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Journal ArticleDOI

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.

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Citations
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Journal ArticleDOI
TL;DR: The basis for new and more positive understandings of the concept of recovery, both as an individual outcome and as a goal of services are examined, with particular emphasis on long-term outcomes in schizophrenia.
Abstract: The recovery movement has emerged as an important and powerful force in the design and implementation of mental health care in many countries around the world. This involves new and more positive understandings of the concept of recovery, both as an individual outcome and as a goal of services. The basis for these understandings is examined, with particular emphasis on longterm outcomes in schizophrenia, and a brief history of the origins of the recovery movement is given. An argument is made for the implementation of a recovery framework within South African mental health services.

8 citations

Journal ArticleDOI
TL;DR: In this article, the challenge facing the mental health field today is the lack of knowledge related to interventions and services that will help people recover from severe mental health problems, and the...
Abstract: The challenge facing the mental health field today is the lack of knowledge related to interventions and services that will help people recover from severe mental health problems. In addition, the ...

8 citations

Journal ArticleDOI
TL;DR: In this article , the authors identified significant structural weaknesses in CAMH and presented a clear call for action to strengthen services and systems in the Western Cape Province of South Africa and in South Africa.
Abstract: Even though child and adolescent mental health is a global health priority, services are very limited, particularly in low- and middle-income countries (LMIC), and therefore need comprehensive strengthening. This requires knowledge of the hardware elements of the system (human resources, financing, medicines, technology, organisational structure, service infrastructure, and information systems). This study sought to examine these elements of child and adolescent mental health (CAMH) services and systems in the Western Cape Province of South Africa.The World Health Organization Assessment Instrument of Mental Health Systems (WHO-AIMS) version 2.2 of 2005 was adapted to identify key variables of interest in CAMH. Data were collected for the calendar year 2016 and focused on the public health sector. We outlined findings based on best available data across the six domains of the WHO-AIMS.In domain 1, we found no provincial CAMH policy or implementation plans to support the national CAMH policy and were unable to identify a CAMH-specific budget. In domain 2, there was no dedicated provincial leadership structure for CAMH, and no dedicated or 'child- and adolescent-friendly' mental health services at primary or secondary care levels. At tertiary level, there were only three specialist CAMH teams. The majority of CAMH resources were based in the City of Cape Town, with limited resources in the rural districts. Essential medicines were available in all facilities, and the majority of children and adolescents had access to free services. In domain 3, data were limited about the extent of training offered to primary healthcare staff, and little or no psychosocial interventions were available in primary care. Domain 4 identified a small and variable CAMH workforce across all levels of care. In domain 5, few public health campaigns focused on CAMH, and little evidence of formal intersectoral collaboration on CAMH was identified. Domain 6 identified significant limitations in health information systems for CAMH, including lack of child- and adolescent-specific and disaggregated data to establish baselines for policy development, monitoring, evaluation and CAMH research.This study identified significant structural weaknesses in CAMH and presents a clear call for action to strengthen services and systems in the province and in South Africa. it would be important to expand research also to include provider and user perspectives for service strengthening.

8 citations

Journal ArticleDOI
TL;DR: In this article, the role of structural violence in relation to mental health and mental disorders is discussed and the authors encourage social workers to be alert for and address these issues in their practice.
Abstract: Social workers traditionally offer emotional, social and financial support to people who are in distress or in crisis. Although the problems presented are usually problems in daily living, these clients often are suffering from a mental disorder such as depression, anxiety, post traumatic stress disorder or substance abuse. These problems in daily living, rather than the symptoms of their emotional state or disorder per se, usually causes their distress and their need to seek help (WHO, 2001a). Sadly, their problems are also often exacerbated, or even caused, by the stigma and marginalisation experienced worldwide by those with mental disorders. It is important, therefore, that all social workers understand the complex relationships between marginalisation and mental health and mental disorders. This includes understanding the role of structural violence in relation to mental health. This article will discuss some of these relationships and aims to encourage social workers to be alert for and address these issues in their practice

7 citations

Journal ArticleDOI
TL;DR: The MH workforce shortages in PRPHC areas are discussed in terms of the evidence based approaches of task-shifting and transdisciplinarity.
Abstract: Background. These data provide national estimates of the human resources and services available to address the mental health (MH) needs of over 17 million rural South Africans, reliant on public rural primary healthcare (PRPHC) facilities. With personnel regarded as the most valuable resource for service delivery within an Mh system, this review’s aim was to inform policy on bridging the mental illness treatment gap that is as high as 85% in lowand middle-income countries (laMics). Objectives. The findings of three MH audits comprising 160 (98%) of South Africa’s (SA) PRPHC facilities are synthesised here to provide a situation analysis of SA’s PRPHC MH human resources and services. Material and methods. The review was based on the analysis of both primary and secondary data. Primary data were collected by interviewing the clinical heads of PRPHC facilities during the audits, while secondary data comprised a desk review. Results. Results indicate that MH nurses (MHNs), clinical psychologists, MH medical doctors (MHMDs) and psychiatrists are practicing in PRPHC areas at rates of 0.68, 0.47, 0.37 and 0.03 per 100 000 population, respectively; 96% of facilities do not have psychiatrists employed, while 81% have no MHMDs, 64% do not have clinical psychologists, and 61% have no MHNs; 69% do not receive specialist MH outreach services, while 78% do not have MH multidisciplinary teams. Conclusions. The MH workforce shortages in PRPHC areas are discussed in terms of the evidence based approaches of task-shifting and transdisciplinarity.

7 citations


Cites background from "Planning for district mental health..."

  • ...MH human resource approximations for rural SA have historically been based on estimates from district analyses [14, 18, 19], leaving considerable knowledge gaps....

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References
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Book ChapterDOI
09 Sep 2002
TL;DR: The last two decades have seen a notable growth in the use of qualitative methods for applied social policy research as discussed by the authors, which is underpinned by the persistent requirement in social policy fields to understand complex behaviours, needs, systems and cultures.
Abstract: The last two decades have seen a notable growth in the use of qualitative methods for applied social policy research. Qualitative research is now used to explore and understand a diversity of social and public policy issues, either as an independent research strategy or in combination with some form of statistical inquiry. The wider use of qualitative methods has come about for a number of reasons but is underpinned by the persistent requirement in social policy fields to understand complex behaviours, needs, systems and cultures.

7,396 citations


"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....

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  • ...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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MonographDOI
01 Jan 2007
TL;DR: The Nature of Qualitative Analysis Data Preparation Writing Thematic Coding and Categorizing Analysing Biographies and Narratives Comparative Analysis Analytic Quality and Ethics Getting Started with Computer Assisted Qualitative Data Analysis Searching and Other Analytic Activities Using Software Putting it All Together.
Abstract: The Nature of Qualitative Analysis Data Preparation Writing Thematic Coding and Categorizing Analysing Biographies and Narratives Comparative Analysis Analytic Quality and Ethics Getting Started with Computer Assisted Qualitative Data Analysis Searching and Other Analytic Activities Using Software Putting it All Together

3,790 citations

Journal ArticleDOI
21 Nov 2001-JAMA
TL;DR: Every country can and should begin now to improve its efforts to treat people with mental illness, and 10 recommendations on how governments can strengthen their country’s mental health care are concluded.
Abstract: As I write these words in mid October I reflect on the way in which we have, during the past 4 weeks, expressed our shared grief in understanding, sympathy, and support for those affected by posttraumatic stress. We are reminded of the extraordinary ability of humans tocopewithextremesofemotion,tohelp each other, and to handle fear, pain, and loss. We work together to preserve our mental health. We see nothing wrong, or mysterious, in our coping mechanisms. But we do not expect people to have to cope alone, in isolation. We understandtheneedforhelpandguidance. As health care professionals, we know that mental illness is not a personal failure. If there is failure, it is in the way society in general and the health sector in particular have responded to people with mental and neurological disorders. By separating mental health care from physical health care—and often separating those who have mental illness from society—the health care profession has reinforced stigma, making successful treatment much harder. I see this as a time of opportunity for change, and I agree strongly with an earlier JOURNAL article by US Surgeon General David Satcher ( JAMA. 2001; 285:1697). Every country can and should begin now to improve its efforts to treat people with mental illness. A recent WHO global survey of mental health policy issues, Atlas of Mental HealthResources in theWorld2001 (http:// www.who.int/mental health/Publication Pages/Pubs 2001.html), found that 40% of the 185 countries surveyed have no national mental health policy, 30% have no programs to improve mental health conditions, and 25% have no specific mental health legislation. Well over one third (37%) of the countries have no community care facilities. The global toll of mental illness and neurological disorders is staggering. Neuropsychiatric disorders account for 31% of the disability in the world— and they affect rich and poor nations and individuals alike. According to the World Health Report 2001, Mental Health: New Understanding, New Hope (http://www.who.int/whr/), 450 million people have a mental or neurological disorder. Of these, 121 million have depression and 50 million have epilepsy. Every year, 1 million people commit suicide and 10 million to 20 million attempt suicide. A great deal of this suffering is unnecessary. We know, for instance, that 60% of those with major depression can fully recover if treated. However, in both industrialized and developing countries, less than 25% of those affected receive treatment, for reasons that include stigma, discrimination, scarce resources, lack of skills in primary health care, and deficient public health policies. The treatment gap is similar or greater for many other easily treatable mental and neurological disorders. Because people do not get the care they need, these disorders impose a range of social and economic costs on individuals, households, employers, and society, ranging from the cost of care to the cost of lost productivity. Solutions based on scientific evidence are available and affordable. Through recent advances in neuroscience, neuroimaging, genetics, and behavioral sciences, we know more about brain functioning and behavior than ever before. Breakthroughs in therapy and medication have occurred. In the World Health Report 2001, WHO summarizes current knowledge about mental and neurological disorders: the global burden, current level of care, latest knowledge about causes and treatment, and ongoing efforts to reform mental health care. The report concludes with 10 recommendations on how governments can strengthen their country’s mental health care: • provide treatment for mental disorders within primary care; • ensure that psychotropic drugs are available; • replace large custodial hospitals with community care facilities backed by general hospital psychiatric beds and home care support; • launch public awareness campaigns to overcome stigma and discrimination; • involve communities, families, and consumers in decision making on policies and services; • establish national policies, programs, and legislation; • train mental health professionals; • link mental health with other social sectors; • monitor community mental health; and • support more research. The report outlines three scenarios to help guide countries and population groups, depending on the resources available and the current status of mental health care in each country. Regarding treatment, for example, if even the poorest countries could ensure that the five most needed psychotropic drugs were available in all health care settings, we could ease the suffering of millions of people. If many middle-income countries could use the experiences of others as a guide and initiate pilot projects for community care, parts of or entire custodial institutions could be shut down, and the financial savings could strengthen further community care activities. If some of the richest countries could review their health care financing rules to ensure parity between mental and physical health problems, a major obstacle to treatment could be removed. We need to speed up and strengthen care for the mentally ill. —Gro Harlem Brundtland, MD, MPH Director-General World Health Organization FROM THE WORLD HEALTH ORGANIZATION

1,683 citations

Journal ArticleDOI
TL;DR: The third in the Child Development Series as discussed by the authors assesses strategies to promote child development and to prevent or ameliorate the loss of developmental potential in developing countries by identifying four well-documented risks: stunting, iodine deficiency, iron deficiency anaemia, and inadequate cognitive stimulation, plus four potential risks based on epidemiological evidence.

927 citations