Background: In the aftermath of apartheid, South Africa has inherited a
fragmented, under-resourced and inequitable public sector mental health
service. Attempts are being made to reform mental health services, in
keeping with new health policy, which proposes the downscaling of
psychiatric institutions and the development of community-based
services. This study set out to develop a set of service norms for the
care of people with severe psychiatric conditions (SPC) in South Africa,
to assist the implementation of the new policy.
Methods: A national situation analysis of current public sector mental
health services was conducted. A model was developed for estimating the
mental health service resource needs of people with SPC. Following
consultation with provincial stakeholders, a set of service norms were
developed taking into account national indicators from the situation
analysis (as a baseline level) and proposals of the model (as a target
Results: The study recommends an increase in the number of acute
psychiatric beds in general hospitals; development of community-based
residential care; redistribution of staff from hospital to community
services, particularly in rural areas; and the development of
information systems to monitor the transitions to community-based care.
Conclusions: The norms proposals presented in this study express mental
health service needs in terms of quantifiable service resource and
utilisation levels. In doing so, the study attempts to make explicit the
assumptions and values on which planning is based.
Social Psychiatry and Psychiatric Epidemiology (2006) 41 (7) 587-594 [doi: 10.1007/s00127-006-0057-z]
Norms for mental health services in South Africa.