Planning for district mental health services in South Africa: a situational analysis of a rural district site

The shift in emphasis to universal primary health care in post-apartheidSouth Africa has been accompanied by a process of decentralizationof mental health services to district level, as set out in thenew Mental Health Care Act, no. 17, of 2002 and the 1997 WhitePaper on the Transformation of the Health System. This studysought to assess progress in South Africa with respect to deinstitutionalizationand the integration of mental health into primary health care,with a view to understanding the resource implications of theseprocesses at district level. A situational analysis in one districtsite, typical of rural areas in South Africa, was conducted,based on qualitative interviews with key stakeholders and theWorld Health Organization's Assessment Instrument for MentalHealth Systems (WHO-AIMS). The findings suggest that the decentralizationprocess remains largely limited to emergency management of psychiatricpatients and ongoing psychopharmacological care of patientswith stabilized chronic conditions. We suggest that, in a similarvein to other low- to middle-income countries, deinstitutionalizationand comprehensive integrated mental health care in South Africais hampered by a lack of resources for mental health care withinthe primary health care resource package, as well as the inefficientuse of existing mental health resources.