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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Journal Article•
TL;DR: It is suggested that traditional healers value occupations such as personal care and some use occupations in their practice, and mistrust on the part of allopathic and traditional health practitioners of each other is suggested.
Abstract: Since 1992 discussions about the South African health care system highlighted the need for including traditional healers, because 80% of South Africans access them. Nonetheless, there is little formal collaboration between allopathic and traditional health practitioners. The purpose of the study was to identify traditional healers’ awareness of occupational therapy, their use of occupations in their interventions, the allopathic health practitioners’ perception of traditional healers’ role in managing patients with mental illness and whether referrals occur between the two health systems. Convenient sampling was used to select research participants. Data for this descriptive study were gathered by means of a survey questionnaire containing open and closed-ended questions. Data were presented using descriptive statistics. This pilot study suggests that traditional healers value occupations such as personal care and some use occupations in their practice. Results indicate, however that the traditional healers are not as familiar with occupational therapists as they are with community rehabilitation workers. The study also suggests mistrust on the part of allopathic and traditional health practitioners of each other. In the absence of research into cooperation between traditional healers and occupational therapists, this study is valuable in identifying research questions about the use and value of occupation. Key words: occupational therapy, traditional health practitioners, occupation
7 citations
TL;DR: This article attempts to answer the question as to whether the author’s particular community service placement, located in the Overberg District Municipality, improved the access to quality mental health care services.
Abstract: In improving access to quality health care, the National Department of Health has made community service mandatory in South Africa for newly graduated health professionals. Largely informed by the ...
7 citations
Cites background or result from "Planning for district mental health..."
...Moreover, the rationale for community service can also be located within the larger global impetus of integrating mental health into primary health care and thus decentralising mental health services (Grazin, 1999; Lund & Flischer, 2009; Mkhize & Kometsi, 2008; Petersen et al., 2009; Pillay & Harvey, 2006)....
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...This is in line with current literature as to the prevalence of common mental disorders within the primary health care sector and at the community level within the South African context (Mkhize & Kometsi, 2008; Petersen et al., 2009)....
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...(2007) to constitute a barrier to the integration of mental health services into primary health care systems, as nursing personnel, given their patient loads, do not possess the time to provide adequate care for patients who present with mental disorders (Grazin, 1999; Petersen et al., 2009)....
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...…al. (2007) to constitute a barrier to the integration of mental health services into primary health care systems, as nursing personnel, given their patient loads, do not possess the time to provide adequate care for patients who present with mental disorders (Grazin, 1999; Petersen et al., 2009)....
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...In being cognisant of these vulnerabilities, Petersen et al. (2009) have advocated for comprehensive integrated mental health care but more so for health care that is responsive to the sociopolitical context “where the legacy of apartheid, poverty and more recently HIV/AIDS have serious…...
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TL;DR: According to the South African Stress and Health Survey (Herman, Steyn, Seedat, Heeringa, Moonal & Williams, 2009), the lifetime prevalence for any mental health problems in South Africa is 30.3% as mentioned in this paper.
Abstract: The International Federation of Social Work places a concern with human rights and social justice at the core of its definition of social work. Social work values are based on “respect for the equality, dignity and worth of all people” (IFSW, 2000), and social work practice has a special concern for vulnerable and oppressed people. People with mental health problems are amongst the most vulnerable members of society and in South Africa they comprise a considerable proportion of our society. According to the South African Stress and Health Survey (Herman, Steyn, Seedat, Heeringa, Moonal & Williams, 2009), the lifetime prevalence for any mental health problems in South Africa is 30.3% and neuropsychiatric disorders rank third in their contribution to the burden of disease in South Africa (Bradshaw, Norman & Schneider, 2007).
7 citations
TL;DR: Results support previous research regarding the type and extent of mental illness stereotypes, and mediating effects of familiarity and suggest significant tension between nurses desire to subscribe to a nursing and national ideology of non-discrimination, a cherished value within the Rwandan context.
Abstract: Mental ill-health contributes significantly to the global burden of disease as the fourth leading cause of global disability. To reduce this burden, by aiming at reduction of the treatment gap, the World Health Organisation recommended integration of mental health care into general health care structures, and deinstitutionalization coupled with community re-integration. Given the distribution of mental health professionals in Sub Sahara Africa the implementation of such integration is largely the work of nurses, specifically non mental health specialist nurses. Previous African studies report nurses difficulties with this integration; lack of preparation, knowledge, expertise, and time. Mental illness stigma is suggested to underscore a large portion of these difficulties. This quantitative study used a cross sectional survey approach to gather mental illness stigma related data from nurses (N=104, n=102) working within in a district hospital in Rwanda. A self-report questionnaire included person variables (age, gender, nursing experience, nursing qualification and category of nurse) and two scales; Level of Contact Scale (LOC), and Community Attitudes towards Mental Illness Scale - Swedish version (CAMI-S).Results support previous research regarding the type and extent of mental illness stereotypes, and mediating effects of familiarity. Significant associations between mental illness stereotypes and; younger and the less experienced nurses were also reported. However, the extent of contradiction within participant responses on the CAMI-S, across all demographics variables, suggests significant tension between nurses desire to subscribe to a nursing and national ideology of non-discrimination, a cherished value within the Rwandan context, and their fears associated with their stereotypical beliefs. In addition to the continued use of contact within health care worker training programs and clinical placements it is recommended that supportive interventions be implemented that are narrative in nature and facilitate the resolution of tension between ‘what I should believe’ and ‘what I do believe’.Key words: mental illness stereotypes, community based care, nurse, Rwanda
6 citations
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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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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
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
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