Mental Health Service Delivery in South Africa from 2000 to 2010: One Step Forward, One Step Back (Original Articles) (Report)

Mental Health Service Delivery in South Africa from 2000 to 2010: One Step Forward, One Step Back (Original Articles) (Report)

In 2000, Rita Thorn published a systematic review of mental health services research in southern Africa, conducted from 1967 to 1999. (1) The review suggested a need to shift from centralised institutional care, which characterised apartheid South Africa, towards decentralised, integrated and community-based services provided within a human rights framework. The use of trained non-specialists to provide mental healthcare was also suggested as a strategy to increase access in the context of a shortage of mental health specialists. Research gaps identified included the need for accurate epidemiological studies; intervention studies demonstrating the efficacy of sustainable models of service delivery in line with policy imperatives for deinstitutionalised and integrated primary mental healthcare; and economic evaluation studies of service delivery models. (2) The latter included cost-effectiveness, cost-benefit and cost-utility analyses. Policies and legislation in post-apartheid South Africa have been consistent with the suggestions emanating from this review in a bid to increase access and quality of care within a human rights framework. (3,4) Emerging from the new Mental Health Care Act No. 17 of 2002 (5) has been the introduction of a legislated 72-hour emergency referral and observation period for mental healthcare users (MHCUs) in designated regional and district general hospitals before onward referral to tertiary hospitals. This innovation aimed to increase availability and accessibility of mental health services locally in less restrictive settings and reduce unnecessary referrals to psychiatric hospitals. (6) A further innovation included the introduction of Mental Health Review Boards that have the explicit agenda of upholding the human and health rights of people with mental disorders and intellectual disabilities. (5) A recent review of decentralised community-oriented care in Africa suggests, however, that many countries struggle to implement policy imperatives for decentralised community-based care. (7) In light of this, we set out to systematically review published literature on mental health services research in South Africa from January 2000 to October 2010, with the aim of assessing how South Africa has fared in this regard over the past decade. Specifically, we aimed to identify progress as well as remaining challenges in the quest for improving access to high quality mental healthcare through decentralised, integrated and community-oriented care, as well as future mental health services research priorities.

Mental Health Service Delivery in South Africa from 2000 to 2010: One Step Forward, One Step Back (Original Articles) (Report)



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