Challenges facing South Africa's mental health care system: stakeholders' perceptions of causes and potential solutions

Abstract

In recent years South Africa has taken some important steps forward in strengthening its mental health systems. Mental health legislation has been reformed and there is some level of policy commitment to mental health. However, there remain ongoing challenges, largely related to implementation. The aim of this paper is to review the major challenges facing the South African mental health system, to provide a greater understanding of these challenges (as articulated by stakeholders from a wide range of sectors) and to highlight stakeholders' recommendations about the best way to address them. Ninety nine interviews and 12 focus group discussions were conducted with stakeholders drawn from the national, provincial and district levels. The major challenges identified include: the lack of officially endorsed mental health policy; the continued low priority of mental health; limited intersectoral policy integration; stigma and discrimination; inadequate integration of mental with primary health care; and ‘de-hospitalisation’ rather than ‘de-institutionalization’. Recommendations include: developing an overarching national mental health policy; lobbying for mental health on national policy agendas; including mental health in poverty alleviation programmes; greater educational and awareness-raising campaigns; standardised evidence-based training of health staff; and the development of community-based mental health services.

Keywords:

• mental health
• healthcare systems
• South Africa
• health policy
• health priorities

Acknowledgements

This study was made possible by funding provided by the Department for International Development (DFID) for a Research Programme Consortium entitled ‘The Mental Health and Poverty Project (MHaPP): Mental health policy development and implementation in four African countries’ (DfID contract number: RPC HD6 2005 – 2010). The views expressed are those of the authors and not necessarily those of DFID. We would like to thank the respondents for sharing their time and insights.