Mental Health Care In South Africa Research Articles

A Decolonized Framework for a Medical Treatment Team Approach to Mental Healthcare in the South African Context

ABSTRACT Medical treatment teamwork is widely advocated as an approach for treating mentally ill patients because the diverse healthcare professionals constituting medical treatment teams all contribute specific expertise for patient care. Approximately 80 per cent of South Africans are influenced by sociocultural factors with reference to their mental health issues. Hence, a decolonial medical treatment team approach to mental healthcare could enable a medical treatment team to cater for important sociocultural aspects in mental healthcare. However, at present, there is no single model or theory that accommodates important aspects such as the medical treatment teamwork and sociocultural aspects that influence mental healthcare. A qualitative, multiple-case study was used for this study to investigate these issues. The conceptual framework was developed from literature and theories and thereafter empirically investigated at two sites, namely the South African Eastern Cape Hospitals of Cecilia Makiwane and Fort England, using three data collection methods that included face-to-face, semi-structured interviews, focus group discussions and official documents. Data were analyzed applying thematic analysis. The findings indicated that sociocultural considerations such as the patient’s culture and the role of their families in mental healthcare should be included in the healthcare process in order to facilitate decolonized effective mental healthcare in South Africa.

Health care providers\u2019 perceptions of barriers to perinatal mental healthcare in South Africa

BackgroundPerinatal mental disorders are a leading contributor to morbidity and mortality during pregnancy and postpartum, and are highly treatable when identified early. However, many women, especially in low and middle-income countries, lack access to routine identification and treatment of mental illness in public health settings. The prevalence of perinatal depression and anxiety disorders, common mental disorders, is three times higher for South African women relative to women in high-income countries. The public health system has begun to integrate mental health into maternal care, making South Africa a relevant case study of perinatal mental healthcare. Yet studies are few. We sought to investigate healthcare providers’ perceptions of the barriers to early identification and screening of common perinatal mental disorders in public health facilities in South Africa.MethodsEmploying qualitative methods, we used purposive sampling to identify study participants, supplemented by snowball sampling. From September 2019–June 2020, we conducted in-depth interviews with 24 key informants in South Africa. All interviews were recorded and transcribed verbatim. We used a thematic approach to generate initial analytical themes and then conducted iterative coding to refine them. We adapted a delivery systems’ framework to organise the findings, depicted in a conceptual map.ResultsReported barriers to early identification and treatment of mental illness in the perinatal period encompassed four levels: (1) structural factors related to policies, systems and resources; (2) socio-cultural factors, including language and cultural barriers; (3) organisational factors, such as lack of provider preparation and training and overburdened clinics; and (4) individual patient and healthcare provider factors.ConclusionBarriers act across multiple levels to reduce quality mental health promotion and care, thereby creating an environment where inequitable access to identification of mental disorders and quality mental health services was embedded into systems and everyday practice. Integrated interventions across multiple levels are essential to improve the early identification and treatment of mental illness in perinatal women in South Africa. We provide recommendations derived from our findings to overcome barriers at each of the four identified levels.

Prehospital care providers' understanding of responsibilities during a behavioural emergency.

BackgroundPrehospital emergency care providers are frequently called to assist with the management of mental healthcare users (MHCUs). The Mental Health Care Act no. 17 of 2002 regulates mental healthcare in South Africa, but the act fails to consider the responsibilities of prehospital emergency care providers in the provision of mental healthcare. Rather South African Police Services were given authority over the well-being of a MHCU in the prehospital setting.AimTo investigate prehospital emergency care providers’ understanding of their responsibilities towards MHCUs and the community during the management of behavioural emergencies.SettingThe research was carried out at prehospital emergency care providers from the three main levels of care, currently operational within the boundaries of Pretoria, South Africa.MethodsA grounded theory qualitative study design was chosen using semi-structured focus groups for each level of prehospital emergency care – basic life support (BLS), intermediate life support (ILS) and advanced life support (ALS). Data from each focus group were collected through audio recordings and transcribed and analysed using a framework approach.ResultsA total of 19 prehospital emergency care providers participated; two focus group interviews were performed for each level of care. The BLS focus groups each consisted of two participants. The ILS focus groups consisted of three participants each, and the ALS focus groups consisted of six and three participants. Four key themes were identified: perceptions of behavioural emergencies, responsibilities, understanding of legislation and barriers experienced.ConclusionParticipants placed high value on their moral and medical responsibilities towards MHCUs, which they described as ensuring the safety of themselves, MHCUs and the community; preventing further harm; and transporting MHCUs to an appropriate healthcare facility. There was a desire for revision of legislation, better education, skill development and awareness of mental healthcare in the prehospital emergency care setting.

Politics of Mental Healthcare in Post-apartheid South Africa

ABSTRACTRecent events in post-apartheid South Africa have exposed a decidedly political dimension to mental healthcare. This was exemplified in three important cases: the recent grants crisis of the South African Social Security Agency, a court case between the state and non-governmental organisations, and the Life Esidimeni tragedy. These events demonstrate that despite significant policy shifts toward basic human rights and care of people living with mental illness, these cases demonstrate the contradictory elements of macroeconomic and health policy exposed a neoliberal tendency towards providing public mental healthcare. In examining these case, key features emerged, including: the commodification of people living with mental illness, the pertinence of auditing, accounting practices, and dynamics of globalisation, de- and re-nationalisation. This article speaks to a tangible gap in the discourse on mental healthcare in South Africa, by highlighting the political dimensions that are involved under an era of neoliberalism.

Mental health service delivery in South Africa from 2000 to 2010: one step forward, one step back.

To identify progress and challenges in mental healthcare in South Africa, as well as future mental health services research priorities. A systematic review of mental health services research. Literature searches were conducted in Medline, PsychInfo and Sabinet databases from January 2000 to October 2010 using key phrases. Hand searches of key local journals were also conducted. Of 215 articles retrieved, 92 were included. Data were extracted onto a spreadsheet and analysed thematically. While progress in epidemiological studies has been good, there is a paucity of intervention and economic evaluation studies. The majority of studies reviewed were on the status of mental healthcare services. They indicate some progress in decentralised care for severe mental disorders, but also insufficient resources to adequately support community-based services, resulting in the classic revolving-door phenomenon. Common mental disorders remain largely undetected and untreated in primary healthcare. Cross-cutting issues included the need for promoting culturally congruent services as well as mental health literacy to assist in improving help-seeking behaviour, stigma reduction, and reducing defaulting and human rights abuses. While there has been some progress in the decentralisation of mental health service provision, substantial gaps in service delivery remain. Intervention research is needed to provide evidence of the organisational and human resource mix requirements, as well as cost-effectiveness of a culturally appropriate, task shifting and stepped care approach for severe and common mental disorders at primary healthcare level.