Practices of Congolese mental health and psychosocial support providers: a qualitative study on challenges and obstacles

Background: Mental health and psychosocial support (MHPSS), including services related to sexual and reproductive health problems, is a highly unaddressed area in Eastern Democratic Republic of Congo (DRC). Whilst ongoing war and crisis in the region have seriously affected the population, health systems and healthcare providers do not seem to be equipped to respond to the needs of the population. Methods: The aim of the study was to identify gaps in current practices of medical staff working at local health centres trying to provide adequate mental health and psychosocial support including sexual and reproductive health services to their patients, as well as obstacles prevalent in the context they operate in. We present findings of a qualitative study amongst 36 local staff working directly with patients at 7 hospitals and health centres in North Kivu. Results: The analysis reveals three main categories of knowledge and skill gaps for staff in Eastern DRC to provide proper mental health and psychosocial support services, with integrated care for sexual and reproductive health, to women and men. These are related to reliance on western imposed approaches that only partly fit the local context, to a strong focus on medication, and to a lack of training. Further, the data show two main obstacles to improve current practices: persistent cultural taboos and misconceptions about what mental health and sexual health problems are and how they come to exist, and a very limited referral system. Conclusion: This qualitative research provides important, context and cultural sensitive information on existing gaps and obstacles that Congolese providers of MHPSS services deal with. These gaps and obstacles illustrate the complex context in Eastern DRC, highlight the importance of locally tailored education and training, and stress the need for system changes to improve access and quality of mental health and psychosocial support services, that include attention for sexual and reproductive health. From a national and regional perspective, the results seem to call for a paradigm shift as to how mental health is approached and embedded in educational systems and society.