Background: There is growing recognition that mental health is an
important public health issue in South Africa. Yet mental health
services remain chronically under-resourced. The aim of this study was
to document levels of current public sector mental health service
provision in South Africa and compare services across provinces, in
relation to current national policy and legislation.
Methods: A survey was conducted of public sector mental health service
resources and utilisation in South Africa during the 2005 calendar year,
using the World Health Organization’s Assessment Instrument for Mental
Health Systems (WHO-AIMS) Version 2.2.
Results: South African policy and legislation both advocate for
community-based mental health service provision within a human rights
framework. Structures are in place at national level and in all nine
provinces to implement these provisions. However, there is wide
variation between provinces in the level of mental health service
resources and provision. Per 100,000 population, there are 2.8 beds
(provincial range 0–7.0) in psychiatric inpatient units in general
hospitals, 3.6 beds (0–6.4) in community residential facilities, 18 beds
(7.1–39.1) in mental hospitals, and 3.5 beds (0–5.5) in forensic
facilities. The total personnel working in mental health facilities are
11.95 per 100,000 population. Of these, 0.28 per 100,000 are
psychiatrists, 0.45 other medical doctors (not specialised in
psychiatry), 10.08 nurses, 0.32 psychologists, 0.40 social workers, 0.13
occupational therapists, and 0.28 other health or mental health workers.
Conclusions: Although there have been important developments in South
African mental health policy and legislation, there remains widespread
inequality between provinces in the resources available for mental
health care; a striking absence of reliable, routinely collected data
that can be used to plan services and redress current inequalities; the
continued dominance of mental hospitals as a mode of service provision;
and evidence of substantial unmet need for mental health care. There is
an urgent need to address weak policy implementation at provincial level
in South Africa.
Social Psychiatry and Psychiatric Epidemiology (2010) 45 (3) 393-404 [doi: 10.1007/s00127-009-0078-5]
Public sector mental health systems in South Africa: inter-provincial comparisons and policy implications.