The Department of Health is set to move mental health care out of specialised hospitals and closer to communities, but clinics may be far from ready for this.
A national review of mental health services found that care remained largely confined to specialised hospitals, which have also received the lion’s share of mental health resources.
The Department of Health plans to develop community mental health facilities to identify and treat those with mental health problems at district level.
The 11 National Health Insurance (NHI) pilot districts will be the first to introduce specialist district mental health teams. Comprised of psychiatrists, psychologists, psychiatric nurses and social workers, each team will support selected health centres and clinics designated to provide mental health care. Establishing these teams in the pilot districts alone is projected to cost about R24 million.
But some health workers say primary health care facilities are not be ready to take up mental health.
Filling the void
Nelson Mandela Metropolitan University (NMMU) recently released preliminary results of a three-year study into barriers to mental health in the Port Elizabeth area.
In partnership with Sweden’s University of Gothenburg, the study interviewed about 25 health workers in the area. Many health workers reported that most primary health care providers do not know enough about mental health to make the shift.
“There’s an incredible need to integrate mental health into primary health care,” said NMMU research Keegan Topper. “The problem is that there are very low levels of general mental health knowledge among your general hospitals and primary health care clinics.”
Dedicated mental health professionals are scarce. In a recent presentation to Parliament, the Department of Health cited a provisional estimate of just 70 psychiatrists and psychologists in the public sector. Meanwhile, the country continues to lose psychiatric nurses to other countries.
Most clinics operate without a psychologist or a social worker, leaving other health care workers to fill the void, according to the research.
“There are roles that people are forced to assume just to get services available,” said one health worker interviewed for the study. “People are forced to act outside the boundaries of their scopes of practice.”
Participants also said that they were torn between providing patients the care they needed and uneasiness with taking up responsibilities they had not been trained for.
“Going beyond your scope of practice, you have to question the quality of care you are offering,” Topper told Health-e.
Patients were often misdiagnosed because health workers lacked knowledge, according to the research.
More than knowledge needed
To increase mental health knowledge, medical interns, nurses and pharmacists will begin rotating through psychiatric hospital units, according to health department plans. Select primary health staff in every facility will also receive basic mental health training and on going supervision, according to the Department of Health.
Currently, regular supervision is problematic and complicated by a lack of transport for health workers who must move between clinics that in the Eastern Cape can be hours apart.
Nelson Mandela Bay Metropolitan District has already begun to train nurses, but without follow-up mentoring, many nurses still feel out of their depth when confronted with mentally-ill patients.
“I find it very difficult to think that we can expect a primary health care nurse who sees an average of 38 patients a day to also see psychiatric patients as well,” said Marina Barnard, the district’s non-communicable diseases co-ordinator.
“I don’t think we can just integrate these services and expect primary health care to take on that burden,” added Barnard, pointing out the psychiatric patients tended to need much more time with health workers than other patients. “I think to do that, we would have to strengthen primary health care with staff as well as knowledge.”
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