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A research report submitted in partial fulfilment of the requirements for the degree of Master of Arts in Psychological Research in the Faculty of Humanities, University of the Witwatersrand, Johannesburg, 2017. / Mental ill-health constitutes a substantial burden of disease worldwide, representing more than the burden of disease caused by all cancers combined. However, the provision of mental health care remains inadequate around the world. To address the shortages in mental health care expenditures, the WHO-HEN (2003) proposed treatment priorities and policy goals in different contexts, based on their financial resources. This study investigates the state of mental health treatment provision in high-, middle-, low-income and the South African contexts, in order to assess the efforts that have been made in these contexts to counter the shortages in mental health care provision, and to promote public mental health, following the WHO-HEN (2003) suggestions. This study uses the mixed methods approach to review literature published between 2004 and 2016 within the AJCP, AJP, CMHJ, SAJPs and SAJP. The findings reveal that treatment trends across contexts align with, and extend beyond the WHO-HEN (2003) suggestions in most cases, and that the balanced care approach is progressively being implemented in the delivery of integrated mental health services in highincome countries and South Africa specifically. These results prove that efforts are being made across contexts to provide effective mental health care, and to ensure the promotion of mental health and prevention of mental disorders. / XL2018

The aim of this study has been to examine, in the light of recent events in the field of Health Care in South Africa, the remarks and claims made by the World Health Organization, and the American Psychiatric Association between 1976 and 1978 on Health Care services, as provided for Blacks, by the South African government. In two reports, these organizations instituted the earliest, and arguably most significant claims against South Africa's system of Health Care. This study sketches firstly the political genesis and social context of the WHO, and APA examinations. Secondly, this study evaluates responses made by the South African State to the critical climate inspired by the above mentioned reports, through a close analysis of recent events associated with the politics, and provision of Health Care Facilities - particularly with regard to Black South Africans. This analysis suggests that the governments' earlier tentative policy of privatisation (which was soundly condemned by WHO and the APA) has been even more enthusiastically pursued - in contradiction to it's avowed policies of Commu ity Health Care, and to the continuing detriment of those South African communities who are in most need of adequate Health Care services. The study concludes that the criticisms raised by the WHO and APA had the effect of inspiring positive reforms in South Africa's health services, but in no way thwarted the governments', at first only tentative plans, to increasingly privatise it's psychiatric and other medical institutions.

Thesis (MA)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: This study is aimed at exploring mental health services for low-income women in the West Coast I Winelands Region of South Africa. In order to understand the extent to which such services are empowering, the accessibility and theoretical underpinnings of these services are investigated. It was found that although services appear to be available, they are often not very accessible. They also often lack a specific gender focus. In certain instances, services need to increase their accessibility in order to accommodate the restrictive environments of women in this region. As such, it is believed that services require greater integration in their approach to intervention concerning both gender and the origins of mental health problems. Results of this study also highlight areas on which future research could focus. These areas include language of service provision, how organizations understand available theories surrounding service provision, and the service needs of women in this region themselves. / AFRIKAANSE OPSOMMING: Hierdie studie is gemik op die ondersoek van geestesgesondheidsdienste vir vroue van lae-inkomste groepe in die Weskus I wynverbouingstreek van Suid Afrika. Die toeganklikheid en teoretiese onderstuttngs van hierdie dienste word ondersoek in In poging om die graad waarin delke dienste bemagtigend is, te verstaan. Bevindinge toon dat dienste, albeit beskikbaar voorkom, dikwels nie baie toeganklik is nie. Dienste toon ook meestal 'n gebrekkige fokus ten opsigte van 'n spesifieke geslag. In sekere gevalle behoort die toeganklikheid van dienste verbeter te word in 'n poging om die beperkende omstandighede van vroue in hierdie streek tegemoet te kom. As sulks benodig dienste 'n hoër mate van integrasie in hul benadering tot intervensie, beide wat geslag en die oorsprong van geestesgesondheidsprobleme betref. Bevindinge lig ook areas uit waarop toekomstige navorsing kan fokus. Hierdie areas sluit die volgende in: die taal van diensvoorsiening, hoe organisasies beskikbare teorieë ten opsigte van diensvoorsiening verstaan, en die behoefts van die vroue in hierdie streek self ten opsigte van dienste.

Child and adolescent mental health represents a key area of concern and public health relevance. Mental health disorders are one of the most prevalent illnesses affecting young people and contribute significantly to the global burden of disease. Childhood and adolescent mental health problems often persist into adulthood and as such frequently result in lifelong negative consequences. Yet despite the growing concern with regards to the mental health needs of children and adolescents, not much research, both internationally and particularly locally, has focused on the provision of mental health services to children and adolescents. Additionally, little has been published on the changes and trends in diagnostic rates and assessment procedures over time. Only a few international studies have investigated mental health trends in children and adolescents; hence, there is a crucial need for South African data to inform preventative and curative services for children in South Africa. This present study therefore investigated the trends and patterns relating to diagnostic rates and assessment practices in children and adolescents over time at a local South African psychological community service centre in Pietermaritzburg. The study was a retrospective chart review and the sample consisted of 679 case files from children and adolescents between 3-17 years of age, who had been seen at a local psychological service centre between 1987-1989, 1997-1999 and 2007-2009. The case files were systematically analysed with regards to diagnosis and assessment practices. It was hypothesised that the years of continuous social and political conflict in the Pietermaritzburg area, namely 1987-1989, had a direct impact on the psychological development and well-being of children and adolescents from this area, and that this would be reflected in the case files from the corresponding years. The research findings with regard to the assessment practices were comparable to the internationally observed trends relating to choice of tests and procedures. In addition, the findings of the current study also showed similar trends with regard to the increasing diagnostic rates for ADD/ADHD, Mood Disorder, and Autism Spectrum Disorders as were observed internationally. Additionally, the reported decreasing diagnostic rates for Mental Retardation and behaviour disorders were also found in this local study. However, the internationally observed increases in Anxiety Disorder diagnoses contrast with the findings of this study, where the results revealed that the rates for Anxiety Disorder and PTSD were considerably higher in the late 1980s and 1990s. This finding supports the initial hypothesis that the violence and social unrest had an effect on children’s psychological well-being. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.

M.A. (Psychology) / Please refer to full text to view abstract

Bibliography: pages 108-115. / The aim of the proposed study is to evaluate demographic factors and treatment characteristics contained in the historical records of those treated as in-patients at the Sonstraal Adolescent unit of Lentegeur Hospital, during the period 1986 to 1990. This demographic study details the following aspects of the adolescent in-patients: size, that is, numbers of those admitted to the unit; composition, including age, sex and area. Treatment characteristics such as reasons for admission, diagnosis of psychopathology, referral agent on admission and discharge and length of stay in the unit are considered. The data for the study have been extracted from the clinical records contained at Sonstraal, namely , the 'Clinical Summary on Discharge' form. This form is completed by the therapist of each adolescent attending the unit. The EpiInfo computer programmes have been utilised to create a database and to select the appropriate procedures and statistics which form the basis for data analysis and interpretation. Data interpretation includes an analysis of the emerging trends and details the implications for policy issues, unit staffing and treatment options. Analysis of the trends and comparisons with literature findings have facilitated the generation of hypotheses which could be tested in future studies. This study therefore provides a working document for future prioritising and planning of in-patient, out-patient and community mental health services to adolescents, their families and communities. This involves recommendations for intervention and community involvement. In addition, the study provides a basis for future research into adolescent mental health care.

A clinic survey was undertaken to investigate the nature of psychiatric problems experienced by the primary health care (PHC) patient population in the Bisho-King William's Town area of the Eastern Cape Region. The study took as its point of departure research findings which attest to the high rate of psychiatric distress amongst this population group in different parts of the world and ohservations regarding the form of presentation in terms of physical complaints. Hypotheses posited relationships between psychiatric problems experienced by patients attending PHC clinics in the study area and four types of variables, namely; somatic complaints, socio-demographic characteristics, patterns of health service utilisation and patient satisfaction with health services. Using a quasi-experimental descriptive approach, a two-stage screening procedure sorted the patient sample into three groups on the basis of the degree of psychiatric symptomatology experienced. The triangulation of the results of between-groups analyses with case materials recorded during psychiatric interviewing provided for an ethnographic account of the cultural experience of distress in the study area. The screening process used standard instruments, the Self-Reporting Questionnaire (SRQ) in the first stage and the Present State Examination (PSE) in the second stage. A pilot study was conducted prior to the fieldwork for the main study. Using the SRQ, thirteen psychiatric paticnts and 31 general PHC patients were sampled for the pilot study and 148 PHC patients were sampled for the main study. Using the PSE, 11 and 57 PSE interviews were conducted in the pilot and main studies respectively. Between-groups analyses used chi-square and F-statistics to investigate possible associations with identified patient correlates (P<0.5). These were socio-demographic, utilisation and satisfaction variables, measured by a separate face-valid self-response instrument compiled for the purposes of this study. Psychiatric symptomatology was found to be statistically significantly related to age, marital status and educational level. Further, patients experiencing more psychiatric symptomatology reported significantly more illnesses requiring treatment, longer consultation periods and a greater number of sick bed days. No statistically significant relationships were found between psychiatric symptomatology and number of children, number of failures at school, amount of treatment utilised, number of consultations, or patient satisfaction with services. Descriptive analyses of symptom and syndrome profiles found certain somatic complaints to be particularly prevalent amongst the patient sample. These include headaches and various tension pains, decreased energy levels and digestive problems. Qualitative analysis of interview data found that many somatic and psychiatric problems experienced constitute culturally defined and meaningful experiences, especially 'umbilini' (or nerves), 'ufufunyana' (a possession state), and accusations of witchcraft. Interpretation of complaints from the local traditional healing perspective, revealed a more complex mode of communication between patients and the health delivery system than may be accounted for in terms of a simple biomedical model. The interpretive analysis in the study showed that some forms of presentation incorporating somatic symptoms, such as 'nerves' may he viewed as help seeking behaviour of the socially unempowered. Implications of the results are discussed in relation to the need for improved identification and management of psychiatric distress at PHC level facilitated by a better developed referral network and closer interaction between biomedical and anthropological perspectives.

The goal of mental health delivery system is to allow the individual with severe and persistent mental illness to live and function effectively in the community and to ensure that the consumers and their families have access to accurate information that promotes learning, self-monitoring and accountability (Stuart & Laraia, 2005:710). In community-based health care, the persons living with severe and persistent mental illness (SPMI) are in their natural environment in the context of the family and the community. The goals of care are focused around maximizing the person living with SPMI’s quality of life (Hunt, 2001:15-16). In South Africa, an integrated package of essential Primary Health Care (PHC) services has been made available to the entire population in order to provide the solid foundation of a single unified health care service (Department of Health, 2000:4). The assessment of health care needs of persons living with SPMI is a dynamic on-going process that is used to collect information, recognise changes, analyse needs and plan health care to provide baseline information to help evaluate the physiological and psychological normality and functional capacity of persons with SPMI (Hunt, 2001:100). There is insufficient information from the Department of Health to either satisfy the enquiry of whether the health care needs of persons living with SPMI are being met comprehensively or whether the practitioners rendering community-based health care are knowledgeable and comply with PHC norms and standards developed by this Department. The researcher is interested in understanding how the persons living with SPMI and their families experience the community-based health care provided by PHC nurses. The purpose of this research study is to develop strategies that would assist the PHC nurses in the selected rural areas of the Eastern Cape to facilitate community-based health care and to render a health care service relevant to the health care needs of the persons living with SPMI and their families. To achieve the objective of the study, the research design was based on a qualitative, exploratory, descriptive, contextual research approach. Phase one includes describing and selecting the research population and the sampling process prior to conducting the field work which comprises individual interviews with persons living with SPMI and their families as well as PHC nurses. According to Dickoff, James and Weidenbach (1968:422) and Chinn and Kramer (1995:78), this strategy involves identifying concepts from fieldwork and creating conceptual meaning to provide a foundation for developing strategies to facilitate community-based care for persons living with mental illness. Phase two of the research design will focus on development of conceptual framework in order to allow better understanding of the phenomenon of interest, as the major concepts will be simplified by connecting all related concepts together by means of statements. This was done by making use of the themes identified during data analysis and the literature sources used throughout this research process. The evaluation criteria of Chinn and Kramer (2008:237-248) were used to evaluate the strategies. It is therefore concluded that the researcher succeeded in achieving the purpose of this study because strategies which were understandable, clear, applicable and relevant to the nursing practice have been developed for use by Department of Health and Primary Health Care to facilitate the multifaceted role of the PHC nurses.

In South Africa, suicidal behaviour in the younger generations has become rapidly part of a major public health problem. It is a well-known fact that adolescence is a critical period of progression in a teenager’s development which makes them more susceptible and vulnerable to suicide. Statistics have shown that there has been an increase in suicide among adolescents within the last decade (Schlebusch, 2005). The main aim of this research study is to explore the perceptions of adolescents regarding the factors that contribute to adolescent suicide. This study reviews literature concerning various risks factors for adolescent suicidality. It also described major social and psychological theories of suicide and the extent to which these studies support the importance to adolescent suicide. In the literature review theories of Bronfenbrenner’s Ecological Systems Theory, Durkheim’s sociological theory of suicide, Freud’s psychological perspective and Baumeister’s Escape Theory were discussed. A qualitative research design will be used by using visual participatory methodology techniques namely photo voice and reflective writing. A sample of 12 grade 11 learners, male and female, was purposely selected to participate in the research study. The focus of the study is to investigate the risk factors underlying adolescent suicidal behaviour in schools in the Northern Areas of Port Elizabeth, as well as to explore the stressors experienced by adolescents that could contribute to them having a higher suicide risk. Another focus point will be to look at prevention strategies as an antipode for suicidal behaviour. The main findings that emerged from the data analysis include contributing factors namely: socio-economic factors, personal factors, psychological factors and educational and school-related factors. The main prevention strategy themes emerged from findings derived from the data and include: parental involvement, religion, professional help and support groups and confiding in someone that you trust.