Every year July is commemorated as Psychosocial Disability Awareness Month, and this year the South African Federation for Mental Health is focusing on the need for upscaling and integration of community mental health care services.
The death of 94 mentally ill patients who were transferred from the Life Healthcare Esidimeni facilities to unlicensed NGO’s by the Gauteng Department of Health has placed the spotlight on the many problems existing within the current mental health system in South Africa. South Africa has good policies and legislation for mental health care, such as the Mental Health Care Act and the Mental Health Policy Framework and Action Plan 2013-2020, but the implementation of these policies remain a challenge. Mental health services have in many cases not been integrated effectively into other primary health services, and as a result mental health remains largely marginalised and underfunded. It is important to recognise that the Life Esidimeni tragedy is an example of a symptom of a mental health care system that does not provide adequate treatment or services to the many South African’s who need mental healthcare, along with a poorly-implemented deinstitutionalisation policy.
Community-based mental health organisations provided crucial services, and without them thousands of Mental Health Care Users (MHCUs) would not receive the treatment and care they need. These community-based organisations are however largely dependent on the support of Government, the private sector and their communities in order to be able to provide effective services. It is necessary for primary health services such as Clinics and Hospitals, as well as social services such as social workers, community care workers, District Health Teams, private sector organisations such as medical schemes, pharmaceutical companies and private sector psychologists and psychiatrist to collaborate more effectively with community-based mental health organisations to provide the services that MHCU need.
Integration of these various services can help to improve access and facilitate the use of services, as well as preventing duplication of services. This collaboration and integration of services can also help to facilitate effective deinstitutionalisation. Deinstitutionalisation is a process of replacing psychiatric hospitals with community-based mental health services for people diagnosed with a mental disorder or intellectual disability.
Throughout the month of July, SAFMH and our Mental Health Societies and partners will be advocating for increased support and funding for community based mental health services, as well as for the integration of mental health services into primary health care on a community level.
The following are recommendations regarding the increased support, and upscaling of resources for community based mental health organisations, as well as for the improved integration of mental health services:
- Mental health services must be prioritised and developed with an equal level of high importance across all provinces in South Africa, and across rural and urban areas
- Existing human and infrastructure resources need to be utilised as efficiently as possible and additional resources need to be developed and or prioritised
- Services and resources at community level should be developed in consultation with MHCU, their families, NGO’s and other key partners/stakeholders/decision makers/service providers to ensure the development of such services is done in an informed and collaborative way
- The prioritisation, implementation and monitoring of the MHPF at provincial level is essential, and provincial Departments of Health need to be held accountable for failure to do so
- Savings generated through budget cuts in tertiary Psychiatric Care Facilities need to be used to support community-based care and to ensure that MHCU have access to high-quality care
- Government needs to address the pervasive shortfalls in resources needed to adequately facilitate deinstitutionalisation policy requirements
- South Africa needs to see the development of a range of comprehensive community-based mental health services to ensure that MHCU are provided with a range of community-based services
- South Africa requires more consistent and more comprehensive subsidisation of community-based services, with adequate increases and timely payments of subsidies to ensure continuity in community-based mental health service delivery
- Government also needs to look at the types of subsidies/funding opportunities that are made available to NGOs; what is required, in addition to post-funding, is more programmes funding for community-based organisation to aid in the development of more concerted service project development for MHCU
- Treatment and rehabilitation of MHCU should be integrated into a system of Psychosocial Rehabilitation (PSR). These PSR systems should focus on areas such as skills training, peer support, vocational services and community resource development, to ensure that MHCU receive support and services enabling them to reintegrate into their communities
Author: Marthe Kotze
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