title: Perceptions of health managers and professionals about mental health and primary care integration in Rio de Janeiro: a mixed methods study.
abstract: Community-based primary mental health care is recommended in low and middle-income countries. The Brazilian Health System has been restructuring primary care by expanding its Family Health Strategy. Due to mental health problems, psychosocial vulnerability and accessibility, Matrix Support teams are being set up to broaden the professional scope of primary care. This paper aims to analyse the perceptions of health professionals and managers about the integration of primary care and mental health.
  
  
  
  In this mixed-method study 18 health managers and 24 professionals were interviewed from different primary and mental health care services in Rio de Janeiro. A semi-structured survey was conducted with 185 closed questions ranging from 1 to 5 and one open-ended question, to evaluate: access, gateway, trust, family focus, primary mental health interventions, mental health records, mental health problems, team collaboration, integration with community resources and primary mental health education. Two comparisons were made: health managers and professionals' (Mann-Whitney non-parametric test) and health managers' perceptions (Kruskall-Wallis non parametric-test) in 4 service designs (General Traditional Outpatients, Mental Health Specialised Outpatients, Psychosocial Community Centre and Family Health Strategy)(SPSS version 17.0). Qualitative data were subjected to Framework Analysis.
  
  
  
  Firstly, health managers and professionals' perceptions converged in all components, except the health record system. Secondly, managers' perceptions in traditional services contrasted with managers' perceptions in community-based services in components such as mental health interventions and team collaboration, and converged in gateway, trust, record system and primary mental health education. Qualitative data revealed an acceptance of mental health and primary care integration, but a lack of communication between institutions. The Mixed Method demonstrated that interviewees consider mental health and primary care integration as a requirement of the system, while their perceptions and the model of work produced by the institutional culture are inextricably linked.
  
  
  
  There is a gap between health managers' and professionals' understanding of community-based primary mental health care. The integration of different processes of work entails both rethinking workforce actions and institutional support to help make changes.
authors.affiliation: Programa de Pós Graduação em Ciências Médicas/ Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. karensathie@gmail.com.
authors.forename: Karen
authors.initials: K
authors.lastname: Athié
authors.affiliation: Laboratório Interdisciplinar em Atenção Primária à Saúde/LIPAPS/Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Alice Lopes do Amaral
authors.initials: AL
authors.lastname: Menezes
authors.affiliation: Laboratório Interdisciplinar em Atenção Primária à Saúde/LIPAPS/Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Angela Machado
authors.initials: AM
authors.lastname: da Silva
authors.affiliation: Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Monica
authors.initials: M
authors.lastname: Campos
authors.affiliation: Núcleo de Pesquisas em Políticas Públicas de Saúde Mental/ Instituto de Psiquiatria da Universidade do Brasil, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Pedro Gabriel
authors.initials: PG
authors.lastname: Delgado
authors.affiliation: Laboratório Interdisciplinar em Atenção Primária à Saúde/LIPAPS/Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Sandra
authors.initials: S
authors.lastname: Fortes
authors.affiliation: Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Dowrick
mesh_terms: D000288:Administrative Personnel; D001291:Attitude of Health Personnel; D001938:Brazil; D003156:Community Mental Health Services / Q000458:organization & administration*; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D006282:Health Personnel / Q000458:organization & administration / Q000523:psychology*; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D001523:Mental Disorders / Q000628:therapy; D008603:Mental Health; D010348:Patient Care Team / Q000458:organization & administration; D010465:Perception; D010865:Pilot Projects; D011216:Practice Management, Medical; D011320:Primary Health Care / Q000458:organization & administration*
keywords: Collaborative care; Implementation science; Integration; LAMIC; MHGAP; Mental health; Mental health matrix support; Mixed methods; Primary care; Public health