South Africa has overhauled its mental health services over the past few years. Unlike the previous health care system which followed a curative and hospital-based approach for mental health, the new  system emphasizes prevention and health promotion with mental health services integrated into the primary health care system.

However, authors of the South African Health Review (SAHR) mental health chapter said common disorders such as anxiety, depression and behavioural problems were not being diagnosed as nurses were not trained to diagnose and handle cases. They found that mental health services remained underdeveloped and poorly resourced.

A study conducted in the Lower Orange district and in Mount Frere found that mental health care was basically psychiatric in nature. While the hospitals provided psychiatric care, no counselling services were available.

Reliable and recent figures on the prevalence of mental disorders are lacking, but two small studies found high rates of depression and anxiety disorders. In Mamre in the Western Cape, the prevalence was over 27% while in a rural KwaZulu-Natal community it was 23,9%.

Another study found that some nurses at primary care level focused on the clinical examination of the body, failing to take into the consideration the ‘€œillness narrative’€ which would assist in diagnosing mental disorders.

The SAHR authors said there was a critical need to train primary health care nurses to diagnose and handle common mental disorders such as anxiety, post traumatic stress disorder, depression, mental retardation and school-related problems.

‘€œPrimary health care workers are overloaded and hence to not have adequate time to cater for people with mental disorders. Neither do they receive necessary support and supervision to enable them to confidently undertake their tasks, ‘€œ wrote the SAHR authors Nhlanhla Mkhize and Molelekoa J Kometsi of the University of KwaZulu-Natal.

They said there were reports that despite the integration of these services non-psychiatric nurses were continuing to leave the onerous task of attending to mentally ill patients entirely to the psychiatric nurses.

It was also found that mental health services remained a low priority when it came to government spending.   An acute shortage of vehicles meant mental health workers were unable to visit patients at home with staff experiencing great difficulty when they have to transfer patients between clinics and the hospital.

A continuous supply of medication was also not guaranteed with hardly any psychotherapy or counselling taking place for victims of trauma, rape, alcoholism or abuse as there are no dedicated spaces where privacy and confidentiality can be accommodated.

‘€œIn South Africa community facilities are under-developed, with poor rural provinces such as Mpumalanga having hardly medium to long community residential facilities. In the provinces where downscaling of patient beds has occurred, the motivation has been financial constraints rather than the development of ambulatory or residential community care,’€ Mkhize and Kometsi found.

They are found that there was a strong relationship between poverty and mental health, while a greater prevalence of common mental disorders has been reported among the poor. ‘€œUnemployment and poor social welfare provisions could lead to anger, despair and loss of hope,’€ wrote Mkhize and Kometsi.