An approach to mental health integration: practices and lessons from a DREAMS programme in South Africa

Aim Since 2014, the multi-country DREAMS programme has aimed to prevent HIV acquisition among highly vulnerable adolescent girls and young women through a multi-dimensional and comprehensive intervention. TB HIV Care ─ a DREAMS implementing partner in South Africa ─ adapted the programme to address local needs, developing an innovative component to positively influence mental health outcomes and further protect adolescent girls and young women from HIV infection. This paper details the integration of TB HIV Care’s mental health component into the programme, and argues that this approach offers a model and lessons for the adoption of better mental health services within the Primary Health Care system. Method Adolescent girls and young women aged 10─24 years were recruited in five districts with high HIV prevalence in the Eastern Cape and KwaZulu-Natal, where TB HIV Care implements the DREAMS programme. Once enrolled in age-appropriate educational sessions, each participant received comprehensive mental health risk screening by trained psychosocial support workers. TB HIV Care’s specially developed electronic risk-reduction screening tool incorporates aspects of Pfizer’s patient health questionnaire; the general anxiety disorder form; the alcohol use disorders identification test, and the drug use disorders identification test, and is used to identify mental health concerns and substance use disorders. This screening system enables the mental health risk profile of clients to be identified for their prompt referral to appropriate treatment services. Results Between October 2022 and May 2024, 145 605 participating adolescent girls and young women underwent mental health screening. While most participants were in a low-risk mental health category, over 5 000 were in need of first-line counselling; 934 required higher-level support, and 506 moderate- to high-risk cases needed in-depth support. TB HIV Care implemented its mental health treatment cascade with these clients, with encouraging results. Conclusion This paper provides lessons for the government in addressing weaknesses and gaps in existing mental health services, not only for adolescent girls and young women, but also for the broader population. Such approaches should be better integrated into the Primary Health Care system to reduce the impact of mental health disorders on young people.