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Norms for mental health services in South Africa

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Abstract

Background

In the aftermath of apartheid, South Africa has inherited a fragmented, under-resourced and inequitable public sector mental health service. Attempts are being made to reform mental health services, in keeping with new health policy, which proposes the downscaling of psychiatric institutions and the development of community-based services. This study set out to develop a set of service norms for the care of people with severe psychiatric conditions (SPC) in South Africa, to assist the implementation of the new policy.

Methods

A national situation analysis of current public sector mental health services was conducted. A model was developed for estimating the mental health service resource needs of people with SPC. Following consultation with provincial stakeholders, a set of service norms were developed taking into account national indicators from the situation analysis (as a baseline level) and proposals of the model (as a target level).

Results

The study recommends an increase in the number of acute psychiatric beds in general hospitals; development of community-based residential care; redistribution of staff from hospital to community services, particularly in rural areas; and the development of information systems to monitor the transitions to community-based care.

Conclusions

The norms proposals presented in this study express mental health service needs in terms of quantifiable service resource and utilisation levels. In doing so, the study attempts to make explicit the assumptions and values on which planning is based.

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Acknowledgements

This paper reports on part of the project to develop norms and standards for the psychiatric care of people with SPC in South Africa. The project was initiated and funded by the Directorate: Mental Health and Substance Abuse of the Department of Health and awarded as a tender to the Department of Psychiatry and Mental Health at the University of Cape Town, in collaboration with the Centre for Health Policy at the University of the Witwatersrand (Tender No. GES 105/96–97). The views expressed in this paper are those of the authors, and not those of the Department of Health. The authors thank Elizabeth Dartnall, Melvyn Freeman, Tennyson Lee, Edith Madela-Mntla, Lauren Muller, Kim Porteus and Brian Robertson for their intellectual contributions.

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Authors and Affiliations

  1. Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, 7700, Cape Town, Rondebosch, South Africa

    Crick Lund & Alan J. Flisher

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  1. Crick Lund
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  2. Alan J. Flisher
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Correspondence to Crick Lund.

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Lund, C., Flisher, A.J. Norms for mental health services in South Africa. Soc Psychiat Epidemiol 41, 587–594 (2006). https://doi.org/10.1007/s00127-006-0057-z

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