Health system governance to support integrated mental health care in South Africa: challenges and opportunities

详细信息    查看全文

• 作者：Debra Leigh Marais ; Inge Petersen
• 关键词：Mental health system ; Integrated care ; Governance ; Barriers & facilitative factors ; South Africa
• 刊名：International Journal of Mental Health Systems
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：9
• 期：1
• 全文大小：740 KB
• 参考文献：The Global Burden of Disease: 2004 Update. WHO, Geneva
  1. Kolappa, K, Henderson, DC, Kishore, SP (2013) No physical health without mental health: lessons unlearned?. Bull World Health Organ 91: pp. 3-3A CrossRef
  2. Ngo, VK, Rubinstein, A, Ganju, V, Kanellis, P, Loza, N, Rabadan-Diehl, C (2013) Grand Challenges: Integrating mental health care into the non-communicable disease agenda. PLoS Med 10: pp. e1001443 CrossRef
  3. Prince, M, Patel, V, Saxena, S, Maj, M, Maselko, J, Philips, MR (2007) No health without mental health. Lancet 370: pp. 859-877 CrossRef
  4. Humayun, Q, Mirza, S (2011) Priority actions for the noncommunicable disease crisis. Lancet 378: pp. 565 CrossRef
  5. Jenkins, R, Baingana, F, Ahmad, R, McDaid, D, Atun, R (2011) Health system challenges and solutions to improving mental health outcomes. Ment Health Fam Med 8: pp. 119-127
  6. Katon, WJ, Lin, EH, Korff, M, Ciechanowski, P, Ludman, EJ, Young, B (2010) Collaborative care for patients with depression and chronic illnesses. N Engl J Med 363: pp. 2611-2620 CrossRef
  7. Patel, V, Thornicroft, G (2009) Packages of care for mental, neurological, and substance use disorders in low- and middle-income countries: PLoS Medicine Series. PLoS Med 6: pp. 1-2
  8. Patel, V, Belkin, GS, Chockalingam, A, Cooper, J, Saxena, S, Unu tzer, J (2013) Grand Challenges: Integrating mental health services into priority health care platforms. PLoS Med 10: pp. 1-6 CrossRef
  Integrating Mental Health into Primary Care: A Global Perspective. WHO, Geneva
  Mental Health Action Plan, 2013-020. WHO, Geneva
  Zero Draft Global Mental Health Action Plan 2013 -2020. WHO, Geneva
  9. Ngui, E, Khasakhala, L, Ndetei, D, Weiss Roberts, L (2010) Mental disorders, health inequalities and ethics: A global perspective. Int Rev Psychiatry 22: pp. 235-244 CrossRef
  10. Bradshaw, D, Steyn, K, Levitt, N, Nojilana, B (2011) Non-Communicable Diseases: A Race against Time. Cape Town, Medical Research Council
  11. Mayosi, BM, Lawn, JE, Niekerk, A, Bradshaw, D, Abdool Karim, SS, Coovadia, HM (2012) or The Lancet South Africa team: Health in South Africa: changes and challenges since 2009. Lancet 308: pp. 2029-2043 CrossRef
  12. Burns, JK (2011) The mental health gap in South Africa: A human rights issue. The Equal Rights Review 6: pp. 99-113
  13. Lund, C, Kleintjes, S, Campbell-Hall, V, Mjadu, S, Petersen, I, Bhana, A (2008) Mental Health Policy Development and Implementation in South Africa: A Situation Analysis. Phase 1 Country Report. Cape Town, Mental Health and Poverty Project
  14. Lund, C, Kleintjes, S, Kakuma, R, Flisher, AJ (2010) Public sector mental health systems in South Africa: inter-provincial comparisons and policy implications. Soc Psychiat Epidemiol 45: pp. 393-404 CrossRef
  15. Williams, DR, Herman, A, Stein, DJ, Heeringa, SG, Jackson, PB, Moomal, H (2008) Twelve month mental disorders in South Africa: prevalence, service use and demographic correlates in the population-based South African Stress and Health Study. Psychol Med 38: pp. 211-220 CrossRef
  16. Seedat, S, Stein, DJ, Herman, A, Kesller, R, Sonnega, J, Heeringa, S (2008) Twelve-month treatment of psychiatric disorders in the South African Stress and Health Study (World Mental Health Survey Initiative). Soc Psychiatry Psychiatr Epidemiol 43: pp. 889-897 CrossRef
  17. Lund, C, Stein, DJ, Flisher, AJ, Mehtar, SL (2007) Editorial: Challenges faced by South African health services in implementing the Mental Health Care Act. S Af Med J 97: pp. 352-353
  18. Stein, DJ (2014) Editorial: A new mental health polic
• 刊物主题：Psychiatry; Clinical Psychology;
• 出版者：BioMed Central
• ISSN：1752-4458

文摘

Background While South Africa has a new policy framework supporting the integration of mental health care into primary health care, this is not sufficient to ensure transformation of the health care system towards integrated primary mental health care. Health systems strengthening is needed, incorporating, inter alia, capacity building and resource inputs, as well as good governance for ensuring that the relevant policy imperatives are implemented. Objectives To identify systemic factors within institutional and policy contexts that are likely to facilitate or impede the implementation of integrated mental health care in South Africa. Methods Semi-structured qualitative interviews were conducted with 17 key stakeholders in the Department of Health and Department of Social Development at national level, at provincial level in the North West Province, and at district level in the Dr Kenneth Kaunda district. Participants were purposively identified based on their positions and job responsibilities. Interview questions were guided by a hybrid of Siddiqi et al.’s governance framework principles and Mikkelsen-Lopez et al.’s health system governance approach. Data were analysed using framework analysis in NVivo. Results Facilitative factors included the recent mental health care policy framework and national action plan that embraces integrated care using a task sharing model and provides policy imperatives for the establishment of district mental health teams to facilitate the development and implementation of district mental health care plans; the roll out of the integrated chronic disease service delivery platform that can be leveraged to increase access and resources as well as decrease stigma; and the presence of NGOs that can assist with service delivery. Challenges included the low prioritisation and stigmatisation of mental illness; weak managerial and planning capacity to develop and implement mental health care plans at provincial and district level; poor pre-service training of generalists in mental health care; weak orientation to integrated care; high staff turnover; weak intersectoral coordination; infrastructural constraints; and no dedicated mental health budget. Conclusion This study identifies strategies to support and improve integrated mental health care in primary health care services.