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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

(n = 62)
(n = 26)
(n = 40)
(n = 12)
(N = 140)
Positive perceptions of program
Program is good/people like itI believe it is the best psychotherapy (P)
People talk good about this therapy (C)
Program is acceptable/agrees with valuesThis therapy suits my values, otherwise I could not come (C)
It is accepted by [when] explaining the treatment (P)
Program is suitable/appropriateIt suits my needs (C)
This treatment is suitable and blessed (D)
Program is feasibleIt is feasible and requires no changes (P)
It is feasible with the current capacities (D)
Program is accessible/is for everyoneEveryone and [every] section of the community can have access to it (C)77
Program impacts
Is useful/effectiveI 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)
Increased knowledge/MH literacyI learned from it that not only I am ill (C)
People’s awareness about mental health sicknesses increased (D)
No harmful impactIt does not have any bad effect for me (C)2727
Empowers clientsIt 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)
Prevents suicidePreviously 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)
Gives security, comfortI had the feeling that I become comfortable when I come here (C)
I felt secure (C)
Gives hopeI have regained hope for life (C)
This mental health section gave hope to people, influenced them and people took benefit (S)
Program attributes
Free of drugsMy problem was solved without taking a single pill (C)
This treatment is better and more effective than drugs (S)
No costThe treatment was free of charge (C)
If treatment is free of charge, poor people will take benefit from the program (S)
Talk-based treatmentI could talk out what was in my heart (C)
I needed someone to listen to me (C)
Simple/easy to followThe home exercises made it easy (C)
We feel the programme is not difficult, patients can apply there, therefore, it is feasible (P)
Flexible schedulingThey set the appointment according to my time (C)1615
Protects confidentialityThere was no name recording (C)
Patients’ private data kept confidential by us (S)
Providers receive trainingWe received good trainings (P)
In the university, I did not know anything, but here I learned (P)
Step-by-step/session-basedWeekly 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)
Provider attributes
Caring/respectfulThere 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)
Providers are capable/specializedThe CHHW was there ready at the exact time (C)
There are capable psychotherapists (D)
Eager/motivated providersAs a psychotherapist, I continue and never quit (P)
Staff eagerness and loyalty for the work (D)
Service environment
Good facilities (large, quiet, clean)The place was quiet (C)
Our building is new and large (D)
Center has good reputationThe say good things about the reputation of the health center (C)
The structure of the program is robust (C)
Separate space/MH sectionThere is a private place where I can talk (C)
I have my own room (P)
Coffee/tea providedThey bring us water, tea and sweets (C)1213
Conveniently locatedThe place was very near for me (C)
In terms of location, our hospital is suitably located (P)
Positive work environment
Good cooperation among staffThey 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)
Supportive leadershipSupervision is at a very good level (S)
The director facilitating a lot of things for us (P)
Client attributes
Supportive friends/familyMy 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)
Autonomy for treatment decisionsI come to this treatment based on my decision (C)5050
Able to arrange work/scheduleI arrange my work ahead of time (C)
In my job, they give me permission [to leave] anytime I want (C)
Trust for the program/CMHWThe CMHW can be trusted so you talk about your problem with them (C)
Patients tell psychotherapists their stories because they trust them (S)
Motivation/recognized needI needed this treatment very much (C)
I wanted to get rid of my problem (C)
Sufficient time availableI have time to come here (C)1213
Childcare availableI take my children to my neighbors (C)1111
Adequate program resources
Financial/material support for clients and programPaying the transport cost made it easy (C)
Help from ‘material’ (Financial) aspect (C)
Provision of incomes for staffProvision of incomes make it suitable to continue (S)1313
Adequate staffing/staff timeI allocate much time for patients (P)
In the past, we suffered lack of doctors and social workers but now we have psychotherapist (S)
  1. “–” indicates response was not provided at that stakeholder level