13 After the initial meeting, the patient was seen two weeks later in order to complete assessments and start working out an action plan for whatever problems identified. The subsequent follow-ups were scheduled at one, three and six month’s intervals from the time of the second session. The SRQ-20 and self-rating scale were completed on each occasion after the initial screening by the referral agent. Each session took between 45 minutes to an hour, depending on the patient`s openness and the issues under discussion. If a patient did not attend for a session, it was rescheduled and a letter sent to the patient. Attempts were made for up to three invitations, and, if the patient did not attend, he or she would then be removed from the register and considered lost. As indicated above, the study began with eighteen identified patients. Eight were lost and ten were seen through to the six-month follow up. The approach is very much linked to the Nursing Process, an approach with which nurses are very familiar, and which has been used internationally. The process has five stages and the nurse guides the patients through each of these stages as is described below: • • • • • Problem Identification Problem Exploration Action Plan Implementation Follow-up A full report is described elsewhere22. The therapy approach itself seemed to be acceptable to the clients, and was not difficult to implement. The clients seemed to appreciate the focus upon their expressed problems rather than a purely symptomatic approach, which is the most common experience in the primary care or outpatient setting. The problem solving approach also differs from other forms of counselling or psychotherapy in that it uses the same method for all problems, although the solutions clearly differ from client to client. The overall aim, that of finding a treatment method for the primary care setting, seems satisfied. The approach is simple to implement, makes sense to the client, and, most important of all, uses skills with which most nurses are already. This is important when it is considered that most psychological disorders will only ever attend at the primary care or outpatient level, and where virtually all these clients will not receive specialist mental health care. Thus, an approach that requires a minimum of skill re-training has decided advantages for the primary care setting, and follows the general approach already tried in the Zimbabwean setting 23. 3. Client Follow-up 22 See Reeler, A..P., & Hlatywayo, E. (2000), A pilot study on the effectiveness of problem solving therapy on primary care patients with psychological problems, (in preparation). 23 See Abas M.A., Broadhead J.C., Mbape P., Khumalo-Sakatukwa, G. (1994) Defeating depression in the developing world. A Zimbabwean Model. British Journal of Psychiatry, 164, 293-296. Training nurses in the assessment and management of psychological disorders: Report of AMANI Trust’s programme in Mashonaland Central Province, Zimbabwe.