Norms for mental health services in South Africa.
BACKGROUND
In the aftermath of apartheid, South Africa has inherited a fragmented, under-resourced and inequitable public sector mental health service. Attempts are being made to reform mental health services, in keeping with new health policy, which proposes the downscaling of psychiatric institutions and the development of community-based services. This study set out to develop a set of service norms for the care of people with severe psychiatric conditions (SPC) in South Africa, to assist the implementation of the new policy.


METHODS
A national situation analysis of current public sector mental health services was conducted. A model was developed for estimating the mental health service resource needs of people with SPC. Following consultation with provincial stakeholders, a set of service norms were developed taking into account national indicators from the situation analysis (as a baseline level) and proposals of the model (as a target level).


RESULTS
The study recommends an increase in the number of acute psychiatric beds in general hospitals; development of community-based residential care; redistribution of staff from hospital to community services, particularly in rural areas; and the development of information systems to monitor the transitions to community-based care.


CONCLUSIONS
The norms proposals presented in this study express mental health service needs in terms of quantifiable service resource and utilisation levels. In doing so, the study attempts to make explicit the assumptions and values on which planning is based.
Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, 7700, Cape Town, Rondebosch, South Africa. clund@rmh.uct.ac.za
Crick
C
Lund
Alan J
AJ
Flisher
D003156:Community Mental Health Services / Q000706:statistics & numerical data; D005544:Forecasting; D018166:Health Care Reform / Q000706:statistics & numerical data*; D006284:Health Plan Implementation / Q000639:trends; D006287:Health Planning Guidelines; D006291:Health Policy / Q000639:trends; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000639:trends; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012112:Residential Facilities / Q000706:statistics & numerical data; D013019:South Africa