A reflection of the current status of the mental healthcare system in South Africa

Mental disorders remain a global health burden. The integration of mental health services into primary healthcare (PHC) can contribute to reduction of this burden. However, studies have reported PHC nurses' lack of knowledge of mental disorders, which leads to their negative attitudes towards people with mental disorders preventing them from seeking help. The objective of this study is to assess the knowledge levels of PHC nurses regarding mental disorders in the Western Cape, South Africa. A quantitative descriptive survey was conducted. A self-administered questionnaire was used to collect data from a sample of 246 PHC nurses in the Cape Town metropole. Data were analysed using descriptive statistics, Chi-square tests and independent sample tests. A cut-off value of ≥ 80% was used to determine the sufficient levels of knowledge. The average knowledge score (15.6; 78.0%) was below the cut-off value of ≥ 80%, indicating insufficient levels of knowledge. Sufficient levels of knowledge were found for over half of the respondents (139, 59.4%). Most of the respondents were knowledgeable about the symptoms of depression (221, 94.4 %), bipolar (217, 92.7%), schizophrenia (213, 91.0%) and anxiety disorders (209, 89.3%). Over half of the PHC nurses could identify the signs and symptoms of common mental disorders. However, the knowledge of dysthymia and psychosis requires more attention.Contribution:This study contributes to the existing body of knowledge in nursing practice and education related to mental disorders.

BackgroundSecurity guards (SGs) play a significant role in health care and are an integral part of many psychiatric institutions. While their main duty is to ensure service users' (SUs) and staff's safety and protect the premises, they are also called upon for other tasks, often ones for which they are not adequately trained. This study aimed to explore the roles, formal and informal tasks performed, training, working conditions and well-being of SGs working in psychiatric services. MethodsGuided interviews were conducted with n = 12 SGs and n = 18 mental healthcare providers (MHCPs) at a psychiatric hospital in the Western Cape of South Africa. All interviews were audio recorded, transcribed verbatim and analyzed using a thematic analysis approach. ResultsIn addition to ensuring safety, SGs take on numerous informal tasks, often for which they are not adequately trained and which formally fall under the purview of other MHCPs, mostly nurses, including talking with SUs about their mental health issues, dressing, showering, feeding, and administering medication. SGs also serve informally as interpreters, raising ethical concerns regarding accuracy and confidentiality. SGs lack formal training for working in psychiatric services and handling aggressive SUs, which may lead to increased violence instead of de-escalation and, in the worst case, injuries. SGs work under precarious working conditions (i.e. low salary, outsourced employment, absence of labour rights and job insecurity) and lack professional recognition, potentially leading to lower job satisfaction and increased emotional distress. ConclusionAddressing the challenges outlined in the study requires collaborative efforts between government, psychiatric institutions, private security companies, SGs and MHCPs. The establishment of clear roles, implementation of comprehensive formal training, psychosocial support and improved working conditions, particularly in-house employment, higher pay, increased employee rights and job security, are needed.

Effectiveness of a task-sharing collaborative care model for the detection and management of depression among adults receiving antiretroviral therapy in primary care facilities in South Africa: A pragmatic cluster randomised controlled trial

Mental health challenges are common among men who have sex with men (MSM) in South Africa and may impact medication adherence. We determined the prevalence and risk factors of medication adherence challenges among 160 pre-exposure prophylaxis (PrEP)- and 40 antiretroviral therapy (ART)-taking MSM registered at two key population clinics in Johannesburg and Pretoria in 2023. We used modified Poisson regression to estimate associations between participant characteristics and medication adherence challenges (missed dosage on ≥1d in the last month). A total of 106 (53.5%) participants (57.6% on PrEP, 37.5% on ART; p=0.02) had medication adherence challenges and 61 (30.5%) participants (31.2% on PrEP, 27.5% on ART; p=0.23) met criteria for moderate to severe symptoms of depression (score ≥10 on the 9-item Patient Health Questionnaire). In multivariable analysis, predictors included PrEP use (adjusted prevalence ratio [aPR]=1.81 [95% confidence interval {CI} 1.21 to 2.73), clinic in Pretoria (aPR 1.43 [95% CI 1.08 to 1.89]), transactional sex (aPR 1.81 [95% CI 1.34 to 2.44]), moderate to severe depression (aPR 1.50 [95% CI 1.19 to 1.89]) and use of social media (aPR 1.45 [95% CI 1.05 to 2.00]). Depression is common and may be an important risk factor for poor medication adherence among MSM in South Africa. Future research should leverage a longitudinal study design to inform potential interventions.

This contribution examines the human rights framework and legislative developments in South Africa on persons with mental illness, revealing that the initial focus of the legislation was on control and detention at the cost of the rights of mental health care users. Presently, under its Constitutional democracy, South Africa has progressive Mental Health Legislation focusing on the rights of mental health care users and the least restrictive means of treatment. The contribution considers the impact of the legislative developments on the human rights of mental health care users. There are, however, challenges with the implementation of the legislation most notably illustrated by the Life Esidimeni disaster where a mass deinstitutionalization project led to the loss of life. South Africa’s revised Mental Health Policy Framework holds a renewed commitment to respect a mental health care user’s right to dignity, integrity, privacy, and freedom of movement. This is one step closer to the realisation of the obligations created by the United Nations Convention on the Rights of Persons with Disabilities (CRPD). The contribution considers the 2018 concluding observations by the United Nations Committee on the Rights of Persons with Disabilities, which lays bare areas where yet further improvement is needed in South Africa to eradicate all forms of discrimination against persons with disabilities and, in particular, persons with mental illness Areas where progress have been made are highlighted. South Africa has made steady progress but needs to intensify its efforts to domesticize the CRPD.

BackgroundForced displacement is a significant issue globally, and it affected 112 million people in 2022. Many of these people have found refuge in low- and middle-income countries. Migrants and refugees face complex and specialized health challenges, particularly in the area of mental health. This study aims to provide an in-depth qualitative assessment of the multi-level barriers that migrants face in accessing mental health services in Germany, Macao (Special Administrative Region of China), the Netherlands, Romania, and South Africa. The ultimate objective is to inform tailored health policy and management practices for this vulnerable population.MethodsAdhering to a qualitative research paradigm, the study centers on stakeholders’ perspectives spanning microsystems, mesosystems, and macrosystems of healthcare. Utilizing a purposive sampling methodology, key informants from the aforementioned geographical locations were engaged in semi-structured interviews. Data underwent thematic content analysis guided by a deductive-inductive approach.ResultsThe study unveiled three pivotal thematic barriers: language and communication obstacles, cultural impediments, and systemic constraints. The unavailability of professional interpreters universally exacerbated language barriers across all countries. Cultural barriers, stigmatization, and discrimination, specifically within the mental health sector, were found to limit access to healthcare further. Systemic barriers encompassed bureaucratic intricacies and a conspicuous lack of resources, including a failure to recognize the urgency of mental healthcare needs for migrants.ConclusionsThis research elucidates the multifaceted, systemic challenges hindering equitable mental healthcare provision for migrants. It posits that sweeping policy reforms are imperative, advocating for the implementation of strategies, such as increasing the availability of language services, enhancing healthcare providers’ capacity, and legal framework and policy change to be more inclusive. The findings substantially contribute to scholarly discourse by providing an interdisciplinary and international lens on the barriers to mental healthcare access for displaced populations.

BackgroundMental health disorders are increasing globally. In South Africa, primary healthcare (PHC) services are tasked with mental healthcare, with limited resources. A task-sharing approach between PHC role-players has also been met with barriers, including negative attitudes towards mental health care, organisational constraints and insufficiently trained staff.AimTo assess the perceptions and experiences of PHC practitioners in managing common mental health disorders.SettingPrimary healthcare facilities in the Garden Route District, South Africa.MethodsAn observational, descriptive study using a cross-sectional survey obtained a representative sample of 130 participants. Redcap© platforms captured data, which were analysed to give frequencies and means using simple descriptive statistics.ResultsMost participants (68.46%) reported average or below average competence in managing mental health conditions. Out-Patient Departments (OPDs) (68.42%) and PHC clinics (56.25%) found reaching a referral practitioner to be challenging. Waiting times of referred patients were longer at hospital OPDs and clinics than at Community Day Centres.ConclusionResources allocated to PHC mental health services remained inadequate, while available support structures were underutilised. The presence of a dedicated mental health practitioner at a facility had a direct influence on the experience of the staff in managing these disorders. Policy makers and managers should motivate for training in mental health and empower the PHC system to offer acceptable mental health services, in accordance with national and international guidelines.ContributionThis research contributed insights into the current mental health ecosystem in primary care, and the need for increased awareness, training and utilising available resources, which could be useful in similar contexts in sub-Saharan Africa.

Approximately one in four adolescents in Sub-Saharan Africa experiences significantly elevated symptoms of anxiety and depression. Those living in resource-constrained communities face heightened risks due to acute distress, trauma, and less responsive health care services. Boikoetliso Ba Boko (meaning 'exercising the mind') is an intervention prototype designed for adolescents and young people experiencing common mental health conditions. The prototype aims to implement a youth-centred community mental health intervention, through collaboration with existing public health systems and community resources. It seeks to enhance access to mental health support for adolescents and young people in Soweto, South Africa, by creating a dynamic and engaging therapeutic environment for those dealing with anxiety, depression, and suicidal ideation. This protocol outlines how we will evaluate the feasibility, acceptability, and implementation process of the prototype mental health intervention. We will enrol 200 at-risk adolescents and young people, aged 14-24 years, who will serve as their own controls, into the intervention and collect assessment and process evaluation data using mixed methods. This study aims to provide a comprehensive understanding of how the Boikoetliso Ba Boko adolescent mental health prototype can be effectively evaluated and scaled up in resource-constrained communities. The findings will inform the development of a Phase II randomized controlled trial protocol to assess the prototype's efficacy. Ethical approval was granted by the Human Ethics Research Committee of the University of the Witwatersrand (M231045 MED23-09-040). Boikoetliso Ba Boko is registered with the Pan African Clinical Trial Registry (PACTR202409702283764).

Beyond averages: Examining depressive symptoms in South African youths at different quantiles

Siyakhana: A hybrid type 2 effectiveness-implementation stepped-wedge trial to reduce stigma towards substance use and depression among community health workers in HIV/TB care in South Africa.