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

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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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

This study was made possible by funding provided by the Department for International Development (DfID) for a Research Programme Consortium entitled “The Mental Health and Poverty Project (MHaPP): Mental health policy development and implementation in four African countries” (DfID contract number: RPC HD6 2005–2010). The views expressed are those of the authors and not necessarily those of DfID. We would like to thank Dr Shekhar Saxena and Dr Jodi Morris of the Department of Mental Health and Substance Abuse, WHO for their assistance in reviewing the WHO-AIMS data for this study; our national and provincial government and NGO partners for their assistance in gathering the data; and Mr Luis Eduardo Sevilla for design of the map.

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Correspondence to Crick Lund.

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The Mental Health and Poverty Project (MHaPP) is a Research Programme Consortium (RPC) funded by the UK Department for International Development (DfID) (RPC HD6 2005–2010) for the benefit of developing countries. The views expressed are not necessarily those of DfID. RPC members include Alan J. Flisher (director) and Crick Lund (coordinator) [University of Cape Town, Republic of South Africa (RSA)]; Therese Agossou, Natalie Drew, Edwige Faydi and Michelle Funk (World Health Organization); Arvin Bhana (Human Sciences Research Council, RSA); Victor Doku (Kintampo Health Research Centre, Ghana); Andrew Green and Mayeh Omar (University of Leeds, UK); Fred Kigozi (Butabika Hospital, Uganda); Martin Knapp (University of London, UK); John Mayeya (Ministry of Health, Zambia); Eva N. Mulutsi (Department of Health, RSA); Sheila Zaramba Ndyanabangi (Ministry of Health, Uganda); Angela Ofori-Atta (University of Ghana); Akwasi Osei (Ghana Health Service); and Inge Petersen (University of KwaZulu-Natal, RSA).

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Lund, C., Kleintjes, S., Kakuma, R. et al. Public sector mental health systems in South Africa: inter-provincial comparisons and policy implications. Soc Psychiat Epidemiol 45, 393–404 (2010). https://doi.org/10.1007/s00127-009-0078-5

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