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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•
Scale up of services for mental health in low-income and middle-income countries.

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Julian Eaton, Layla McCay1, Maya Semrau2, Sudipto Chatterjee, Florence Baingana3, Ricardo Araya4, Christina Ntulo5, Graham Thornicroft2, Shekhar Saxena •
University of London1, King's College London2, Makerere University3, University of Bristol4, BasicNeeds5
29 Oct 2011-The Lancet
TL;DR: Assessment of progress in scaling up mental health services worldwide using a systematic review of literature and a survey of key national stakeholders in mental health suggested that successful strategies can be adopted to overcome barriers to scaling up.

549 citations

Journal Article•DOI•
Public sector mental health systems in South Africa: inter-provincial comparisons and policy implications

[...]

Crick Lund1, Sharon Kleintjes1, Ritsuko Kakuma2, Ritsuko Kakuma1, Alan J. Flisher3, Alan J. Flisher1 •
University of Cape Town1, University of Toronto2, University of Bergen3
01 Mar 2010-Social Psychiatry and Psychiatric Epidemiology
TL;DR: There remains widespread inequality between provinces in the resources available formental health care; a striking absence of reliable, routinely collected data that can be used to plan services and redress current inequalities; the continued dominance of mental hospitals as a mode of service provision; and evidence of substantial unmet need for mental health care.
Abstract: Background There is growing recognition that mental health is an important public health issue in South Africa. Yet mental health services remain chronically under-resourced. The aim of this study was to document levels of current public sector mental health service provision in South Africa and compare services across provinces, in relation to current national policy and legislation.

212 citations

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]....

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Journal Article•DOI•
Collaboration between traditional practitioners and primary health care staff in South Africa: developing a workable partnership for community mental health services.

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Vicky Campbell-Hall1, Inge Petersen1, Arvin Bhana1, Sithembile Mjadu1, Victoria Hosegood2, Alan J. Flisher3 •
University of KwaZulu-Natal1, University of London2, University of Cape Town3
12 Oct 2010-Transcultural Psychiatry
TL;DR: Perceptions of service users and providers of current interactions between the two systems of care and ways in which collaboration could be improved in the provision of community mental health services are explored.
Abstract: The majority of the black African population in South Africa utilize both traditional and public sector Western systems of healing for mental health care. There is a need to develop models of collaboration that promote a workable relationship between the two healing systems. The aim of this study was to explore perceptions of service users and providers of current interactions between the two systems of care and ways in which collaboration could be improved in the provision of community mental health services. Qualitative individual and focus group interviews were conducted with key health care providers and service users in one typical rural South African health sub-district. The majority of service users held traditional explanatory models of illness and used dual systems of care, with shifting between treatment modalities reportedly causing problems with treatment adherence. Traditional healers expressed a lack of appreciation from Western health care practitioners but were open to training in Western biomedical approaches and establishing a collaborative relationship in the interests of improving patient care. Western biomedically trained practitioners were less interested in such an arrangement. Interventions to acquaint traditional practitioners with Western approaches to the treatment of mental illness, orientation of Western practitioners towards a culture-centred approach to mental health care, as well as the establishment of fora to facilitate the negotiation of respectful collaborative relationships between the two systems of healing are required at district level to promote an equitable collaboration in the interests of improved patient care.

180 citations

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…...

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  • ...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)....

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  • ...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)....

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Journal Article•DOI•
Mental Health Policy Development and Implementation in Four African Countries

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Alan J. Flisher1, Crick Lund1, Michelle Funk2, Mwanza Banda3, Arvin Bhana4, Victor Doku, Natalie Drew2, Fred Kigozi, Martin Knapp5, Mayeh Omar6, Inge Petersen7, Andrew Green6 •
University of Cape Town1, World Health Organization2, University of Zambia3, Human Sciences Research Council4, London School of Economics and Political Science5, University of Leeds6, University of KwaZulu-Natal7
01 May 2007-Journal of Health Psychology
TL;DR: The research programme undertakes an analysis of existing mental health policies in four African countries, and will carry out and evaluate interventions to assist in the development and implementation of mental Health policies in those countries, over a five-year period.
Abstract: The purpose of the research programme introduced in this article is to provide new knowledge regarding comprehensive multisectoral approaches to breaking the negative cycle of poverty and mental ill-health. The programme undertakes an analysis of existing mental health policies in four African countries (Ghana, South Africa, Uganda, Zambia), and will carry out and evaluate interventions to assist in the development and implementation of mental health policies in those countries, over a five-year period. The four countries in which the programme is being conducted represent a variety of scenarios in mental health policy development and implementation.

155 citations

Journal Article•DOI•
Mental health service delivery in South Africa from 2000 to 2010: One step forward, one step back

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Inge Petersen1, Crick Lund2•
University of KwaZulu-Natal1, University of Cape Town2
28 Sep 2011-South African Medical Journal
TL;DR: There has been some progress in the decentralisation of mental health service provision, but substantial gaps in service delivery remain and intervention research is needed to provide evidence of the organisational and human resource mix requirements and cost-effectiveness of a culturally appropriate, task shifting and stepped care approach for severe and common mental disorders at primary healthcare level.
Abstract: In 2000, Rita Thom published a systematic review of mental health services research in southern Africa, conducted from 1967 to 1999. 1 The review suggested a need to shift from centralised institutional care, which characterised apartheid South Africa, towards decentralised, integrated and community-based services provided within a human rights framework. The use of trained non-specialists to provide mental healthcare was also suggested as a strategy to increase access in the context of a shortage of mental health specialists. Research gaps identified included the need for accurate epidemiological studies; intervention studies demonstrating the efficacy of sustainable models of service delivery in line with policy imperatives for deinstitutionalised and integrated primary mental healthcare; and economic evaluation studies of service delivery models. 2 The latter included cost-effectiveness, cost-benefit and cost-utility analyses. Policies and legislation in post-apartheid South Africa have been consistent with the suggestions emanating from this review in a bid to increase access and quality of care within a human rights framework. 3,4

155 citations

References
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Journal Article•DOI•
Cohort Profile: Africa Centre Demographic Information System (ACDIS) and population-based HIV survey

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Frank Tanser1, Victoria Hosegood1, Victoria Hosegood2, Till Bärnighausen1, Kobus Herbst1, Makandwe Nyirenda1, William Muhwava1, Colin Newell1, Johannes Viljoen1, Tinofa Mutevedzi1, Marie-Louise Newell1, Marie-Louise Newell3 •
University of KwaZulu-Natal1, University of London2, University College London3
01 Oct 2008-International Journal of Epidemiology
TL;DR: The most salient features of ACDIS and the population-based HIV cohort are described and some of the most important results to date are presented.
Abstract: The health and demography of the South African population has been undergoing substantial changes as a result of the rapidly progressing HIV epidemic. Researchers at the University of KwaZulu-Natal and the South African Medical Research Council established The Africa Centre for Health and Population Studies in 1997 funded by a large core grant from The Wellcome Trust, UK. Given the urgent need for high quality longitudinal data with which to monitor these changes, and with which to evaluate interventions to mitigate impact, a demographic surveillance system (DSS) was established in a rural South African population facing a rapid and severe HIV epidemic. 1 The DSS, referred to as the Africa Centre Demographic Information System (ACDIS), started in 2000. In 2003, population-based HIV testing (also funded by the Wellcome Trust, UK) was started in ACDIS through annual surveys. In this article, we seek to describe the most salient features of ACDIS and the population-based HIV cohort and briefly present some of the most important results to date.

380 citations

"Planning for district mental health..." refers methods in this paper

  • ...Longitudinal socio-demographic data have been collected by the Africa Centre for Health and Population Studes, details of which have been published elsewhere (e.g. Hosegood and Timæus 2005; Tanser et al. 2007)....

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Book•
Culture and Mental Health: A Southern African View

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Leslie Swartz1•
University of Oxford1
15 Jul 1999
TL;DR: This is a long awaited text within the field of mental health in South Africa, as there is very little written about culture and mental health within the specific context of South Africa.
Abstract: This is a long awaited text within the field of mental health in South Africa, as there is very little written about culture and mental health within the specific context of South Africa. This book is very useful for students in any field of mental health like psychology, nursing, social work and medicine. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

294 citations

"Planning for district mental health..." refers background in this paper

  • ...…of specialists in these roles is supported by evidence which suggests that mental health service work undertaken by general and lay workers equipped with basic skills can have good outcomes, but only in the context of adequate training and close supervision and support (Swartz 1998; Saraceno 2007)....

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  • ...…are located within a district mental health care framework which provides the necessary training and support infrastructure from mental health specialists, given that insufficient training and supervision could lead to inappropriate services and poor outcomes (Swartz 1998; Saraceno et al. 2007)....

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  • ...Further, the use of specialists in these roles is supported by evidence which suggests that mental health service work undertaken by general and lay workers equipped with basic skills can have good outcomes, but only in the context of adequate training and close supervision and support (Swartz 1998; Saraceno 2007)....

    [...]

  • ...It would, however, be imperative that these workers are located within a district mental health care framework which provides the necessary training and support infrastructure from mental health specialists, given that insufficient training and supervision could lead to inappropriate services and poor outcomes (Swartz 1998; Saraceno et al. 2007)....

    [...]

Journal Article•DOI•
Twelve-month mental disorders in South Africa: prevalence, service use and demographic correlates in the population-based South African Stress and Health Study.

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David R. Williams1, Allen Herman2, Dan J. Stein3, Steven G. Heeringa4, Pamela Braboy Jackson5, Hashim Moomal6, Ronald C. Kessler1 •
Harvard University1, University of Limpopo2, University of Cape Town3, University of Michigan4, Indiana University5, University of the Witwatersrand6
01 Feb 2008-Psychological Medicine
TL;DR: Psychiatric disorders are much higher in South Africa than in Nigeria and there is a high level of unmet need among persons with severe and moderately severe disorders.
Abstract: Background South Africa’s history and current social conditions suggest that mental disorders are likely to be a major contributor to disease burden, but there has been no national study using standardized assessment tools.

286 citations

"Planning for district mental health..." refers background in this paper

  • ...5% of adults who had suffered from a common mental disorder in the previous 12 months, only one in four had reported receiving treatment (Williams et al. 2008)....

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  • ...In addition, this treatment was most often from the general health sector, with the mental health sector only providing care to a small percentage of cases (Williams et al. 2008)....

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  • ...…representative epidemiological survey of common mental disorders such as anxiety and depression in South Africa, found that of the 16.5% of adults who had suffered from a common mental disorder in the previous 12 months, only one in four had reported receiving treatment (Williams et al. 2008)....

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Journal Article•DOI•
Achieving the Millennium Development Goals: does mental health play a role?

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J. Jaime Miranda1, Vikram Patel•
University of London1
13 Sep 2005-PLOS Medicine
TL;DR: Miranda and Patel argue that mental disorders are among the most important causes of disability and premature mortality in developing countries.
Abstract: Miranda and Patel argue that mental disorders are among the most important causes of disability and premature mortality in developing countries.

172 citations

"Planning for district mental health..." refers background in this paper

  • ...As suggested by Miranda and Patel (2005) and Patel et al. (2008), lack of attention to mental health services could seriously compromise achieving the Millennium Development Goals in LMICs....

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Journal Article•DOI•
Evaluation of a community-based rehabilitation model for chronic schizophrenia in rural India

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Sudipto Chatterjee, Vikram Patel1, Achira Chatterjee, Helen A. Weiss1•
University of London1
02 Jan 2003-British Journal of Psychiatry
TL;DR: The CBR model is a feasible model of care for chronic schizophrenia in resource-poor settings and compliant participants had significantly better outcomes compared with partially compliant or non-complaint participants.
Abstract: Background There are no community services for the majority of the estimated 10 million persons with schizophrenia in India. Community-based rehabilitation (CBR) is a model of care which has been widely used for physical disabilities in resource-poor settings. Aims To compare CBR with out-patient care (OPC) for schizophrenia in a resource-poor setting in India. Method A longitudinal study of outcome in patients with chronic schizophrenia contrasted CBR with OPC. Outcome measures were assessed using the Positive and Negative Symptom Scale and the modified WHO Disability Assessment Schedule at 12 months. Results Altogether, 207 participants entered the study, 127 in the CBR group and 80 in the OPC group. Among the 117 fully compliant participants the CBR model was more effective in reducing disability, especially in men. Within the CBR group, compliant participants had significantly better outcomes compared with partially compliant or non-complaint participants ( P <0.001). Although the subjects in the CBR group were more socially disadvantaged, they had significantly better retention in treatment. Conclusions The CBR model is a feasible model of care for chronic schizophrenia in resource-poor settings.

159 citations

"Planning for district mental health..." refers background in this paper

  • ...Further, trained community members have been shown to be able to effectively provide this service in a low to middle income country (Chatterjee et al. 2003)....

    [...]

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Public sector mental health systems in South Africa: inter-provincial comparisons and policy implications

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Benedetto Saraceno, Mark van Ommeren, Rajaie Batniji, Alex S. Cohen, Oye Gureje, John Mahoney, Devi Sridhar, Chris Underhill 
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