Mental health care user participation in mental health policy development and implementation in South Africa

This paper describes current support for mental health care user participation in policy development and implementation in South Africa and suggests strategies for improving participation. The World Health Organization (WHO) Mental Health Policy Checklist and WHO Mental Health Legislation Checklist were completed. Between August 2006 and August 2009 96 semi-structured interviews with national, regional and district stakeholders were conducted. Most respondents felt that inclusion of user perspectives in policy processes would improve policy development. In practice, mental health care user consultation in policy development and implementation has been limited during the 16 years of democracy in South Africa. Strategies to create a supportive environment for user participation include social action directed at reducing stigma, advocating for acceptance of users' rights to participate in decision making, crafting a supportive regulatory framework to promote participation, and equipping providers and policy makers to support inclusion. User capacity for participation could be strengthened through early and effective access to treatment and support, development of a national user lobby, skills training and practical exposure to the policy and service development environment.     

Mental health care user participation in mental health policy development and implementation in South Africa

This paper describes current support for mental health care user participation in policy development and implementation in South Africa and suggests strategies for improving participation. The World Health Organization (WHO) Mental Health Policy Checklist and WHO Mental Health Legislation Checklist were completed. Between August 2006 and August 2009 96 semi-structured interviews with national, regional and district stakeholders were conducted. Most respondents felt that inclusion of user perspectives in policy processes would improve policy development. In practice, mental health care user consultation in policy development and implementation has been limited during the 16 years of democracy in South Africa. Strategies to create a supportive environment for user participation include social action directed at reducing stigma, advocating for acceptance of users’ rights to participate in decision making, crafting a supportive regulatory framework to promote participation, and equipping providers and policy makers to support inclusion. User capacity for participation could be strengthened through early and effective access to treatment and support, development of a national user lobby, skills training and practical exposure to the policy and service development environment.     

Ancestor reverence and mental health in South Africa

The great majority of South Africa's people consult traditional healers. The deeper meaning of much traditional healing centres on ancestor reverence. This belief system and its accompanying rituals may positively influence the mental health of the individual and the community. Among traditional Xhosa-speaking peoples, the relationship with the ancestors is given expression in life cycle rituals that have much in common with Western psychotherapeutic principles and practices. The common thread that underpins many rituals is that of making links via concrete, literal means. Examples include the participation of the community in the healing of the individual; the linking of body and mind through dancing and drumming. Dreams form an essential connection between conscious life and the unconscious. Understanding the psychological depth of these practices is important so that a respectful relationship between Western-trained professionals and traditional healers can develop. Analytical psychology, with its notion of the collective unconscious has a particular contribution to make to cross-cultural understanding. The ancestors may be understood as archetypal representations of the collective unconscious.     

Child and adolescent mental health in South Africa

Mental health problems in childhood and adolescence pose a major threat to public health. Epidemiological studies in high, middle and low income countries indicate that approximately one in five children and adolescents suffer from a mental disorder. In many instances these persist into adulthood. In South Africa, HIV infection, substance use, and exposure to violence increase vulnerability to mental disorders. Child and adolescent mental health services play a key role in reducing the burden of mental disorders in childhood and later in adulthood. This paper focuses on service needs for children and adolescents in South Africa. It commences with a discussion of the prevalence of child and adolescent psychiatric disorders after which the legal and policy context of child and adolescent psychiatric services is described. A framework for child and adolescent mental health service provision is presented, following which steps for reducing the extent of unmet service need are considered. The paper concludes with a call to scale up child and adolescent mental health services in South Africa, based on the stark realities of unmet need and the constitutional rights of children and adolescents to appropriate mental health care.     

Community mental health in the nineties: Public sector managed care

A previous version of this article was published in The Community Psychiatrist, the newsletter of the AACP.     

Norms for mental health services in South Africa

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.     

Public policy,ethical issues,and mental health administration

The authors discuss ethical issues faced by mental health administrators. Among the primary concerns are patient rights, marketing, privatization, managed care, serving the poor. It is suggested that professional organizations develop ethical guidelines to help administrators maintain their ethical positions.A previous version of this paper was prepared for the Annual Meeting of the American College of Mental Health Administration, Williamsburg, VA, March 28–31, 1990.     

The mental health policy template: domains and elements for mental health policy formulation

Mental disorders are a major and rising cause of disease burden in all countries. Even when resources are available, many countries do not have the policy and planning frameworks in place to identify and deliver effective interventions. The World Health Organization (WHO) and the World Bank have emphasized the need for ready access to the basic tools for mental health policy formulation, implementation and sustained development. The Analytical Studies on Mental Health Policy and Service Project, undertaken in 1999-2001 by the International Consortium for Mental Health Services and funded by the Global Forum for Health Research aims to address this need through the development of a template for mental health policy formulation. A mental health policy template has been developed based on an inventory of the key elements of a successful mental health policy. These elements have been validated against a review of international literature, a study of existing mental health policies and the results of extensive consultations with experts in the six WHO regions of the world. The Mental Health Policy Template has been revised and its applicability will be tested in a number of developing countries during 2001-2002. The Mental Health Policy Template and the work of the Consortium for Mental Health Services will be presented and the future role of the template in mental health policy development and reform in developing countries will be discussed.     

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     

Mental health policy and development in Egypt - integrating mental health into health sector reforms 2001-9

Background  

Following a situation appraisal in 2001, a six year mental health reform programme (Egymen) 2002-7 was initiated by an Egyptian-Finnish bilateral aid project at the request of a former Egyptian minister of health, and the work was incorporated directly into the Ministry of Health and Population from 2007 onwards. This paper describes the aims, methodology and implementation of the mental health reforms and mental health policy in Egypt 2002-2009.     

Restructuring of a community mental health center and regional sector policy: structuring or destructuring?

Reorganizing the structure of wards in a mental hospital shows inadequacy of a sectorial plan. The answers are different and a particular significance if we compare those of the intentional plan with the realization. Instead of being on the spot and taking care out patients in conformity with their needs like a night hospital, the shortage of staff and a defective development is running a great risk of wrecking restructuration and making maladjustment.     

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.     

Administration and policy in mental health

Conclusion The upshot of these needs for change is both dismaying and exciting, both disturbing in the destruction of long-familiar patterns of dealing with human suffering, and paradoxically hopeful in raising the possibility that significant failures in our health care systems of the past — limited access to medical care and grossly inadequate public sector non-systems, for example — may now be addressed more successfully.The mounting complexity of our field suggests that these substantial gains will come only as a result ofcoordinated efforts that recognize the importance of a systems perspective — about our field, about ourselves and our relationships with our colleagues, and about the nature of mental illness itself.If these efforts are to produce better answers than the ones we now have, the taks of managing these systems will fall heavily upon administrators and leaders of a new kind: broadly conceptual managers who have successfully combined a sophisticated knowledge of planning with a sophisticated understanding of treating mental illness. Our task in the meantime is to figure out how to develop the managers our future requires.In 1972, Dr. Menninger was President of the Menninger Foundation in Topeka, Kansas. Since then he has held various academic and clinical appointments, including Clinical Professor of Psychiatry at the University of Kansas Medical Center in Wichita, Consultant/Attending Services at Colmery-O'Neil VA Medical Center in Topeka, and faculty member of the Menninger School of Psychiatry. Dr. menninger is currently Chairman and CEO of The Menninger Foundation. He also serves on a number of editorial and other boards.     

State mental health policy: critical priorities confronting state mental health agencies

The authors of this column report on an environmental scan conducted via intensive interviews of the 55 state and territorial state mental health agency (SMHA) directors who collectively oversee a $28 billion budget and serve nearly six million Americans who have a serious mental illness. Currently, a dynamic set of forces are substantively reshaping the role, resources, and capacities of the SMHA within the larger fabric of state government. As such, SMHA directors developed year 2007 priorities. These priorities include integrating health and mental health care, enhancing consumer empowerment, addressing mental health workforce crises (for example, training and recruitment), and ensuring financial stewardship.     

Lessons from case studies of integrating mental health into primary health care in South Africa and Uganda

Background  

While decentralized and integrated primary mental healthcare forms the core of mental health policies in many low- and middle-income countries (LMICs), implementation remains a challenge. The aim of this study was to understand how the use of a common implementation framework could assist in the integration of mental health into primary healthcare in Ugandan and South African district demonstration sites. The foci and form of the services developed differed across the country sites depending on the service gaps and resources available. South Africa focused on reducing the service gap for common mental disorders and Uganda, for severe mental disorders.     

Lessons from case studies of integrating mental health into primary health care in South Africa and Uganda

Background

Studies on the mental health of refugees have tended to focus upon the impact of traumatic experiences in the country of origin, and acculturation processes in exile. The effects of crises in the country of origin on refugees living in exile have been little studied. This article examines how the final stages of the civil war in Sri Lanka in 2009 influenced members of pro-LTTE Tamil NGO's in Norway.

Method

Ethnographic fieldwork methods were employed within Tamil NGO's in the two largest cities in Norway between November 2008 and June 2011.

Results

The findings suggest that collective resources became severely drained as a result of the crisis, severely disrupting the fabric of social life. Public support from the majority community remained scarce throughout the crisis.

Conclusions

The study suggests that there is a need for public support to exile groups indirectly affected by man-made crises in their country of origin.     

Federal mental health policy trends and issues: Impact on state mental health agencies

The views expressed in this paper are solely those of the authors. Inquiries may be made to Dr. Ross at NASMHPD, 1101 King St., Suite 160, Alexandria, VA 22314.