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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TL;DR: It is suggested that an occupational therapy-led day treatment centre could be effective in reducing the use of inpatient mental health services in South Africa and is therefore beneficial to mental health care users and service providers.
Abstract: Purpose: The aim of this study was to determine whether attendance at an occupational therapy-led day treatment centre for mental health care users affects the use of inpatient services in ...
5 citations
TL;DR: The issues affecting the development and delivery of improved mental health services in Uganda are reviewed, with a particular focus on psychiatric nursing and conclusions drawn regarding the development of future services.
Abstract: Estimates are that up to 35% of the Ugandan populations have a mental health condition; however access to psychiatric care, particularly for people living in rural areas, is poor. Additionally, cultural and lay beliefs and stigma affect both the individual with mental illness and healthcare professionals. The Ugandan government has recognized the need to modernize legislation and develop policies designed to provide modern psychiatric services to the whole population. Strategies include, passing new legislation, integrating services into primary care, including psychiatric illness in nurse education. Nevertheless, evidence suggests that this rhetoric is not being fully enacted. This paper reviews the issues affecting the development and delivery of improved mental health services, with a particular focus on psychiatric nursing. Actions that have already successfully addressed issues with psychiatric services in Uganda are highlighted and conclusions drawn regarding the development of future services.
5 citations
TL;DR: In this paper , a critical overview of the training and practice of professional psychology in South Africa, selection and recruitment processes, the relevance of the profession, impact of telepsychology and the implications of COVID-19 for professional training.
Abstract: Psychology in South African has a contentious history owing to its alignment with apartheid era ideologies of racial segregation. Although the profession has undergone significant transformation since democracy in 1994, almost three decades later less than a quarter of professional psychologists in the country are black African. Structured psychology training programmes select an average of 8 candidates per year, which has promoted criticism and scrutiny of recruitment and selection procedures that may be more oriented towards those from privileged educational backgrounds. In this interview with Jean-Pierre Bouchard, psychology researchers Anita Padmanabhanunni, Kyle Jackson, Zorina Noordien and Tyrone Pretorius from the University of the Western Cape provide a critical overview of the training and practice of professional psychology in South Africa, selection and recruitment processes, the relevance of the profession, impact of telepsychology and the implications of COVID-19 for professional training and practice. La psychologie en Afrique du Sud a une histoire controversée en raison de son alignement sur les idéologies de ségrégation raciale de l’époque de l’apartheid. Bien que la profession ait subi d’importantes transformations depuis l’instauration de la démocratie en 1994, près de trois décennies plus tard, moins d’un quart des psychologues professionnels du pays sont des Africains noirs. Les programmes structurés de formation en psychologie sélectionnent en moyenne huit candidats par an, ce qui a encouragé la critique et l’examen des procédures de recrutement et de sélection qui pourraient être plus orientées vers les personnes issues de milieux éducatifs privilégiés. Dans cet entretien avec Jean-Pierre Bouchard, les chercheurs en psychologie Anita Padmanabhanunni, Kyle Jackson, Zorina Noordien et Tyrone Pretorius, de l’université de Western Cape, donnent un aperçu critique de la formation et de la pratique de la psychologie professionnelle en Afrique du Sud, des processus de sélection et de recrutement, de la pertinence de la profession, de l’impact de la télé-psychologie et des implications de la COVID-19 dans la formation et l’exercice professionnels.
5 citations
Dissertation•
01 Jan 2015
5 citations
TL;DR: In this article , a low-cost multicomponent implementation strategy integrated into routine government mental health care in Mozambique has been proposed to close the mental health treatment gap, which often exceeds 90% in many low and middle-income countries.
Abstract: Abstract Background Significant investments are being made to close the mental health (MH) treatment gap, which often exceeds 90% in many low- and middle-income countries (LMICs). However, limited attention has been paid to patient quality of care in nascent and evolving LMIC MH systems. In system assessments across sub-Saharan Africa, MH loss-to-follow-up often exceeds 50% and sub-optimal medication adherence often exceeds 60%. This study aims to fill a gap of evidence-based implementation strategies targeting the optimization of MH treatment cascades in LMICs by testing a low-cost multicomponent implementation strategy integrated into routine government MH care in Mozambique. Methods Using a cluster-randomized trial design, 16 clinics (8 intervention and 8 control) providing primary MH care will be randomized to the Systems Analysis and Improvement Approach for Mental Health (SAIA-MH) or an attentional placebo control. SAIA-MH is a multicomponent implementation strategy blending external facilitation, clinical consultation, and provider team meetings with system-engineering tools in an overall continuous quality improvement framework. Following a 6-month baseline period, intervention facilities will implement the SAIA-MH strategy for a 2-year intensive implementation period, followed by a 1-year sustainment phase. Primary outcomes will be the proportion of all patients diagnosed with a MH condition and receiving pharmaceutical-based treatment who achieve functional improvement, adherence to medication, and retention in MH care. The Consolidated Framework for Implementation Research (CFIR) will be used to assess determinants of implementation success. Specific Aim 1b will include the evaluation of mechanisms of the SAIA-MH strategy using longitudinal structural equation modeling as well as specific aim 2 estimating cost and cost-effectiveness of scaling-up SAIA-MH in Mozambique to provincial and national levels. Discussion This study is innovative in being the first, to our knowledge, to test a multicomponent implementation strategy for MH care cascade optimization in LMICs. By design, SAIA-MH is a low-cost strategy to generate contextually relevant solutions to barriers to effective primary MH care, and thus focuses on system improvements that can be sustained over the long term. Since SAIA-MH is integrated into routine government MH service delivery, this pragmatic trial has the potential to inform potential SAIA-MH scale-up in Mozambique and other similar LMICs. Trial registration ClinicalTrials.gov; NCT05103033 ; 11/2/2021.
5 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