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Table 4 Facilitators to mental health service implementation reported across stakeholder levels

From: Stakeholder perspectives on integration of mental health services into primary care: a mixed methods study in Northern Iraq

  Examples Clients
(n = 62)
(n = 26)
(n = 40)
(n = 12)
(N = 140)
Positive perceptions of program
Program is good/people like it I believe it is the best psychotherapy (P)
People talk good about this therapy (C)
58 26 40 11 137
Program is acceptable/agrees with values This therapy suits my values, otherwise I could not come (C)
It is accepted by [when] explaining the treatment (P)
51 26 33 6 116
Program is suitable/appropriate It suits my needs (C)
This treatment is suitable and blessed (D)
47 26 29 11 113
Program is feasible It is feasible and requires no changes (P)
It is feasible with the current capacities (D)
18 27 10 55
Program is accessible/is for everyone Everyone and [every] section of the community can have access to it (C) 7 7
Program impacts
Is useful/effective I had the feeling that I was getting better session after session (C)
We were able to treat most of our patients’ problems (P)
Patients get rid of psychological stress and it is useful for the community (D)
The good thing is that patients recover to enjoy better normal health status (S)
58 18 24 5 106
Increased knowledge/MH literacy I learned from it that not only I am ill (C)
People’s awareness about mental health sicknesses increased (D)
9 15 4 28
No harmful impact It does not have any bad effect for me (C) 27 27
Empowers clients It enables patients to depend upon oneself (P)
It teaches people better know their problems and have them solved by themselves (S)
I have learned a lot from this treatment that I can control my mental issues (C)
14 5 2 21
Prevents suicide Previously I had suicide idea but now it is no longer in my mind (C)
This treatment helps decrease the level of suicide and self-burning (P)
9 1 5 15
Gives security, comfort I had the feeling that I become comfortable when I come here (C)
I felt secure (C)
15 15
Gives hope I have regained hope for life (C)
This mental health section gave hope to people, influenced them and people took benefit (S)
5 3 8
Program attributes
Free of drugs My problem was solved without taking a single pill (C)
This treatment is better and more effective than drugs (S)
34 9 18 5 66
No cost The treatment was free of charge (C)
If treatment is free of charge, poor people will take benefit from the program (S)
29 13 14 4 60
Talk-based treatment I could talk out what was in my heart (C)
I needed someone to listen to me (C)
36 35
Simple/easy to follow The home exercises made it easy (C)
We feel the programme is not difficult, patients can apply there, therefore, it is feasible (P)
16 3 4 22
Flexible scheduling They set the appointment according to my time (C) 16 15
Protects confidentiality There was no name recording (C)
Patients’ private data kept confidential by us (S)
12 1 2 1 15
Providers receive training We received good trainings (P)
In the university, I did not know anything, but here I learned (P)
13 13
Step-by-step/session-based Weekly you sit with a CMHW for an hour or two; possibly you could not do so with someone else (C)
This program is step-by-step that is why it will have effect on the patient (C)
7 7
Provider attributes
Caring/respectful There is someone who listens to you and trusts your decisions (C)
We are always ready for any patient without difference (P)
In this treatment, patients are respected and listened to (S)
54 6 12 73
Providers are capable/specialized The CHHW was there ready at the exact time (C)
There are capable psychotherapists (D)
13 8 11 3 35
Eager/motivated providers As a psychotherapist, I continue and never quit (P)
Staff eagerness and loyalty for the work (D)
10 3 13
Service environment
Good facilities (large, quiet, clean) The place was quiet (C)
Our building is new and large (D)
35 7 17 3 62
Center has good reputation The say good things about the reputation of the health center (C)
The structure of the program is robust (C)
41 41
Separate space/MH section There is a private place where I can talk (C)
I have my own room (P)
10 4 3 18
Coffee/tea provided They bring us water, tea and sweets (C) 12 13
Conveniently located The place was very near for me (C)
In terms of location, our hospital is suitably located (P)
8 1 1 10
Positive work environment
Good cooperation among staff They show readiness for giving their places whenever there is patients or when I ask them (P)
Staff are very cooperative to the programme (S)
Employees enjoy a good cooperation between them (D)
25 37 12 74
Supportive leadership Supervision is at a very good level (S)
The director facilitating a lot of things for us (P)
1 15 28 4 48
Client attributes
Supportive friends/family My mother told me many times to use this treatment to get better and this made me continue (C)
My friends were happy that I came here (C)
53 53
Autonomy for treatment decisions I come to this treatment based on my decision (C) 50 50
Able to arrange work/schedule I arrange my work ahead of time (C)
In my job, they give me permission [to leave] anytime I want (C)
21 21
Trust for the program/CMHW The CMHW can be trusted so you talk about your problem with them (C)
Patients tell psychotherapists their stories because they trust them (S)
10 4 5 20
Motivation/recognized need I needed this treatment very much (C)
I wanted to get rid of my problem (C)
19 20
Sufficient time available I have time to come here (C) 12 13
Childcare available I take my children to my neighbors (C) 11 11
Adequate program resources
Financial/material support for clients and program Paying the transport cost made it easy (C)
Help from ‘material’ (Financial) aspect (C)
12 1 4 17
Provision of incomes for staff Provision of incomes make it suitable to continue (S) 13 13
Adequate staffing/staff time I allocate much time for patients (P)
In the past, we suffered lack of doctors and social workers but now we have psychotherapist (S)
6 3 8
  1. “–” indicates response was not provided at that stakeholder level