Health Policy and Planning Advance Access published online on January 15, 2009
Health Policy and Planning, doi:10.1093/heapol/czn049
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Planning for district mental health services in South Africa: a situational analysis of a rural district site
1School of Psychology, University of KwaZulu-Natal, Durban, South Africa.
2Child, Family, Youth and Social Development Unit, Human Sciences Research Council, Durban, South Africa.
3Department of Psychiatry and Mental Health, University of Cape Town, South Africa.
4Africa Centre for Health and Population Studies/University of KwaZulu-Natal, South Africa, and London School of Hygiene and Tropical Medicine, UK.
5Research Centre for Health Promotion, University of Bergen, Norway.
*Corresponding author. School of Psychology, Howard College, University of KwaZulu-Natal, Durban, 4001, South Africa. Tel: +27-31–260 7423. Fax: +27-31–260 2618. E-mail: peterseni{at}ukzn.ac.za
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.
Key Words: Primary mental health care, de-institutionalization, district, South Africa
Accepted for publication 18 September 2008.