INSTALMENT 2: Mental health and political factors

12 October 2020

Political factors related to mental health in the South African context are here discussed in
terms of two domains, namely 1) the institutional framework and 2) the health system.
1. Institutional framework
South Africa currently has a 2013-2020 Mental Health Policy Framework and Strategic Action Plan, the country’s first ever official mental health policy. The policy recommends:
 Upscaling of decentralised and integrated Primary Mental Health Services, including community-based, primary health clinic and district hospital level care
 Promoting mental health by improving public attitudes and mental health literacy
 Empowering local communities
 Safeguarding the human rights of mental health care users
 Tackling the vicious cycle of poverty and poor mental
 Developing stronger monitoring and evaluation systems for mental health care
 Ensuring mental health planning and provision is evidence-based
There is however no current national mental health policy for post-2020, but the policy framework is foreseen to stay active in guiding the planning of mental health services, financing, advocacy and human rights until new guidelines have been developed.
Despite South Africa’s comprehensive policy framework, the mental health system continues to suffer from neglect, fragmentation and poor service delivery, a lack of specialised workforce and the continued prioritisation of institutional over community-based care. There has also been criticism over the lack of implementation of the Strategic Action Plan, e.g. the lack of any suicide prevention guidelines, despite its rising incidence in the country (suicide rates vary between 11.5 – 20 per 100,000 of the population) and it being one of the primary recommendations in the policy document.
2. The health system
In 1994, South Africa went through a democratisation of its political system, along with adopting the concept of universal primary health care. This led to a programme of ongoing decentralisation and integration, with the result that the public health sector is at present managed by provincial health departments and operated at the primary, secondary and tertiary levels across all nine provinces, while all public health services and planning is coordinated through the National Department of Health.
Approximately 84% of the population is served by the public health sector, and a national health insurance (NHI) system is in the process of being developed and implemented. The process of deinstitutionalisation in South Africa started in the 1990’s, and involves moving mental health care users out of hospital settings and focusing efforts on the management of these individuals at primary health care level. However, consistently long inpatient stays, along with persistent rates of readmission, are both factors preventing the country from successfully progressing towards more equitable, cost-effective community-based care.