https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(11)60891-X.pdf

Scale up of services for mental health in low-income and middle-income countries.

Background
There is growing recognition that mental health is an important public health issue in South Africa. Yet mental health services remain chronically under-resourced. The aim of this study was to document levels of current public sector mental health service provision in South Africa and compare services across provinces, in relation to current national policy and legislation.

Public sector mental health systems in South Africa: inter-provincial comparisons and policy implications

The majority of the black African population in South Africa utilize both traditional and public sector Western systems of healing for mental health care. There is a need to develop models of collaboration that promote a workable relationship between the two healing systems. The aim of this study was to explore perceptions of service users and providers of current interactions between the two systems of care and ways in which collaboration could be improved in the provision of community mental health services. Qualitative individual and focus group interviews were conducted with key health care providers and service users in one typical rural South African health sub-district. The majority of service users held traditional explanatory models of illness and used dual systems of care, with shifting between treatment modalities reportedly causing problems with treatment adherence. Traditional healers expressed a lack of appreciation from Western health care practitioners but were open to training in Western biomedical approaches and establishing a collaborative relationship in the interests of improving patient care. Western biomedically trained practitioners were less interested in such an arrangement. Interventions to acquaint traditional practitioners with Western approaches to the treatment of mental illness, orientation of Western practitioners towards a culture-centred approach to mental health care, as well as the establishment of fora to facilitate the negotiation of respectful collaborative relationships between the two systems of healing are required at district level to promote an equitable collaboration in the interests of improved patient care.

Collaboration between traditional practitioners and primary health care staff in South Africa: developing a workable partnership for community mental health services.

The purpose of the research programme introduced in this article is to provide new knowledge regarding comprehensive multisectoral approaches to breaking the negative cycle of poverty and mental ill-health. The programme undertakes an analysis of existing mental health policies in four African countries (Ghana, South Africa, Uganda, Zambia), and will carry out and evaluate interventions to assist in the development and implementation of mental health policies in those countries, over a five-year period. The four countries in which the programme is being conducted represent a variety of scenarios in mental health policy development and implementation.

Mental Health Policy Development and Implementation in Four African Countries

In 2000, Rita Thom published a systematic review of mental health services research in southern Africa, conducted from 1967 to 1999. 1 The review suggested a need to shift from centralised institutional care, which characterised apartheid South Africa, towards decentralised, integrated and community-based services provided within a human rights framework. The use of trained non-specialists to provide mental healthcare was also suggested as a strategy to increase access in the context of a shortage of mental health specialists. Research gaps identified included the need for accurate epidemiological studies; intervention studies demonstrating the efficacy of sustainable models of service delivery in line with policy imperatives for deinstitutionalised and integrated primary mental healthcare; and economic evaluation studies of service delivery models. 2 The latter included cost-effectiveness, cost-benefit and cost-utility analyses. Policies and legislation in post-apartheid South Africa have been consistent with the suggestions emanating from this review in a bid to increase access and quality of care within a human rights framework. 3,4

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Mental health service delivery in South Africa from 2000 to 2010: One step forward, one step back

The shift in emphasis to universal primary health care in post-apartheid South Africa has been accompanied by a process of decentralization of mental health services to district level, as set out in the new Mental Health Care Act, no. 17, of 2002 and the 1997 White Paper on the Transformation of the Health System. This study sought to assess progress in South Africa with respect to deinstitutionalization and the integration of mental health into primary health care, with a view to understanding the resource implications of these processes at district level. A situational analysis in one district site, typical of rural areas in South Africa, was conducted, based on qualitative interviews with key stakeholders and the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). The findings suggest that the decentralization process remains largely limited to emergency management of psychiatric patients and ongoing psychopharmacological care of patients with stabilized chronic conditions. We suggest that, in a similar vein to other low- to middle-income countries, deinstitutionalization and comprehensive integrated mental health care in South Africa is hampered by a lack of resources for mental health care within the primary health care resource package, as well as the inefficient use of existing mental health resources.

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Planning for district mental health services in South Africa: a situational analysis of a rural district site

Cross-national qualitative research is an increasingly common approach to health system research Whilst cross-national qualitative research presents many challenges, the benefits include the development of new perspectives and the opportunity to work with people from different backgrounds and develop capacity In particular, qualitative data analysis must be scientifically robust, balancing comparability with context-driven research, and must be collaborative and incorporate capacity development The Mental Health and Poverty Project employed a three-stage approach to cross-national qualitative research, consisting of development of a common structure in a workshop, adaptation by country teams and ongoing support Through this process, the project developed broad thematic frameworks which were adapted by each study country and used as a skeleton for the data analysis This paper critically reflects on the approach employed and reports the experiences of researchers throughout the analysis process The pa

Victoria Campbell-Hall

Papers

Planning for district mental health services in South Africa: a situational analysis of a rural district site

Cross-national qualitative research: the development and application of an analytic framework in the Mental Health and Poverty Project