Planning for district mental health services in South Africa: a situational analysis of a rural district site
TL;DR: It is suggested 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 mentally health care within the primary health care resource package, as well as the inefficient use of existing mental health resources.
Abstract: 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.
Cites methods from "Planning for district mental health..."
...It is clear that an instrument of this nature is not designed to provide detailed analyses of political and cultural factors, and in the case of South Africa, we have used qualitative methodologies to explore these aspects in other papers [41, 42]....
Cites background from "Planning for district mental health..."
...One important finding from the MHaPP situational analysis at district level in South Africa (cf. Petersen et al., 2009) was the need for the establishment of a multisectoral mental health advisory group to plan and facilitate the integration of mental health services at district and sub-district…...
...In this regard, primary health care nurses and doctors provided care for users with mental health needs but had very little training in mental health and the requisite supervision structure was deemed inadequate (Petersen et al., 2009)....
...As a consequence, the mental health care provision focused predominantly on emergency and symptom management of serious mental illnesses, particularly psychotic and mood disorders requiring hospitalization and psychopharmacological care (Petersen et al., 2009)....
"Planning for district mental health..." refers methods in this paper
...A framework analysis approach (Ritchie and Spencer 1994) was used to analyse the qualitative data....
...Framework analysis was specifically developed for qualitative data analysis in applied policy analysis research (Ritchie and Spencer 1994; Lacey and Luff 2001)....
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