Community access to mental health services : lessons and recommendations : Primary Health Care : programme areas

Abstract

According to the Alma Ata Declaration, health is a fundamental human right. Post-1994, South Africa passed legislation that moved the country in the direction of Primary Health Care at the district level. This chapter reviews the challenges to community-wide access to mental heath services in South Africa. The background to mental health care in South Africa is first presented. The introduction of Primary Health Care in South Africa is discussed in relation to the Alma Ata Declaration and other international developments, such as selective Primary Health Care. The challenges regarding the integration of mental health care into the Primary Health Care system, namely poverty, the biomedical orientation of health care, staff workload and inadequate support, poor infrastructure, and limited funding and resources, are discussed, followed by an overview of the de-institutionalisation process. It is argued that integration within the framework of a biomedical model is insufficient. A holistic approach to integration, incorporating the social, economic, psychological and cultural aspects of illness, is necessary. The chapter concludes with recommendations for policy implementation, training and research.