Closing the mental health treatment gap in South Africa: a review of costs and cost-effectiveness

Abstract

Background

Nearly one in three South Africans will suffer from a mental disorder in his or her lifetime, a higher prevalence than many low- and middle-income countries. Understanding the economic costs and consequences of prevention and packages of care is essential, particularly as South Africa considers scaling-up mental health services and works towards universal health coverage. Economic evaluations can inform how priorities are set in system or spending changes.

Objective

To identify and review research from South Africa and sub-Saharan Africa on the direct and indirect costs of mental, neurological, and substance use (MNS) disorders and the cost-effectiveness of treatment interventions.

Design

Narrative overview methodology.

Results and conclusions

Reviewed studies indicate that integrating mental health care into existing health systems may be the most effective and cost-efficient approach to increase access to mental health services in South Africa. Integration would also direct treatment, prevention, and screening to people with HIV and other chronic health conditions who are at high risk for mental disorders. We identify four major knowledge gaps: 1) accurate and thorough assessment of the health burdens of MNS disorders, 2) design and assessment of interventions that integrate mental health screening and treatment into existing health systems, 3) information on the use and costs of traditional medicines, and 4) cost-effectiveness evaluation of a range of specific interventions or packages of interventions that are tailored to the national context.

• mental health
• South Africa
• economics
• health planning
• policy
• costs and cost analysis

Responsible Editors: Nawi Ng, Umeå University, Sweden; Barthélémy Kuate Defo, University of Montreal, Canada.

This paper is part of the Special Issue: Epidemiological Transitions – Beyond Omran's Theory. More papers from this issue can be found at http://www.globalhealthaction.net

Responsible Editors: Nawi Ng, Umeå University, Sweden; Barthélémy Kuate Defo, University of Montreal, Canada.

This paper is part of the Special Issue: Epidemiological Transitions – Beyond Omran's Theory. More papers from this issue can be found at http://www.globalhealthaction.net

Acknowledgements

Thanks to Patrizia Favini and Alex K Smith for their assistance in the preparation of this manuscript.

Notes

Responsible Editors: Nawi Ng, Umeå University, Sweden; Barthélémy Kuate Defo, University of Montreal, Canada.

This paper is part of the Special Issue: Epidemiological Transitions – Beyond Omran's Theory. More papers from this issue can be found at http://www.globalhealthaction.net