Psychology

The 2013 Human Development Report – "The Rise of the South: Human Progress in a Diverse World" – examines the profound shift in global dynamics driven by the fast-rising new powers of the developing world and its long-term implications for human development.

China has already overtaken Japan as the worlds second biggest economy while lifting hundreds of millions of its people out of poverty. India is reshaping its future with new entrepreneurial creativity and social policy innovation. Brazil is lifting its living standards through expanding international relationships and antipoverty programs that are emulated worldwide.

Overview

The WHO Mental Health Atlas 2011 represents the latest estimate of global mental health resources available to prevent and treat mental disorders and help protect the human rights of people living with these conditions.

It presents data from 184 WHO Member States, covering 98% of the world’s population. Facts and figures presented in Atlas indicate that resources for mental health remain inadequate.

The distribution of resources across regions and income groups is substantially uneven and in many countries resources are extremely scarce. Results from Atlas reinforce the urgent need to scale up resources and care for mental health within countries.

South Africa has undergone major changes in the last decade. These have had an impact on health systems and services in the country. Mental Health is an area that has been underdeveloped, under-resourced and lacked priority in the past. With political transformation, mental health has been prioritised and there has been extensive policy development in the field of mental health. There is a concern however, that implementation is lagging behind, and that there are significant obstacles in the way of effective implementation.

BACKGROUND AND INTRODUCTIONS: The Health Systems Trust has funded a significant number of research projects related to Mental Health Services since its inception. There was a perception that there was a lot of duplication of research, and that the findings of research projects were not reaching key stakeholders, and thus not impacting on policy or implementation of services. There was also a lack of any systematic review of the field. With this in mind, the Health Systems Trust commissioned a project to review research that has been conducted in the field of Mental Health Services. The objectives of the project are thus: - To compile and communicate the findings and recommendations of existing research on mental health services to all role-players - To identify gaps in existing work - To make recommendations for future research - To identify obstacles or barriers to the implementation of research recommendations - To facilitate the sharing of information amongst key stakeholders OBJECTIVES OF DISSEMINATION WORKSHOP: 1. To confirm a mental health services research agenda for the Health Systems Trust (and possibly also for Essential National Mental Health Research). 2. To make recommendations for good research practices/processes in mental health services research. 3. To make recommendations for a dissemination strategy for Mental Health Services research that will reach all role players. Fifty key role-players in the mental health services field were invited to attend the dissemination workshop. The invitees were selected in terms of their positions and also in terms of their response to previous contact within the context of this project. There were thirty-eight participants at the workshop.

This project was undertaken to establish a database of mental health services literature from Southern Africa. This review of the literature indicates that South Africa is similar to many other developing countries in the world, with a considerable burden of mental ill-health and inadequate mental health services, that are in need of transformation. Recommendations for future research, and suggestions for how this particular database and report can be used, are made.

Since 1994, the direction of national policy has been towards the integration of mental health services into the primary healthcare system, thus ending years of segregation and stigmatisation of psychiatric patients. National policy also envisions the development of psychiatric services so as to reflect a broader definition of mental health, incorporating preventive activities and substance abuse services.

Mental health has over many decades acquired the unwelcome reputation of being a pariah or stepchild of the health services. This was partly because it was narrowly understood as psychiatric illness, an area of concern for only psychiatrists, psychiatric nurses, patients and their families. However, the past three to four years have seen mental health care steadily moving out of this quarantine, towards mainstream health care. Also, mental health care has begun to address issues that distress South Africans on a day to day basis such as crime, violence and HIV/AIDS. This is starting to change peoples perceptions of mental health as an abstract, mysterious set of interventions, to an understanding that this is a component of health that addresses issues of general psychological well being and problems of day-to-day living. This transformation of mental health has been made possible by a diversity of developments, pioneered by the Mental Health Directorate in the National Department of Health, working in conjunction with provincial departments of health, non-governmental organisations and other interest groups. Some of these developments deserve special mention: * The Draft Mental Health Bill of 1999 which was published for public comment in the Government Gazette on the 4th February 2000. This draft Bill provides the legislative framework for the provision of mental health care in a humane manner, based on the individual rights espoused by our Constitution, and resonant with the times in which we live. Should this Bill be passed in the year 2000, as it is intended, this will be an important milestone. The new challenge that will obviously arise from this is the formulation of pragmatic implementation strategies. * Violence Surveillance Project, undertaken by the Mental Health Directorate in conjunction with the Institute for Health and Social Sciences, as part of the National Crime Prevention Strategy * Training of Primary Health Care Workers in Victim Empowerment * Development of Secondary level studies for Victims of Violence * Development, together with the Centre for the Study of Violence, of the Violence Prevention Project in Schools * Collaboration between the Mental Health and HIV/AIDS directorates to develop policies for pre-and-post test counselling of individuals * Development, together with Columbia University in New York, of interventions to prevent the spread of HIV/AIDS in institutions for people with intellectual disabilities The above areas of focus do not imply that people with psychiatric illness have been neglected. The Mental Health Directorate has also paid attention to: Development of Norms for Severe Psychiatric Care and Standards for monitoring Quality of Care in institutions providing mental health care. This was done together with the University of Cape Town. De-institutionalisation of people with mental health problems, to provide care in a milieu as close to the family of the patients as possible. This project was done together with the Centre for Health Policy (CHP) (see Research hot off the Press). Identification of barriers to the implementation of findings of mental health research. Areas of focus where more attention is needed include: Integration of mental health care into Primary Health Care (PHC) based on the District Health System. A lot of effort has been dedicated to this, for instance, by the Community-based Mental Health Project (CMHP), attached to the University of Durban-Westville. A scientific evaluation by an external team that could help to identify factors that facilitate and those that inhibit integration would be useful. Identification of barriers to the implementation of mental health research findings, most of which have been hailed as breaking new ground. Strengthening the capacity of provincial departments of health (and welfare) to translate the mental health policies of the national department into workable strategies. Focusing on the issues that affect us a nation on a daily basis such as crime and violence will almost certainly enhance peoples understanding of mental health as an integral aspect of daily living and not as a far-off illness that only affects some people who are hidden away in institutions. Of course, results speak louder than aspirations, and I have begun to see some of the interventions, for instance, the training of health workers in victim empowerment, beginning to enhance confidence and change attitudes. The formulation of the legislation is another important development. The partnership between the Mental Health Directorate and various NGOs, academic institutions and other interest groups, in enhancing the mental health care of the people of South Africa, as already been highlighted, is commendable. So although there is still a long way to go before the mental health system in South Africa approaches the ideal for this country, some important steps forward have been taken and the future looks promising.

Discharge potential and service needs of psychiatric inpatients in KwaZulu-Natal and the Eastern Cape, South Africa. See brief article in HST Update 50