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Mental Health Services in Primary Care Settings: Challenges, Opportunities and Best Practices

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Behavioral and Mental Health".

Deadline for manuscript submissions: 31 August 2025 | Viewed by 2034

Special Issue Editors

Dr. Maria do Perpétuo S. S. Nóbrega

E-Mail Website
Guest Editor
1. Department of Mother and Child and Psychiatric Nursing, School of Nursing, University of São Paulo (EEUSP), São Paulo, Brazil
2. Postgraduate Program in Nursing (PPGE), Av. Dr. Enéas de Carvalho Aguiar, 419, São Paulo 05403-000, SP, Brazil
Interests: mental health; primary health care; substance abuse; drugs; substance use disorder; digital technologies; women's mental health; use of psychoactive substances woman; mental health policies
Dr. Odete Araújo

E-Mail Website
Guest Editor
1. School of Nursing, University of Minho, Nursing Research Centre, 4710-057 Braga, Portugal
2. Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3045-043 Coimbra, Portugal
Interests: mental health literacy; aging; family caregivers; cognitive decline

Special Issue Information

Dear Colleagues,

Welcome to the Special Issue “Mental Health Services in Primary Care Settings: Challenges, Opportunities and Best Practices”.

Primary health care services are generally more accessible, available, and accepted by communities. Providing mental health services in primary health care is imperative to provide access to comprehensive, longitudinal, and quality care to populations. Primary health care still faces challenges in providing mental health care in terms of first aid in mental health, mental health literacy, positive mental health, psychological vulnerability, substance use disorders, care for the elderly population, family caregivers, social determinants of health (gender, sexuality, race, class, religion, nationality, sexuality, and generation, among others), early identification of serious, persistent and common mental disorders, comorbid physical health problems, the prevention and promotion of mental health, treatment, psychosocial rehabilitation, reducing stigma and/or prejudice, and considering the sustainable development goals set out by the World Health Organization. To this end, promoting mental health integration within primary care settings requires complex interventions, with cost-effectiveness and high levels of evidence, and management through evaluation indicators that quantify and monitor the quality in the implementation of sustainable and integrated care. We have prepared this Special Issue and invite high-quality academic articles that address ways to overcome difficulties, foster opportunities, and provide best practices for integrating mental health care within primary health care.

Dr. Maria do Perpétuo S. S. Nóbrega
Dr. Odete Araújo
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • primary health care
  • mental health
  • health evaluation

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Published Papers (5 papers)

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Research

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18 pages, 320 KiB  
Article
Engineering Integrated Care Expansion and Innovation: Drawing upon Nursing Leadership
by Kathleen R. Delaney, Margaret R. Emerson, Victoria Soltis-Jarrett, Amy J. Barton and Mary Weber
Int. J. Environ. Res. Public Health 2025, 22(4), 598; https://doi.org/10.3390/ijerph22040598 - 11 Apr 2025
Viewed by 343
Abstract
In the United States (US), a longstanding solution to the unmet need for mental health treatment is integrated behavioral health care (IBH). Within a primary care model, problems are identified and treatment combines care for physical, mental and substance use disorders. Treatments are [...] Read more.
In the United States (US), a longstanding solution to the unmet need for mental health treatment is integrated behavioral health care (IBH). Within a primary care model, problems are identified and treatment combines care for physical, mental and substance use disorders. Treatments are delivered through the collaboration of primary and behavioral health providers. According to US federal billing guidelines, in one integrated model, the Collaborative Care Model (CoCM), the psychiatric consultant must be a medical professional trained in psychiatry and capable of prescribing medications, i.e., either a psychiatrist, Psychiatric Mental Health Nurse Practitioner (PMHNP) or Physician Assistant. The development of integrated care has been slow for particular vulnerable populations, in part due to the lack of psychiatric consultants. PMHNPs are increasingly taking on the role of psychiatric consultants on CoCM teams and creating nurse-led IBH models for underserved populations. In this paper, eight such models are discussed along with implementation challenges and the strategies used to address them. Nurse leaders have the capacity to enhance and expand integrated care, particularly for underserved populations, through the optimal utilization of care teams, expanding measured outcomes, and developing measures for team-based effectiveness. Future directions are proposed that will accelerate this PMHNP-led expansion of IBH. Full article
(This article belongs to the Special Issue Mental Health Services in Primary Care Settings: Challenges, Opportunities and Best Practices)
25 pages, 352 KiB  
Article
Integrating Mental Health Services into Primary Care Settings: A Multiple Case Study of Congolese Experiences Testing the Feasibility of the WHO’s Mental Health Gap Action Programme
by Erick Mukala Mayoyo, Bart Criel, Aline Labat, Yves Coppieters and Faustin Chenge
Int. J. Environ. Res. Public Health 2025, 22(3), 457; https://doi.org/10.3390/ijerph22030457 - 20 Mar 2025
Viewed by 347
Abstract
Some experiences of integrating mental health into primary care settings, testing the feasibility of the World Health Organization’s mental health Gap Action Programme, have been launched in the Democratic Republic of the Congo to address treatment gaps. However, they have not yet been [...] Read more.
Some experiences of integrating mental health into primary care settings, testing the feasibility of the World Health Organization’s mental health Gap Action Programme, have been launched in the Democratic Republic of the Congo to address treatment gaps. However, they have not yet been documented to look at scaling up. This study described the health outcomes and lessons learned from two of these experiences. A multiple case study was conducted on two integration programmes in the urban Tshamilemba district in the Haut-Katanga province, ongoing since 2021, and in the rural Mangembo district in the Kongo Central province, ongoing since 2022. Data were collected between July and August 2024 from focus group discussions, interviews, document reviews, including routine health information systems. We carried out descriptive statistical analyses to measure indicators of accessibility and the use of services, and content analysis to explore the lessons learned. A total of 1708 individuals with mental disorders were treated in primary care settings between 2021/22 and 2024 under both programmes. From 2021 to 2024, the curative consultations rate for mental disorders, which was unknown at the start of both programmes, reached 14.4 new cases/1000 inhabitants/year in the Tshamilemba district and 14.2 new cases/1000 inhabitants/year in the Mangembo district. Several lessons were learned, related to each phase of mental health Gap Action Programme. The findings confirm the feasibility and effectiveness of the mental health Gap Action Programme in the Congolese context and highlight the need for concerted action to address the identified challenges. Full article
(This article belongs to the Special Issue Mental Health Services in Primary Care Settings: Challenges, Opportunities and Best Practices)
15 pages, 560 KiB  
Article
Construction and Validation of Nursing Actions to Integrate Mobile Care–Educational Technology to Assist Individual in Psychic Distress
by Dárcio Tadeu Mendes, Priscila de Campos Tibúrcio, Geni da Mota Cirqueira, Priscila Maria Marcheti, Sonia Regina Zerbetto, Carla Sílvia Fernandes and Maria do Perpétuo Socorro de Sousa Nóbrega
Int. J. Environ. Res. Public Health 2025, 22(3), 419; https://doi.org/10.3390/ijerph22030419 - 13 Mar 2025
Viewed by 361
Abstract
Psychic suffering is typical of the human condition and involves multideterminant factors in its origin, with significant influence from affective–relational–economic issues, invariably marked by negative and positive experiences. Objective: The objective of this study is to describe the process of construction and content [...] Read more.
Psychic suffering is typical of the human condition and involves multideterminant factors in its origin, with significant influence from affective–relational–economic issues, invariably marked by negative and positive experiences. Objective: The objective of this study is to describe the process of construction and content validation of a set of nursing actions to integrate a mobile educational technology to assist individuals in psychic distress in primary health care. Methods: This was a methodological study in four stages: scope review, qualitative research, elaboration of a set of nursing actions and content validation. It was carried out from December/2022 to December/2023, with 16 Brazilian specialists, a minimum Content Validity Index of 80% and Cronbach’s Alpha (α). Results: Six sets of actions were elaborated and evaluated: nursing actions in the initial assessment of the individual in psychic distress (99% α 0.47); nursing actions towards individuals in psychic distress with complaints associated with Depressive Disorder (93.4% α 0.84); nursing actions towards individuals in psychic distress with complaints associated with Anxiety Disorder (95.4% α 0.88); nursing actions towards individuals in psychic distress with Suicidal Ideation (96.3% α 0.71); nursing actions towards individuals in psychic distress resulting from the use of psychoactive substances (99.6% α 0.77) and; nursing actions towards individuals in psychic distress as a result of grief situations (98.6% α 0.28). Conclusions: The set of actions proved to be validated and to have acceptable reliability, thus contributing to supporting the development of educational technology. The conclusions of this research highlight the possibility for nurses to conduct nursing actions in the care of people in psychic distress, in a non-specialized context. In addition, this is a resource to improve the routine mental health care of nurses who work in primary health care. Full article
(This article belongs to the Special Issue Mental Health Services in Primary Care Settings: Challenges, Opportunities and Best Practices)
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13 pages, 544 KiB  
Article
Comparing Short Cognitive Screening Instruments in an Outreach Memory Clinic in Primary Care
by Rónán O’Caoimh, Sheena Cadoo, Brian Daly and D. William Molloy
Int. J. Environ. Res. Public Health 2025, 22(3), 410; https://doi.org/10.3390/ijerph22030410 - 11 Mar 2025
Viewed by 411
Abstract
Few studies have investigated the possibility of offering outreach from hospital-based memory clinic services to primary care. Such models could potentially improve access to specialised mental healthcare. We report on the reliability and validity of a pilot cognitive screening pathway in general practice [...] Read more.
Few studies have investigated the possibility of offering outreach from hospital-based memory clinic services to primary care. Such models could potentially improve access to specialised mental healthcare. We report on the reliability and validity of a pilot cognitive screening pathway in general practice (GP) in Ireland. Consecutive patients with memory complaints attending two primary care clinics were screened and diagnosed clinically by a physician-run memory clinic in GP. Follow-up in secondary care confirmed the diagnosis. Inter-rater reliability (IRR) and diagnostic validity of the Quick Mild Cognitive Impairment (Qmci) screen was compared to the Montreal Cognitive Assessment (MoCA) and General Practitioner Assessment of Cognition (GPCOG). In all, 63 patients, 31 with subjective memory complaints (SMC), 16 with mild cognitive impairment and 16 with dementia were screened. Their median age was 73 and 67% were female. The IRR of the Qmci screen between GP and clinic was excellent (r = 0.89). The Qmci was more accurate than the GPCOG in identifying cognitive impairment; the area under the curve (AUC) was 0.95 versus 0.80 (p = 0.008). The Qmci and MoCA had similar accuracy, with an AUC of 0.95 versus 0.91 (p = 0.117), respectively, but was significantly shorter (p < 0.001), suggesting it may be a useful instrument in this setting. Based on these results, a definitive study is now planned to examine the benefits and challenges of utilizing these instruments as part of establishing an outreach memory clinic service in primary care. Full article
(This article belongs to the Special Issue Mental Health Services in Primary Care Settings: Challenges, Opportunities and Best Practices)
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Review

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14 pages, 457 KiB  
Review
Nurses’ Perceptions on the Role of Advanced Psychiatric Nurses in Mental Healthcare: An Integrative Review
by Femi Edward Duyilemi and Nkhensani Florence Mabunda
Int. J. Environ. Res. Public Health 2025, 22(4), 626; https://doi.org/10.3390/ijerph22040626 - 16 Apr 2025
Viewed by 101
Abstract
Background/Objectives: Advanced psychiatric nurses’ clinical skills and expertise are increasingly challenging registered nurses in mental health. Understanding registered nurses’ perceptions of the role of advanced psychiatric nurses is vital for improving mental healthcare delivery and fostering collaboration for effective patient outcomes. This integrative [...] Read more.
Background/Objectives: Advanced psychiatric nurses’ clinical skills and expertise are increasingly challenging registered nurses in mental health. Understanding registered nurses’ perceptions of the role of advanced psychiatric nurses is vital for improving mental healthcare delivery and fostering collaboration for effective patient outcomes. This integrative review aims to explore how registered nurses perceive the role of advanced psychiatric nurses in mental healthcare. Methods: An integrative review methodology was used to synthesize the existing literature following PRISMA guidelines. Both qualitative and quantitative studies provided a comprehensive understanding of the registered nurses’ perceptions regarding the role of advanced psychiatric nurses in mental health nursing. Results: Several key themes emerged from studies included in this review, including recognition of expertise, role ambiguity and boundaries, and the need for structured education and training. Conclusions: This review highlights the need to clarify roles and how communication is essential for improving collaboration, team cohesion, and patient outcomes while promoting interprofessional education to optimize mental healthcare, in addition to bridging the knowledge gap or the discrepancy between registered nurses and advanced psychiatric nurses. What registered nurses know and what they need to know to perform tasks will improve the quality of mental healthcare and optimize services for individuals with mental health needs. Full article
(This article belongs to the Special Issue Mental Health Services in Primary Care Settings: Challenges, Opportunities and Best Practices)
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