Skip to main content
×
×
Home

Integrating mental health into chronic care in South Africa: The development of a district mental healthcare plan

  • Inge Petersen (a1), Lara Fairall (a2), Arvin Bhana (a1), Tasneem Kathree (a1), One Selohilwe (a1), Carrie Brooke-Sumner (a1), Gill Faris (a2), Erica Breuer (a3), Nomvula Sibanyoni (a4), Crick Lund (a5) and Vikram Patel (a6)...
Abstract
Background

In South Africa, the escalating prevalence of chronic illness and its high comorbidity with mental disorders bring to the fore the need for integrating mental health into chronic care at district level.

Aims

To develop a district mental healthcare plan (MHCP) in South Africa that integrates mental healthcare for depression, alcohol use disorders and schizophrenia into chronic care.

Method

Mixed methods using a situation analysis, qualitative key informant interviews, theory of change workshops and piloting of the plan in one health facility informed the development of the MHCP.

Results

Collaborative care packages for the three conditions were developed to enable integration at the organisational, facility and community levels, supported by a human resource mix and implementation tools. Potential barriers to the feasibility of implementation at scale were identified.

Conclusions

The plan leverages resources and systems availed by the emerging chronic care service delivery platform for the integration of mental health. This strengthens the potential for future scale up.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Integrating mental health into chronic care in South Africa: The development of a district mental healthcare plan
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Integrating mental health into chronic care in South Africa: The development of a district mental healthcare plan
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Integrating mental health into chronic care in South Africa: The development of a district mental healthcare plan
      Available formats
      ×
Copyright
This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
Corresponding author
Inge Petersen, School of Applied Human Sciences, School of Applied Human Sciences, Howard College, University of KwaZulu-Natal, Durban, 4000, South Africa. Email: peterseni@ukzn.ac.za
Footnotes
Hide All

This study is an output of the PRogramme for Improving Mental health carE (PRIME). The material has been funded by UK aid from the UK government. However, the views expressed do not necessarily reflect the UK government's official policies.

Declaration of interest

None.

Footnotes
References
Hide All
1 Williams, DR, Herman, A, Stein, DJ, Heeringa, SG, Jackson, PB, Moomal, H, et al. 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 2008; 38: 211–20.
2 Stein, DJ, Seedat, S, Herman, A, Moomal, H, Heeringa, SG, Kessler, RC, et al. Lifetime prevalence of psychiatric disorders in South Africa. Br J Psychiatry 2008; 192: 112–7.
3 Kessler, RC, Aguilar-Gaxiola, S, Alonso, J, Chatterji, S, Lee, S, Ormel, J, et al. The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiol Psichiatr Soc 2009; 18: 2333.
4 World Health Organization. Global Burden of Mental Disorders and the Need for a Comprehensive, Coordinated Response from Health and Social Sectors at the Country Level. WHO, 2011 (http://apps.who.int/gb/ebwha/pdf_files/EB130/B130_9-en.pdf).
5 Kohn, R, Saxena, S, Levav, I, Saraceno, B. The treatment gap in mental health care. Bull World Health Organ 2004; 82: 858–66.
6 Petersen, I, Lund, C. Mental health service delivery in South Africa from 2000 to 2010: one step forward, one step back. S Afr Med J 2011; 101: 751–7.
7 Lund, C, Kleintjes, S, Kakuma, R. Public sector mental health systems in South Africa: inter-provincial comparisons and policy implications. Soc Psychiatry Psychiatr Epidemiol 2010; 45: 393404.
8 Lund, C, Tomlinson, M, Da Silva, M, Fekadu, A, Shidhaye, R, Jordans, M, et al. PRIME: a programme to reduce the treatment gap for mental disorders in five low and middle-income countries. PLoS Med 2012; 9: e1001359.
9 Department of Health. National Health Insurance in South Arica. Policy Paper. Department of Health, 2011.
10 Matsotso, MP, Fryatt, R. National Health Insurance: the first 18 months. In South African Health Review 2012/13 (eds Padarath, A, English, R): 2133. Health Systems Trust, 2013.
11 Mayosi, BM, Flisher, AJ, Lalloo, UG, Sitas, F, Tollman, SM, Bradshaw, D. The burden of non-communicable diseases in South Africa. Lancet 2009; 374: 934–47.
12 Department of Health. Primary Care 101. Department of Health, 2012.
13 Asmall, S, Mahomed, OH. The Integrated Chronic Disease Management Manual. Department of Health, 2013.
14 Gonzalez, JS, Batchelder, AW, Psaros, C Safren, SA. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. J Acquir Immune Defic Syndr 2011; 58: 181–7.
15 Moussavi, S, Chatterji, S, Verdes, E, Tandon, A, Patel, V, Ustun, B. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 2007; 370: 851–8.
16 Neuman, MG, Schneider, M, Nanau, RM, Parry, C. Alcohol consumption, progression of disease and other comorbidities, and responses to antiretroviral medication in people living with HIV. AIDS Res Treatment 2012; 2012: 751827.
17 Hanlon, C, Luitel, NP, Kathree, T, Murhar, V, Shrivasta, S, Medhin, G, et al. Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries. PloS One 2014; 9: e88437.
18 Vogel, I. Review of the Use of ‘Theory of Change’ in International Development. UK Department of International Development, 2012.
19 Breuer, E, De Silva, M, Fekadu, A, Luitel, NP, Murhar, V, Nakku, J, et al. Using workshops to develop Theories of Change in five low and middle income countries: lessons from the Programme for Improving Mental Health Care (PRIME). Int J Ment Health Systems 2014; 8: 15.
20 Breuer, E, De Silva, MJ, Shidaye, R, Petersen, I, Nakku, J, Jordans, MJD, et al. Planning and evaluating mental health services in low- and middle-income countries using theory of change. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153841).
21 Ritchie, R, Spencer, L. Qualitative data analysis for applied policy research. In Analyzing Qualitative Data (eds Bryman, A, Burgess, RG): 173–94. Routledge, 1994.
22 Petersen, I, Hanass Hancock, J, Bhana, A, Govender, K, Members of Programme for Improving Mental Health Care. Closing the treatment gap for depression co-morbid with HIV in South Africa: voices of afflicted women. Health 2013; 5: 557–66.
23 Kathree, T, Selohilwe, OS, Bhana, A, Petersen, I. Perceptions of postnatal depression and health care needs in a South African sample: the “mental” in maternal health care. BMC Women's Health 2014; 14: 140.
24 Brooke-Sumner, C, Petersen, I, Lund, C. Perceptions of disability and recovery among mental health services users and their caregivers in the North West Province, South Africa: lessons for development of a psychosocial rehabilitation programme. Afr J Disability 2014; 3: 110.
25 Petersen, I, Hanass Hancock, J, Bhana, A, Govender, K. A group-based counselling intervention for depression comorbid with HIV/AIDS using a task shifting approach in South Africa: a randomized controlled pilot study. J Affect Disord 2014; 158: 7884.
26 Dua, T, Barbui, C, Clark, N, Fleischmann, A, Poznyak, V, van Ommeren, M, et al. Evidence-based guidelines for mental, neurological, and substance use disorders in low- and middle-income countries: summary of WHO recommendations. PLoS Med 2011; 8: e1001122.
27 Patel, V, Weiss, HA, Chowdhary, N, Naik, S, Pednekar, S, Chatterjee, S, et al. Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial. Lancet 2010; 376: 2086–95.
28 Rehm, J, Chisholm, D, Room, R, Lopez, AD. Alcohol. In Disease Control Priorities in Developing Countries (2nd edn) (eds Jamison, D, Breman, J, Measham, A, Alleyne, G, Claeson, M, Evans, DB, et al.): 887906. Oxford University Press, 2006.
29 Department of Health. Mental Health Care Act (2002). Department of Health, 2004.
30 Chatterjee, S, Naik, S, John, S, Dabholkar, H, Balaji, M, Koschorke, M, et al. Effectiveness of a community-based intervention for people with schizophrenia and their caregivers in India (COPSI): a randomised controlled trial. Lancet 2014; 384: 1385–94.
31 Barker, PM, McCannon, CJ, Mehta, N, Green, C, Youngleson, MS, Yarrow, J, et al. Strategies for the scale-up of antiretroviral therapy in South Africa through health system optimization. J Infect Dis 2007; 196 (suppl 3): S45763.
32 Patel, V, Belkin, GS, Chockalingam, A, Cooper, J, Saxena, S, Unützer, J. Grand challenges: integrating mental health services into priority health care platforms. PLoS Med 2013; 10: e1001448.
33 Petersen, I. Comprehensive integrated primary mental health care for South Africa. Pipedream or possibility? Soc Sci Med 2000; 51: 321–34.
34 Thornicroft, G, Tansella, M. Are community mental health services relevant in low- and middle-income countries? Epidemiol Psychiatr Sci 2014; 23: 115–8.
35 Petersen, I, Fairall, L, Egbe, CO, Bhana, A. Optimizing lay counsellor services for chronic care in South Africa: a qualitative systematic review. Patient Educ Couns 2014; 95: 201–10.
36 Shidhaye, R, Shrivastava, S, Murhar, V, Samudre, S, Ahuja, S, Ramaswamy, R, et al. Development and piloting of a plan for integrating mental health in primary care in Sehore district, Madhya Pradesh, India. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153700).
37 Chisholm, D, Burman-Roy, S, Fekadu, A, Kathree, T, Kizza, D, Luitel, NP, et al. Estimating the cost of implementing district mental healthcare plans in five low- and middle-income countries: the PRIME study. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153866).
38 Hartley, M, Tomlinson, M, Greco, E, Comulada, WS, Stewart, J, Roux, I, et al. Depressed mood in pregnancy: prevalence and correlates in two Cape Town peri-urban settlements. Reprod Health 2011; 8: 9.
39 Walker, SP, Wachs, TD, Gardner, JM, Lozoff, B, Wasserman, GA, Pollitt, E, et al. Child development: risk factors for adverse outcomes in developing countries. Lancet 2007; 369: 145–57.
40 Peltzer, K, Ramlagan, S. Alcohol use trends in South Africa. J Soc Sci 2009; 18: 112.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Integrating mental health into chronic care in South Africa: The development of a district mental healthcare plan

  • Inge Petersen (a1), Lara Fairall (a2), Arvin Bhana (a1), Tasneem Kathree (a1), One Selohilwe (a1), Carrie Brooke-Sumner (a1), Gill Faris (a2), Erica Breuer (a3), Nomvula Sibanyoni (a4), Crick Lund (a5) and Vikram Patel (a6)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *