perceived that they require basic training, adequate staffing and improved Government support to provide health care to those who are suffering from mental illnesses. The findings matched a study that investigated public health professionals’ opinions of mental health programs in Equatorial Guinea, Central-West Africa [23] . According to those interviewed, the current mental health system does not match the demands of the community. Professionals cited infrastructure capacity, stigmatization, and a lack of other resources such as training programmes, knowledgeable staff, medications, and data as key factors limiting the efficacy of mental healthcare [20] [24] .

Evidence from this study supports that there is a need for community education and the building of capacity of health care workers for integration of the care of the mentally to be feasible in PHCs. The major source of the respondent’s knowledge of mental health was published educational articles hence a reliable means of circulating medical information. Meanwhile, classroom lectures and social media were equally other powerful means of circulating information and thus might be responsible for the outcome. In addition, the study aimed to determine the attitudes of health workers toward mentally ill patients. From the analysis above, it can be deduced that health workers exhibit some degree of positive attitude towards the care of the mentally ill. This might be as a result of the awareness some have concerning mental illness and as a result of knowledge gained while in school or experience gained over the years of practice. Finally, the researchers investigated how health care providers felt about the process of integrating mental health care into primary care settings. Due to a lack of public knowledge of mental diseases, mental illness is related to stigmatization. This means that there is a need to deepen the knowledge and information access of mentally ill care providers to ensure that they are abreast with evolving techniques and relevant evidence. Care providers expressed significant support for incorporating mental health within primary health care, which would help to reduce stigma and promote human rights for persons with mental health concerns. Basic training for mental health care providers is required to improve their knowledge and skills.

The self-reported surveys utilized in the study had a propensity to underestimate reality, particularly in issues involving substance use among adolescents, however, the instrument had adequate face validity was acceptable reliability.

The author declares no conflicts of interest regarding the publication of this paper.

Ezeruigbo, C.F.S. (2022) Health Workers’ Preparedness towards Integrating Mental Healthcare into Primary Health Settings: Evidence from Nigeria. International Journal of Clinical Medicine, 13, 379-390. https://doi.org/10.4236/ijcm.2022.138026