scholarly journals Policy, power, stigma and silence: Exploring the complexities of a primary mental health care model in a rural South African setting

2016 ◽  
Vol 53 (6) ◽  
pp. 719-742 ◽  
Author(s):  
Rochelle Ann Burgess

The Movement for Global Mental Health’s (MGMH) efforts to scale up the availability of mental health services have been moderately successful. Investigations in resource-poor countries like South Africa have pointed to the value of an integrated primary mental health care model and multidisciplinary collaboration to support mental health needs in underserved and underresourced communities. However, there remains a need to explore how these policies play out within the daily realities of communities marked by varied environmental and relational complexities. Arguably, the lived realities of mental health policy and service delivery processes are best viewed through ethnographic approaches, which remain underutilised in the field of global mental health. This paper reports on findings from a case study of mental health services for HIV-affected women in a rural South African setting, which employed a motivated ethnography in order to explore the realities of the primary mental health care model and related policies in South Africa. Findings highlighted the influence of three key symbolic (intangible) factors that impact on the efficacy of the primary mental health care model: power dynamics, which shaped relationships within multidisciplinary teams; stigma, which limited the efficacy of task-shifting strategies; and the silencing of women’s narratives of distress within services. The resultant gap between policy ideals and the reality of practice is discussed. The paper concludes with recommendations for building on existing successes in the delivery of primary mental health care in South Africa.

1992 ◽  
Vol 22 (2) ◽  
pp. 339-348 ◽  
Author(s):  
Melvyn Freeman ◽  
Cedric de Beer

As South Africa shifts from a social structure based on the principles of apartheid to a democratic society, social policies must be developed that are consonant with the ideals of the “new” society. These must, however, take into account the current realities of the South African context. This article suggests that the application of the principles of primary mental health care is the approach most likely to meet mental health needs in the future South Africa, but that difficulties are likely to arise in the transition to this approach. These difficulties must be identified and dealt with. The authors discuss the problems in providing competent curative care to all and in shifting emphasis to prevention and promotion in mental health care. The discussion covers both practical and political complications. The authors conclude that though the process to primary mental health care will be a long one, the problems are unlikely to be insurmountable.


2018 ◽  
Vol 41 (5) ◽  
pp. 627-640 ◽  
Author(s):  
Natalie R. Stevens ◽  
Nicole M. Heath ◽  
Teresa A. Lillis ◽  
Kenleigh McMinn ◽  
Vanessa Tirone ◽  
...  

Author(s):  
Sally Field ◽  
Emily Baron ◽  
Ingrid Meintjes ◽  
Thandi van Heyningen ◽  
Simone Honikman

2017 ◽  
Vol 14 (3) ◽  
pp. 69-71 ◽  
Author(s):  
Christopher Paul Szabo ◽  
Sean Zalman Kaliski

Mental health law in South Africa has been dominated in recent times by the Mental Health Care Act 2002. This paper provides selective insights into specific aspects of that Act and highlights its impact on clinical practice within a broad clinical setting and in so doing suggests areas for review and revision.


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