Bed/population ratios in South African public sector mental health services

Background In post-apartheid South Africa, mental health service planners face critical decisions regarding appropriate and affordable inpatient care. Before a fashion of deinstitutionalisation is followed blindly in South Africa, effective community services should be in place and sufficient psychiatric beds should remain in hospitals for those who cannot be catered for in the community. In order to maintain the delicate balance between hospital and community-based services, it is essential that useful indicators of inpatient care are established. This study documents current bed/population ratios per 100 000 population in public sector mental health services in South Africa. Method A questionnaire was distributed to provincial mental health coordinators requesting psychiatric bed numbers in acute and medium-long stay facilities across all service levels. The information was supplemented by consultations with mental health coordinators in each of the nine provinces. Population data were obtained from preliminary findings of the 1996 census. Results For acute facilities, the mean bed/population ratio was 13 (provincial range: 6–18) per 100 000 population. For medium-long stay facilities, it was 16 (provincial range: 0–29) excluding contracted facilities, and 35 (provincial range: 0–83) including contracted facilities per 100 000 population. Conclusions There were low levels of inpatient service provision in South Africa, and there was considerable variability between provinces. This study gives further support to the need to develop acute inpatient psychiatric services, reduce levels of chronic care where appropriate, and redirect resources towards the development of community-level residential and day-care services. It is crucial to develop accurate indicators to monitor this process. Accepted: 1 March 2002     

Child Mental Health Services in the New South Africa

Health departments in the new South Africa are undergoing major restructuring and, in some cases, severe financial cutbacks as new policies attempt to redress the inequities of the past. A district system is being phased in, with a shift in funding from academic hospitals to secondary and primary level care. The process is being undermined by the current recession, which also affects Welfare and Education facilities, and by widespread poverty, violence, and other adverse conditions. Child mental health services are discussed in the light of current human resources, epidemiological data, the effects of violence and cultural issues, together with some reflections on their future.     

Developing mental health services in Nigeria

This grass-roots level mental health awareness programme considerably increased use of community-based mental health services in a part of Nigeria where knowledge about treatability of mental illness was limited. The benefits of the programme were sustained for a significant period after the initial awareness programme. In order for attitude changes to be reinforced, similar awareness programmes must be repeated at regular intervals.     

The influence of internal migration on mental health status in South Africa

Mental health status is fundamental to overall health and well-being but most studies on the relationship between migration and mental health status deal with international migration and neglects internal migration. Therefore, this study compares the mental health status of internal migrants with that of non-migrants; and also appraises the socio-demographic factors associated with mental health status in South Africa. Data were from the National Income Dynamics Study (NIDS), waves 3 (2012), and 4 (2014) of South Africa. Univariate analysis was used to describe the study population, bivariate analysis was use to explain the mental health status of the population, and binary logistic regression was used analyze the socio-demographic factors associated with mental health status. The study found significant differences in the mental health status of migrants and non-migrants across the waves of NIDS used for this study. While, the migrants had better mental health status in 2012, the non-migrants had better mental health status in 2014. In addition, factors significantly associated with mental health status in 2012, were marital status, income, and province of residence. On the other hand, only race, and province of residence were significantly associated with mental health status in 2014.     

Disengagement from mental health services

This paper reviews the literature on disengagement from mental health services examining how the terms engagement and disengagement are defined, what proportion of patients disengage from services, and what sociodemographic variables predict disengagement. Both engagement and disengagement appear to be poorly conceptualised, with a lack of consensus on accepted and agreed definitions. Rates of disengagement from mental health services vary from 4 to 46%, depending on the study setting, service type and definition of engagement used. Sociodemographic and clinical predictors of disengagement also vary, with only a few consistent findings, suggesting that such associations are complex and multifaceted. Most commonly reported associations of disengagement appear to be with sociodemographic variables including young age, ethnicity and deprivation; clinical variables such as lack of insight, substance misuse and forensic history; and service level variables such as availability of assertive outreach provision. Given the importance of continuity of care in serious mental disorders, there is a need for a consensual, validated and reliable measure of engagement which can be used to explore associations between patient, illness and service related variables and can inform service provision for difficult to reach patients.     

Making progress in mental health policy in conservative times: one step at a time

Progress in mental health services has been made incrementally in a sequence of policy steps. In recent years, in spite of political conservatism, progressive changes have advanced new principles of service delivery. Reports from the surgeon general and the President's New Freedom Commission on Mental Health advanced these principles, including recovery and evidence-based practices. Both of these high-level reports were influenced by the findings of the Schizophrenia Patient Outcomes Research Team (PORT). The Schizophrenia PORT established the effectiveness of mental health treatments and supports, which provided a scientific foundation for the optimistic focus on recovery and its expectation of improved outcomes for individuals with severe mental disorders. The PORT study also established the gap between treatment recommendations and actual services. Concern about this gap has motivated efforts to transform services by implementing evidence-based practices. Advances in broad mental health and social policy, coupled with continued advances in science, have the potential to improve the care of individuals who experience severe mental disorders, such as schizophrenia.     

Previous help sought by patients presenting to mental health services in Kumasi,Ghana

Abstract.Objective: There are four services providing mental health care to the people of Kumasi, Ghana. This study aimed to identify previous help sought by patients presenting to the services for an initial assessment.Method: New patients presenting to each of the four services were asked about distance travelled, previous help sought and time since symptoms of illness started. Staff also recorded basic demographic details and clinical diagnoses.Results: Of the 322 patients presenting to the four sites,only 6% had seen a traditional healer whereas 14% had seen a pastor before presentation. There was a greater delay in presenting to that service if the patient had seen a traditional healer or pastor. Many patients had previously used one of the other mental health units in Kumasi.Conclusion: It is possible that fewer patients with mental health problems present to traditional healers in modern, urban Africa compared to rural areas. More patients consult with pastors than traditional healers and liaison with these groups may improve mental health care. It is important to maintain liaison between the four services as patients presenting to one clinic may have presented previously to another local clinic.     

Current status of yoga in mental health services

Abstract

Yoga (derived from ‘yuj’ which means to yoke together or unite) has been used for millennia as a tool for self-improvement, with the ultimate goal of uniting the individual consciousness with the universal. The physical elements of yoga, although seen as necessary in the path to achieve the goal, they were not considered as the endpoint for a practitioner. Sage Patanjali, who codified the practices into an eight-limbed model (Ashtanga yoga) in the Patanjali Yoga Sutras, makes it clear that the target of yoga is primarily the mind. However, in the modern world, yoga practices have become immensely popular as aids to improve health. Yoga-based practices are being extensively used as therapeutic ingredients, alone or as adjuncts to other therapies in a variety of disorders, both physical and mental. There is now strong evidence to suggest that yoga-based interventions are beneficial in several lifestyle disorders. Recent research has also shown significant benefits in mental disorders such as depression, anxiety, and psychosis. This paper discusses the place of yoga as one of the therapeutic strategies in the holistic approach to mental disorders, and the challenges inherent to research in this area.     

Establishing mental health policy and services in Vanuatu

With a population of 245,000 spread mostly over six groups of islands and a total land area of 12,189 km², Vanuatu is one of the larger Pacific Island countries. Compared to other Pacific Island countries of similar or larger size, mental health has received little attention from government until very recently. While systematic studies are lacking, the limited available data suggest that mental disorders and suicide are increasing. The first ever National Mental Health Policy and Strategic Plan were launched in October 2009. Key areas include formalization of the National Mental Health Committee established in 2007, financing, mental health legislation, service organization, human resources, essential medicines, information systems, quality, advocacy, and monitoring and evaluation. In 2010, mental health was inserted for the first time into the new Ministry of Health organizational structure. The Ministry of Health mandate is to work with partners to achieve sustainable progress in reducing all key risk factors to improve the wellbeing of everybody with mental illness. The country has commenced a program of mental health training for workers at primary and secondary health facilities and community awareness, with support from the World Health Organization Pacific Island Mental Health Network (PIMHnet) and others. A foundation for modern mental health services has been laid.     

Qualitative analysis of key informant interviews about adolescent stigma surrounding use of school mental health services

Given the increased access to mental health services that schools provide, there has been a growing consensus among mental health professionals for the delivery of services for youth in schools. Building the capacity of schools to provide evidence-based socio-emotional supports across a continuum of care has been prioritized in recent decades. However, despite policy changes to implement more mental health services in schools, these services still remain widely underutilized by adolescents experiencing mental health problems. Understanding the factors impacting students’ decisions to seek help or use resources provided in a school setting is crucial for actually increasing utilization of care. Yet, little is known about the role of stigma in students’ underutilization of school mental health services. The current study examined stigma about mental health and services in schools through a qualitative analysis of 15 school personnel and student interviews at three high schools in South Carolina. Thematic analysis of interviews indicated that students have a negative outlook of mental health services because of fear of being stereotyped or embarrassed as a result of receiving school counseling. Data from this exploratory study directly contribute to the field of education by providing a model for professionals to implement strategies to eliminate the stigma that causes underutilization of school mental health services.     

农村社区精神卫生服务中初级卫生人员培训的对照研究

农村培训初级医务人员开展精神卫生服务工作，以如何安排为好？我们对此进行了随机整群抽样对照研究。实验组为理论培训并实践中示范辅导，对照组仅为理论培训。评价其理论知识掌握程度，处理病人工作能力及工作质量。一年的随访结果表明：实验组在这三方面都明显好于对照组，表明除多次理论培训外，实践中示范辅导是很重要的培训方法。     

The effect of family and neighbourhood social capital on youth mental health in South Africa

IntroductionDespite the prevalence of mental illness among young adults in South Africa, few studies have examined its correlation with social capital using nationally representative data. Sources of social capital are different for youth, which is why understanding the correlation between family and neighbourhood social capital and mental health outcomes is important for designing optimal interventions. The objective of this study was to examine the relationship between social capital and youth mental health. We also sought to understand whether family social capital was more protective for the mental health of youth compared to neighbourhood social capital.MethodsUsing the National Income Dynamics Survey data for South Africa, we examine these associations among 2307 youth aged 15–24 across the four waves. Multilevel logistic regression was used to examine these associations.ResultsOur findings emphasize the substantial burden of mental illness among youth in South Africa (26% in wave 4). Although results for parental presence were not significant, family social capital measured by household income significantly decreased the odds of incident depression only for those belonging to the third quintile (aOR 0.74, 95% CI 0.54–1.01). High perception of crime in the neighbourhood was associated with significantly higher odds of incident depression (aOR 1.33, 95% CI 1.06–1.67).ConclusionsOur results confirm the independent effect of neighbourhood characteristics on youth mental health and did not support family social capital as being protective for developing depression. This implies that youth program planners must focus on community context in improving youth developmental outcomes such as mental health.     

Evaluating mental health services in a Greek community

This study aims to evaluate rendered mental health services for children and adolescents through the investigation of those factors which are related to non-compliance with therapy and which affect treatment outcome. Data were collected from the files of all new cases who applied to a Community Mental Health Centre in Athens during 2000–2002 (N = 363). For each case, the following factors were examined: age, sex, family situation, parents’ educational level, referral source, child’s psychiatric and psychosocial diagnoses, type of proposed therapy, phase at which termination of therapy occurred and outcome. Around 45.7% of the sample did not complete therapy. The probability of treatment compliance increased when the patient was male, with a diagnosis of a specific developmental disorder, treated in a well-structured therapy programme, was from a healthy family environment and his mother was better educated. On the contrary, an adverse family situation (one-parent family, inadequate parental supervision) and the female sex had a negative association with treatment compliance. Most of the cases discontinued their treatment upon completion of the diagnostic procedure. Referral source did not influence treatment compliance. Evaluation of our service has shown that more attention should be paid to less-educated families and those in adverse situations, particularly when the patient is female.     

Mental health care providers talk about their experiences preventing suicide in people with substance use disorders in South Africa: implications for clinical practice

Objective: This study explored mental health care providers’ experiences of preventing suicide in people with substance use disorders and their perceptions of factors related to clinical practice that contributed to these experiences.

Methods: In-depth, semistructured interviews were conducted with 18 mental health care providers working in South Africa. Thematic analysis was used to analyse the data inductively with Atlas.ti software.

Results: Participants described feeling hopeless, helpless, powerless and guilty and needed to debrief from their experiences of preventing suicide. They perceived their experiences to be related to the difficulties of treating substance use disorders, the difficulties of assessing and managing suicide risk and how treating substance use might increase suicide risk.

Conclusions: The ways in which mental health care providers think about suicide and make sense of their experiences affects their perceived abilities to prevent suicide. Educating mental health care providers to transcend the limitations of risk factor approaches to suicide prevention and utilise evidence-based strategies for treating substance use disorders and associated problems, may be important to empower them and make them feel competent in suicide prevention. Empowering people with substance use disorders may help prevent suicide and may require collaboration between mental health care providers and allied professionals.     

The role of carers in evaluating mental health services for older people

Objectives. To examine, using the published literature and local service experience, the contributions that carers can make to the development and evaluation of specialist mental health services for the elderly. Methods. MEDLINE search for relevant papers about carers and the elderly, especially with mental disorders; review of recent experience of service planning, implementation and evaluation in the Cambridge area. Results. Increased emphasis on the role of carers in recent literature, extending into acknowledgement of the carer perspective in official publications; few papers on the role of carers specifically in evaluating services, with only one study looking solely at an old age psychiatry service. Conclusions. There is considerable scope for involving carers in the development and evaluation of services, though there are also some potential concerns, not least that carers and users may have different perspectives. These issues are discussed, along with possible future developments, such as the need for a standardized assessment of carer satisfaction. Copyright © 1998 John Wiley & Sons, Ltd.     

Assessing the content of mental health services: a review of measures

Background Measurement of service content is necessary to understand what services actually provide and explain variation in service outcomes. There is no consensus about how to measure content of care in mental health services. Method Content of care measures for use in mental health services were identified through a search of electronic databases, hand searching of references from selected studies and consultation with experts in the field. Measures are presented in an organising methodological framework. Studies which introduced or cited the measures were read and investigations of empirical associations between content of care and outcomes were identified. Results Twenty five measures of content of care were identified, which used three different data collection methods and five information sources. Seven of these measures have been used to identify links between content of care and outcomes, most commonly in Assertive Community Treatment settings. Discussion Measures have been developed which can provide information about service content. However, there is a need for measures to demonstrate more clearly a theoretical or empirical basis, robust psychometric properties and feasibility in a range of service settings. Further comparison of the feasibility and reliability of different measurement methods is needed. Contradictory findings of associations between service content and outcomes may reflect measures’ uncertain reliability, or that crucial process variables are not being measured. Conclusion Measures providing a greater depth of information about the nature of interventions are needed. In the absence of a gold standard content of care measure, a multi-methods approach should be adopted.