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Journal Article•DOI•

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

Inge Petersen1, Arvin Bhana1, Arvin Bhana2, Victoria Campbell-Hall1, Sithembile Mjadu1, Crick Lund3, Sharon Kleintjies3, Victoria Hosegood4, Alan J. Flisher5, Alan J. Flisher3 •
University of KwaZulu-Natal1, Human Sciences Research Council2, University of Cape Town3, University of London4, University of Bergen5
01 Mar 2009-Health Policy and Planning (Oxford University Press)-Vol. 24, Iss: 2, pp 140-150
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 Article•DOI•
At the coalface of collaborative mental health care: A qualitative study of governance and power in district-level service provision in South Africa.

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André Janse van Rensburg1, André Janse van Rensburg2, André Janse van Rensburg3, Rabia Khan4, Edwin Wouters5, Edwin Wouters1, Dingie van Rensburg1, Pieter Fourie2, Piet Bracke3 •
University of the Free State1, Stellenbosch University2, Ghent University3, University of Toronto4, University of Antwerp5
01 Oct 2018-International Journal of Health Planning and Management
TL;DR: The paper highlights the complexities and different facets of power in integrated mental health care in a South African district, adding to growing literature on the social mechanisms that influence collaboration.
Abstract: Globally, there is an urgency to address fragmented mental health systems, especially in low-to-middle income countries. State and non-state mental health service collaboration is a central strategy to strengthen care. The study was undertaken to analyse the power in governance processes of public mental health service provision. Semi-structured interviews were conducted with state and non-state actors in mental health care in a South African district. Transcriptions were thematically analysed using the Framework for Assessing Power in Collaborative Processes. Findings suggested that collaborative processes were significantly state-owned, in terms of funding models, administrative and legislative jurisdiction, and state hierarchical referral structure. No formal agreements were in place, elevating the importance of key network actors to bring less-endowed NGOs into the service network. Fragmentation between the Departments of Health and Social Development was telling in district forums. Resistance to power structures unfolded, some participants sidestepping traditional hierarchies to leverage funding and support. The paper highlights the complexities and different facets of power in integrated mental health care in a South African district, adding to growing literature on the social mechanisms that influence collaboration.

5 citations

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

  • ...In South Africa's pluralistic, state‐driven health system, close collaboration between state and private mental health service providers is a key strategy in addressing the burden of mental illness.(2,3) Private (non‐state, non‐government, or third‐sector) organisations are a core component of local public health service provision, although their presence often goes hand‐in‐hand with activity overlap, blurred lines of responsibility, and fragmentation in the provision of care....

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Dissertation•
Views of social workers on their role in mental health outpatient and community-based services

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Abigail Ornellas
01 Apr 2014

4 citations

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

  • ...According to Petersen et al. (2009), the end product of deinstitutionalization was more of a cost-saving exercise without the simultaneous development of sufficient and appropriate outpatient and community support structures and systems....

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  • ...…and deinstitutionalization have had a negative impact on service rendering and service availability for the mentally ill individual (Lund, Kleintjies, Campbell-Hall, Mjadu, Petersen, Bhana, Kakuma, Mlanjeni, Bird, Drew, Faydi, Funk, Green, Omar & Flisher, 2008; Petersen et al., 2009)....

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  • ...…the diagnosis, sufficient information provision in terms of the individual’s diagnosis, symptom management and medication adherence, assistance in the reintegration of the patient into society, employment support and overall psychosocial support (Barlow & Durand, 2012; Petersen et al., 2009)....

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  • ...Within the South African context, research has shown that post deinstitutionalization, a large treatment gap exists for mental health disorders in South Africa (Petersen et al.,2009)....

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  • ...Studies found that 16.5% of South African’s presented with common mental disorders within a period of 12 months; within that group it was estimated that only 1 in 4 individuals received treatment (Lund & Petersen, 2011; Petersen et al., 2009)....

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Journal Article•DOI•
Exploring a group of South African psychologists’ well-being: competencies and contests:

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Erika Hitge1, Izanette Van Schalkwyk1•
North-West University1
01 Dec 2018-South African Journal of Psychology
TL;DR: In this article, a study was conducted to establish the levels of well-being of South African psychologists by implementing a mixed method research design, positive psychology was used as framework as psychosoc...
Abstract: The aim of this study was to establish the levels of well-being of South African psychologists by implementing a mixed method research design. Positive psychology was used as framework as psychosoc...

4 citations

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

  • ...Years ago, Petersen et al. (2009) indicated that 16.5% of the population require mental health services, but only 25% of the 16.5% receive care....

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Book Chapter•DOI•
Mental Health Programs and Policies in South Asia: Initiatives and Obstacles

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Rahul Shidhaye1, Siham Sikander, Mark J. D. Jordans, Prasantha De Silva, Sudipto Chatterjee2 •
Public Health Foundation of India1, University of Melbourne2
01 Jan 2015
TL;DR: The current status of mental health programs and policies in South Asia are reviewed, the progress made is highlighted and the continuing challenges are identified that need to be addressed urgently to close the treatment gap in the near future.
Abstract: The South Asian region is one of biggest providers of specialist mental health human resources to rich countries, but paradoxically mental health systems in this region are highly inadequately resourced which has resulted in a huge treatment gap of around 90 %. In this chapter, we review the current status of mental health programs and policies in South Asia, highlight the progress made and identify the continuing challenges (and potential solutions) that need to be addressed urgently to close the treatment gap in the near future. In order to address the huge and largely unmet burden of mental health disorders in the region, it is essential to scale-up evidence-based interventions by progressively strengthening existing mental health systems. The implementation of mental health programs at national level is very poor in most of the South Asian countries. Planning of mental health programs should be based on robust situational analysis and needs assessment and the components of mental health program should be integrated with other national health programs. Political commitment to improve public mental health resource allocation, a strong mental health policy framework with strategies for efficient implementation, equitable distribution of human and financial resources, increasing the demand for mental health services and contextualization of mhGAP guidelines and it’s delivery through an emphasis on task sharing and active involvement of the NGO and private sector are some of the approaches that can address the barriers in scaling-up of mental health services.

3 citations

The experiences of professional nurses working in district hospitals in the Western Cape metropole, where 72-hour assessments are conducted

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Verna van Zyl
01 Jan 2016
TL;DR: This document summarizes current capabilities, research and operational priorities, and plans for further studies that were established at the 2015 USGS workshop on quantitative hazard assessments of earthquake-triggered landsliding and liquefaction in the Czech Republic.
Abstract: Background: The integration of mental health into primary health care meant that patients were admitted into a less restrictive environment. They received treatment for mental illness in their communities, therefore, averting unnecessary hospitalisation in psychiatric hospitals. However, given that patients with mental illnesses were admitted to district hospitals as involuntary mental health care users (MHCUs), this setting was purported to be fraught with challenges for both staff and patients. Aim and objectives: The aim of this study was to explore and describe the experiences of professional nurses, working at selected district hospitals in the Western Cape metropole, where 72-hour assessments of involuntary mental health care users are conducted. The objectives of this study were to determine how the 72-hour unit functioned in the general ward, the experiences of professional nurses regarding the integration of the 72-hour assessment units in the general ward and suggested improvements. Methodology: A qualitative research approach, with a descriptive phenomenological design, was used to collect data through semi-structured interviews from eight (8) professional nurses, working in the two selected district hospitals in the Cape Town metropole area. Purposive sampling was employed to select the participants. Data were analysed using Tesch’s method of qualitative data analysis. Four themes, namely, patient management process affected the functioning of the ward, patient management challenges in rendering patient care, burden of caring on the Self, and staff and patient support to create a therapeutic environment, emerged during data analysis, which encapsulated the nurse's experience of working in 72-hour assessment units in selected district hospitals. Findings: The findings of this revealed that the district hospitals were ill prepared for the admission of involuntary mental health care users. There were challenges, in terms of resources, namely, infrastructure to create a therapeutic environment, knowledgeable and skilled staff to care for the MHCUs. The MHCUs were contained in the district hospitals for longer than was legislated, rather than receiving therapeutic interventions at psychiatric facilities. Needs were identified to improve the functioning of the 72-hour assessment units, which included education and training of personnel, Discussion: The non-therapeutic environment had a negative impact on the staff working in the 72-hour assessment units. Nursing staff were burdened with caring for patients in an environment where they, as well as the MHCUs, were stigmatised due to the diagnosis of mental illness. However, the participants internalised their own experiences, as they prioritised the MHCUs well-being. The findings supported previous studies, which revealed that the objectives of the Mental Health Care Act (No. 17 of 2002), which supported the integration of mental health into primary health care, were not realised after more than a decade of implementation. Recommendations: Given the limited scope…

2 citations

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

  • ...In South Africa, the proposals were contained in the White Paper for the Transformation of the Health System in South Africa (SA DoH, 2010; Petersen, 2000; South Africa, Department of Health [DoH], 1997)....

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  • ...Some of the core characteristics that define qualitative research are:         20 Data are collected in a natural setting, which implies that the researcher interacts, face-to-face, with the participants, talking to them and observing how they behave in their context; The researcher is the key instrument, as the researcher is usually the one, who actually gathers the information; Multiple forms of data, such as interviews, observation, documentation and audio visual information are usually gathered, instead of relying on a single data source; Researchers do inductive, as well as deductive analysis, by building their patterns, categories and themes from the bottom up, organising the data into increasingly more abstract units of information; Emphasis is totally focussed on the participants’ conception of the problem, or issue; The research process is emergent, as the problem, or issue is learnt from the participants and explored in the research to obtain the information; Researchers reflect on their role in the study and their personal background; and Qualitative researchers maintain a holistic account, by generally sketching the larger picture that emerges (Creswell, 2013)....

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  • ...According to Creswell (2013), consideration for sample size in qualitative research is to study a few individuals and collect extensive detail about each studied individual, until data saturation is reached....

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  • ...A survey by South African Stress and Health [SASH] study estimated that the Western Cape had a higher lifetime prevalence of substance use, compared with other provinces, and predicted that 30% of adults in the Western Cape Province will develop a mental disorder in their life-time (Herman, Steyn, Seedat, Heeringa, Moomal, Williams & the SASH study, 2009). A study by Kalebka, Bruijns & Van Hoving (2012)...

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  • ...According to Creswell (2009), the coding process provides a description of the setting, or people, and generates categories, or themes for analysis....

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References
More filters
Book Chapter•DOI•
Qualitative data analysis for applied policy research

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Jane Ritchie, Liz Spencer
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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Monograph•DOI•
Analyzing Qualitative Data

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Graham R. Gibbs
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

The World Health Report 2000

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Joseph S. Coyne, Peter E. Hilsenrath
01 Jan 2002

2,867 citations

Journal Article•DOI•
From the World Health Organization. Mental health: new understanding, new hope.

[...]

Gro Harlem Brundtland
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 Article•DOI•
Strategies to avoid the loss of developmental potential in more than 200 million children in the developing world

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Patrice Engle1, Maureen M. Black2, Jere R. Behrman3, Meena Cabral de Mello4, Paul Gertler5, Lydia Kapiriri6, Reynaldo Martorell7, Mary Eming Young8 •
UNICEF1, University of Maryland, Baltimore2, University of Pennsylvania3, World Health Organization4, University of California, Berkeley5, University of Toronto6, Emory University7, World Bank8
20 Jan 2007-The Lancet
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

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