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

Published online by Cambridge University Press:  02 January 2018

Inge Petersen*
Affiliation:
School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
Lara Fairall
Affiliation:
Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa
Arvin Bhana
Affiliation:
School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
Tasneem Kathree
Affiliation:
School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
One Selohilwe
Affiliation:
School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
Carrie Brooke-Sumner
Affiliation:
School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
Gill Faris
Affiliation:
Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa
Erica Breuer
Affiliation:
Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
Nomvula Sibanyoni
Affiliation:
National Department of Health, Pretoria, South Africa
Crick Lund
Affiliation:
Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa, and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
Vikram Patel
Affiliation:
Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK and Centre for Mental Health, the Public Health Foundation of India, India
*
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
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Abstract

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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.

Type
Papers
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
Copyright
Copyright © Royal College of Psychiatrists, 2016

Footnotes

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.

References

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.Google Scholar
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.Google Scholar
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.CrossRefGoogle ScholarPubMed
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).Google Scholar
5 Kohn, R, Saxena, S, Levav, I, Saraceno, B. The treatment gap in mental health care. Bull World Health Organ 2004; 82: 858–66.Google ScholarPubMed
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.Google Scholar
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.Google Scholar
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.CrossRefGoogle Scholar
9 Department of Health. National Health Insurance in South Arica. Policy Paper. Department of Health, 2011.Google Scholar
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.Google Scholar
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.Google Scholar
12 Department of Health. Primary Care 101. Department of Health, 2012.Google Scholar
13 Asmall, S, Mahomed, OH. The Integrated Chronic Disease Management Manual. Department of Health, 2013.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
18 Vogel, I. Review of the Use of ‘Theory of Change’ in International Development. UK Department of International Development, 2012.Google Scholar
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.CrossRefGoogle ScholarPubMed
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).Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
29 Department of Health. Mental Health Care Act (2002). Department of Health, 2004.Google Scholar
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.Google Scholar
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
33 Petersen, I. Comprehensive integrated primary mental health care for South Africa. Pipedream or possibility? Soc Sci Med 2000; 51: 321–34.CrossRefGoogle ScholarPubMed
34 Thornicroft, G, Tansella, M. Are community mental health services relevant in low- and middle-income countries? Epidemiol Psychiatr Sci 2014; 23: 115–8.Google Scholar
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.Google Scholar
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).Google Scholar
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).CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
40 Peltzer, K, Ramlagan, S. Alcohol use trends in South Africa. J Soc Sci 2009; 18: 112.Google Scholar
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