Introduction: Mental health is increasingly acknowledged as a crucial
public health issue in South Africa (SA). However, it is not given the
priority it deserves on policy agendas in this and many other low- and
middle-income countries. The aim of this analysis is to describe the
content of mental health policy and the process of its development in
Methods: Quantitative data regarding SA's mental health system were
gathered using the World Health Organization (WHO) Assessment Instrument
for Mental Health Systems. The WHO Checklist for Mental Health Policy
and Plans was completed for SA's 1997 mental health policy guidelines.
Semi-structured interviews provided understanding of processes,
underlying issues and interactions between key stakeholders in mental
health policy development.
Results: There is uncertainty at provincial level regarding whether the
1997 policy guidelines should be considered national policy. At national
level the guidelines are not recognized as policy, and a new policy is
currently being developed. Although the guidelines were developed
through wide consultation and had approval through national policy
development processes, difficulties were encountered with dissemination
and implementation at provincial level. The principles of these policy
guidelines conform to international recommendations for mental health
care and services but lack clear objectives.
Discussion: The process of mental health policy implementation has been
hindered by the low priority given to mental health, varying levels of
seniority of provincial mental health coordinators, limited staff for
policy and planning, varying technical capacity at provincial and
national levels, and reluctance by some provincial authorities to accept
responsibility for driving implementation.
Conclusion: These findings highlight the importance of national
leadership in the development of new mental health policy, communication
between national and provincial levels, the need for provincial
structures to take responsibility for implementation, and capacity
building to enable policy makers and planners to develop, monitor and
Health Policy and Planning (2009) 24 (5), 342-356 [doi:10.1093/heapol/czp027]
Mental health policy in South Africa: development process and content.