Background
History of CAMH Policy development in South Africa
Year | Policy development |
---|---|
1977 (Apartheid era) | The Potgieter commission emphasized intersectoral collaboration, early identification of CAMH disorders at primary healthcare level and in schools, and increasing capacity of teachers and health staff to identify CAMH disorders [14] |
1994 (post-apartheid era) | The first democratic President acknowledged the importance of children and their vulnerability [14] |
1997 | White paper for the transformation of the health system in South Africa [15] |
National Policy guidelines for improved mental health care [16] | |
2001–2003 | National policy guidelines for youth health and CAMH [14] |
2003 | National CAMH policy guidelines, 2003 [14] |
2002 | National mental health care act, no. 17 of 2002 [17] |
2003 | Norms and standards to develop CAMH services [18] |
2005 | A situational analysis of CAMH services in South Africa [19] |
2008 | The draft of the strategic mental health plan for the Northern Cape Province finalised by the national multidisciplinary committee (NHC), awaiting adoption as of 2016 [20] |
2012 | The national mental health summit facilitated the adoption of the national mental health policy guidelines to improve mental health care [13] |
2012 | The mental health summit adopted the “Ekurhuleni declaration” [13] |
2013 | The “mental health policy framework and strategic plan” was formally adopted for implementation [13] |
Methods
Search strategy
Data extraction and analysis
Results
Policy documents identified
Policy document | Explanation of the document |
---|---|
Stand-alone mental health policy | Defines the vision for the future mental health of the population, specifying the framework which will be put in place to manage and prevent priority mental and neurological disorders |
Stand-alone child and adolescent mental health policy | Defines the vision for the future mental health of the children and adolescents, specifying the framework which will be put in place to manage and prevent priority mental and neurological disorders |
CAMH plans | Is a pre-formulated detailed scheme to implement the vision and objectives defined in the child and adolescent mental health policy. It includes the concrete strategies and activities to be implemented and specifies targets to be achieved by the government. It clarifies the roles of the different stakeholders in implementing the activities of the mental health plan |
Mental health legislation | Regulates mental health care co-ordinates access to services. It sets out the rights and duties of patients and providers, and explains how the property of mentally ill persons may be dealt with in a court of law |
General health policy | Defines the vision for the future health of the population, specifying the framework which will be put in place to manage and prevent priority health disorders |
Strategic plan | Outlines the broad strategic goals for the department |
Annual performance plans | Sets out a framework to align strategic plans and annual performance plans. Puts emphasis on the outcomes oriented monitoring and evaluation approach |
Policy document | National level | Provincial level | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
South Africa | Western Cape | Eastern Cape | Kwa Zulu Natal | Northern Cape | Limpopo | Mpumalanga | Free State | North West | Gauteng | |
Stand-alone mental health policy | Mental health policy framework and strategic plan 2013–2020 [13] | X | X | X | X | X | X | Provincial mental healthcare (22 January 2001) policy. 2004 year of review: 2009 #outdated | X | X |
Stand-alone child and adolescent mental health policy | Child and adolescent mental health policy guidelines 2003 [14] | X | X | X | X | X | X | X | X | X |
CAMH plans | None | X | X | X | X | X | X | X | X | X |
Mental health legislation | National mental health act no. 17 of 2002 [17] | |||||||||
Other comprehensive general health care documents | ||||||||||
General health policy | Healthcare 2030: the Road to Wellness [25] | X | X | X | X | X | X | X | X | |
Strategic plan | X | Strategic plan 2015–2019 [26] | X | X | X | Free state strategic 5 year plan 2010/11–14/15 [27] #outdated | X | X | ||
Annual performance plans | Annual performance plan 2013/14–15/16 [28] | X | X | Annual performance plan 2008/09–2011(March 2008) [29] #outdated | Annual performance plan 2016/17 [30] | X | X |
Mental health policy
CAMH policy
Implementation plans
Strategic plans and annual performance plans
Policy analysis using the Walt and Gilson policy triangle
The content
Mental health and comprehensive general health document | Free State | Western Cape | Limpopo | KwaZulu-Natal | Mpumalanga | Eastern Cape | |
---|---|---|---|---|---|---|---|
Mental health care policy and procedures policy. 2004. Due for review: 2009 #outdated | 5-year strategic plan 2010/11–2014/15 #outdated | Healthcare 2030: the Road to Wellness | Annual performance plan 2008/09–2011 #outdated | Strategic plan 2015–2019 | Annual performance plan 2016/17 | Annual performance plan 2013/14–2015/16 | |
Year | 2009 | 2010 | 2014 | 2008 | 2015 | 2016 | 2013 |
Content focus | Emphasis is on provision of mental health services at all levels of care using intersectoral collaboration between correctional services, justice, social development, education, non-profit organisations, and groups of beneficiaries | Seven strategic goals 1. Provision of strategic leadership and creation of social compact for better health outcomes 2. Improve the quality of health care services 3. Reduce the burden of disease 4. Revitalisation of physical infrastructure 5. Improve human resource management 6. Overhaul the health care system and improve its management 7. Research and development | Focuses on strengthening primary health care (PHC) and district hospitals service as well as integration of services CAMH falls into general health plans The document focuses on reducing HIV and TB, improving healthy lifestyle, preventing injuries and violence, improving maternal and child health, strengthening child health, and improving mental health | Policies and programmes are mainly focused on primary health care, district health care, hospitals and resource management. The main focus is on reducing morbidity and mortality arising from communicable diseases, vaccination of preventable childhood diseases, diseases of lifestyle, HIV and AIDS and TB, trauma, and violence against women and children | Provision of sustainable, coordinated and integrated comprehensive health system at all levels using the primary healthcare approach through the district health system | Reference is made to promoting mental health and increasing the number of patients screened for mental disorders and increasing the number of mental health teams | The focus is on re-engineering of the PHC and strengthening of emergency medical services, pharmaceutical and hospital services |
Service provision plans and clear guidelines for CAMH | No specific reference to children and adolescents | Some mention of MH services and plans | No. An acknowledgement of the need to separate children with mental health disorders from adults and to develop service for them in future | No | Acknowledges CAMH disorders but unclear service provisions | No | Some recognition of the CAMH disorders but no clear plans for service provision |
The context
Province | Free State | Western Cape | Limpopo | KwaZulu-Natal | Mpumalanga | Eastern Cape | |
---|---|---|---|---|---|---|---|
Policy document | Mental health care policy and procedures policy. 2004 year of review: 2009 #outdated | 5-year strategic plan 2010/11–2014/15 #outdated | Health care 2030 | Annual performance plan 2008/09–2011 #outdated | Strategic plan 2015–2019 | Annual performance plan 2016/17 | annual performance plan 2013/14–2015/16 |
Year | 2009 | 2010 | 2014 | 2008 | 2015 | 2016 | 2013 |
Context | The mental health care act, 2002 No. 17 of 2002) framework part of the legislative mandate | The need to address service delivery challenges comprehensively | The policy is driven by the following Changes in the external environment (demography, socio-economic determinants of health, burden of diseases and its associated risk factors such as climate change, advances in technology and limited resources) Changing policy environment and policy imperatives such as millennium development goals (MDGs), the 2030 national development plan (NDP), the priority national health outcomes and the provincial strategic objectives to improve wellness Need to ensure continuous improvement in the patient experience and providing quality health services as well as caring for the staff | The plan is based on the 5-year strategic plan aligned to the departmental service transformation plan that provides long-term vision for the provision of health services in the province | The national development plan 2030, the medium strategic framework 2014–2019, the provincial growth development plan 2030, the 2015 cabinet Lekgatlo resolutions, other sector priorities and the burden of diseases and demand for service shaped the document | To put systems in place to ensure effective service delivery | Taking responsibility to support the country effort in the realization of millennium development goals (MDGs), to mitigate HIV and AIDS and TB, as well as challenges around maternal and child mortality |
The process and actors
Province | Free State | Western Cape | Limpopo | KwaZulu-Natal | Mpumalanga | Eastern Cape | |
---|---|---|---|---|---|---|---|
Policy document | Mental health care policy and procedures policy. 2004 year of review: 2009 #outdated | 5-year strategic plan 2010/11–2014/15 #outdated | Health care 2030 | Annual performance plan 2008/09–2011 #outdated | Strategic plan 2015–2019 | Annual performance plan 2016/17 | Annual performance plan 2013/14–2015/16 |
Year | 2009 | 2010 | 2014 | 2008 | 2015 | 2016 | 2013 |
Process | Various options were weighed. i.e. vertical program and a decision was taken to choose an option that will embrace the primary health care approach, and bring services closer to the people within the available resources The Free State community psychiatric approach was revised to be in line with the primary health care approach | Extensive consultation within and between clusters (workshops and task teams) with top management structures, information systems and service delivery components. The document is approved by the acting HOD and the MEC | The department’s preliminary thinking was shared in a draft document circulated for public comment in 2012 and again in December of 2013 Facilitated dialogue sessions were convened with a range of external stakeholders and staff through sessions by the geographic service area management structures Many submissions were received on both occasions and colleagues raised interesting, relevant and creative ideas during the dialogue sessions All comments were considered and the written comments were individually responded to. It was endorsed by the provincial cabinet | No relevant data | The strategic plan was formulated through an extensive consultative process with internal and external stakeholders and was endorsed by the provincial cabinet The process of formulating the strategic plan was done in four phases Phase 1. performance reviews (April–July 2014) Phase 2. strategic vision and strategic priorities 2015–2019 (August–September 2014) Phase 3: top-down-Bottom-up consultation to refine provincial Priorities (October–November 2014) Phase 4: finalising and tabling the document (December–February 2015) | No consultation with external stakeholders | Consultation with various stakeholders |
Province | Free State | Western Cape | Limpopo | KwaZulu-Natal | Mpumalanga | Eastern Cape | |
---|---|---|---|---|---|---|---|
Policy document | Mental health care policy and procedures policy. 2004 year of review: 2009 #outdated | 5-year strategic plan 2010/11–2014/15 #outdated | Healthcare 2030: the Road to Wellness | Annual performance plan 2008/09-2011 #outdated | Strategic plan 2015–2019 | Annual performance plan 2016/17 | Annual performance plan 2013/14–2015/16 |
Year | 2009 | 2010 | 2014 | 2008 | 2015 | 2016 | 2013 |
Actors | Assistant manager (mental health and substance abuse); manager (personal health); and various unspecified stakeholders from all other departments and at all levels from bottom up | Top management structures, management structures, acting HOD and MEC | Unspecified internal and external stakeholders (the public, geographic service area management teams, provincial cabinet | The works of the department were coordinated by the head office which provides the legislative interface between the governments, civil society and other relevant unspecified stakeholders, and provides strategic direction and overall management and administration of the department | The unspecified internal and external stakeholders | The document was developed by the provincial department of health in Mpumalanga, under the guidance of the MEC | Department of health |
Inclusion of child and adolescent mental health expects and users in the formulation of these policies | No data | No data | No data | No data | No data | No data |
Comparison of findings to previous analysis in 2010
Documents | Kleintjes et al. [19] | Current state of CAMH policy development and implementation (this study) | ||
---|---|---|---|---|
Nationally | Provincially | Nationally | Provincially | |
Mental health policy | National mental health policy guidelines of 1997 (not formally adopted) | None | National mental health policy guidelines of 1997 formally adopted in 2013 | None |
Mental health plans | None | Northern cape mental health draft plan | “Mental health policy framework and strategic plan 2013–2020” | None Northern Cape mental health plan finalised 2008 but not yet officially adopted |
Child and adolescent mental health policy | Child and adolescent mental health policy guideline 2002 | None | Child and adolescent mental health policy guideline 2002 | None |
Child and adolescent mental health plan | None | None | None | None |
Mental health legislation | Mental health act no. 17 of 2002 | National mental health act no. 17 of 2002 | Mental health act no. 17 of 2002 | National mental health act no. 17 of 2002 |
Provision for the protection of minors in national legislation | The legislation addressed only one out of six provisions recommended for the protection of minors by the WHO legislation checklist | The legislation addressed only one out of six provisions recommended for the protection of minors by the WHO legislation checklist | The legislation addressed only one out of six provisions recommended for the protection of minors by the WHO legislation checklist | The legislation addressed only one out of six provisions recommended for the protection of minors by the WHO legislation checklist |
Inclusion of child and adolescent mental issues in national legislation | No | No | No | No |