Collaborative mental health care in the bureaucratic field of post-apartheid South Africa

ABSTRACT

South Africa's long and arduous journey from colonial and apartheid-era care for people with mental illness to more comprehensive, equitable mental health care is well-described. Deeper engagement with the structural power dynamics involved in providing collaborative mental health services are less-well described, especially in its post-apartheid era. This conceptual article positions state and non-state mental health service providers – along with their relationships and conflicts – within Bourdieu's bureaucratic field. It is suggested that key internecine struggles in South Africa's post-apartheid socio-political arena have influenced the ways in which collaborative mental health care is provided. Drawing from two recent examples of conflict within the bureaucratic field, the article illustrates the ways in which neoliberal forces play out in contemporary South Africa's mental health service delivery. Struggles between the state and private healthcare in the Life Esidimeni tragedy receive focus, as well as the shifting of responsibility onto civil society. A court case between the state and a coalition of non-profit organisations provides further evidence that neoliberal rationalities significantly influences the position and power of non-state service providers. Unless serious consideration is given to these dynamics, collaborative mental health care in South Africa will remain out of reach.

KEYWORDS:

• Collaborative mental health care
• South Africa
• bureaucratic field
• power
• neoliberalism

Acknowledgements

The institutional support of the Centre for Health Systems Development, University of the Free State is gratefully acknowledged. The authors also wish to thank three anonymous reviewers, who provided substantial and constructive critique.

Disclosure statement

The article is part of doctoral research and benefited the first author towards achieving a PhD degree. No financial or other interests are disclosed.

ORCID

Edwin Wouters http://orcid.org/0000-0003-2268-3829

Additional information

Funding

The institutional support of the Centre for Health Systems Development, University of the Free State is gratefully acknowledged.