Public sector mental health systems in South Africa: inter-provincial comparisons and policy implications
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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.
A survey was conducted of public sector mental health service resources and utilisation in South Africa during the 2005 calendar year, using the World Health Organization’s Assessment Instrument for Mental Health Systems (WHO-AIMS) Version 2.2.
South African policy and legislation both advocate for community-based mental health service provision within a human rights framework. Structures are in place at national level and in all nine provinces to implement these provisions. However, there is wide variation between provinces in the level of mental health service resources and provision. Per 100,000 population, there are 2.8 beds (provincial range 0–7.0) in psychiatric inpatient units in general hospitals, 3.6 beds (0–6.4) in community residential facilities, 18 beds (7.1–39.1) in mental hospitals, and 3.5 beds (0–5.5) in forensic facilities. The total personnel working in mental health facilities are 11.95 per 100,000 population. Of these, 0.28 per 100,000 are psychiatrists, 0.45 other medical doctors (not specialised in psychiatry), 10.08 nurses, 0.32 psychologists, 0.40 social workers, 0.13 occupational therapists, and 0.28 other health or mental health workers.
Although there have been important developments in South African mental health policy and legislation, there remains widespread inequality between provinces in the resources available for mental 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. There is an urgent need to address weak policy implementation at provincial level in South Africa.
KeywordsHealth planning Mental health policy Mental health services South Africa
- 3.Kleintjes S, Flisher A, Fick M, Railon A, Lund C, Molteno C, Robertson B (2006) The prevalence of mental disorders among children, adolescents and adults in the Western Cape, South Africa. S Afr Psychiatr Rev 9:157–160Google Scholar
- 4.Truth and Reconciliation Commission (2000) Report of the Truth and Reconciliation Commission of South Africa. McMillan, LondonGoogle Scholar
- 7.Bhorat H, Kanbur R (2005) Poverty and well-being in post-apartheid South Africa: an overview of data, outcomes and policy. Development Policy Research Unit, University of Cape Town, Cape TownGoogle Scholar
- 10.WHO (2001) World Health Report 2001, mental health: new understanding, new hope. WHO, GenevaGoogle Scholar
- 14.Siskind D, Bolton P, Kim J (2007) Country contextualization of cost-effectiveness analysis of treatments for depression in Chile and Uganda using a Markov model. J Mental Health Policy Econ 10:S40–S41Google Scholar
- 16.WHO (1996) Psychosocial rehabilitation: a consensus statement. WHO, GenevaGoogle Scholar
- 17.Department of National Health (1996) Restructuring the national health system for universal primary health care. Department of National Health, PretoriaGoogle Scholar
- 18.Lund C, Flisher AJ (2003) Community/hospital indicators in South African public sector mental health services. J Mental Health Policy Econ 6:181–187Google Scholar
- 19.Department of Health (1997) White paper for the transformation of the health system in South Africa. Government Gazette, PretoriaGoogle Scholar
- 20.Department of Health (1997) National health policy guidelines for improved mental health in South Africa. Department of Health, PretoriaGoogle Scholar
- 21.WHO (2005) WHO resource book on mental health, human rights and legislation. WHO, GenevaGoogle Scholar
- 22.Lund C, Flisher AJ (2001) South African mental health process indicators. J Mental Health Policy Econ 4:9–16Google Scholar
- 28.WHO (2005) WHO Assessment Instrument for Mental Health Systems (AIMS) Version 2.1. WHO, GenevaGoogle Scholar
- 30.Lund C, Kleintjes S, Campbell-Hall V, Mjadu S, Petersen I, Bhana A, Kakuma R, Mlanjeni B, Bird P, Drew N, Faydi E, Funk M, Green A, Omar M, Flisher AJ (2008) Mental health policy development and implementation in South Africa. Phase 1 Country Report. Mental Health and Poverty Project, University of Cape Town, Cape TownGoogle Scholar
- 31.Southern African Regional Poverty Network (2004) Fact sheet: poverty in South Africa. Southern African Regional Poverty Network, PretoriaGoogle Scholar
- 34.Day C, Gray A (2008) Health and related indicators. In: Barron P, Roma-Reardon J (eds) South African health review 2008. Health Systems Trust, Durban, pp 239–396Google Scholar
- 35.Kautzky K, Tollman SM (2008) A perspective on Primary Health Care in South Africa. In: Barron P, Roma-Reardon J (eds) South African health review 2008. Health Systems Trust, Durban, pp 17–30Google Scholar
- 36.Blecher M, Day C, Dove S, Cairns R (2008) Financing in the public sector. In: Barron P, Roma-Reardon J (eds) South African health review 2008. Health Systems Trust, Durban, pp 179–194Google Scholar
- 37.Lehmann U (2008) Strengthening human resources for primary health care. In: Barron P, Roma-Reardon J (eds) South African health review 2008. Health Systems Trust, Durban, pp 163–178Google Scholar
- 38.WHO (2005) Atlas: mental health resources in the world. WHO, GenevaGoogle Scholar
- 42.Petersen I, Bhana A, Campbell-Hall V, Mjadu S, Lund C, Kleintjes S, Hosegood V, Flisher AJ, the Mental Health and Poverty Research Programme Consortium (2009) Planning for district mental health services in South Africa. A situational analysis of a district site. Health Policy Plan. doi:10.1093/heapol/czn049 PubMedGoogle Scholar