Bridging the gap: investigating challenges and way forward for intersectoral provision of psychosocial rehabilitation in South Africa
OBJECTIVE This study examined service utilization patterns and pathways to specialist mental health services among individuals with schizophrenia spectrum disorders in the Western Cape, South Africa, an area that has undergone deinstitutionalization since the mid-1990s. METHODS Individuals who were consecutively admitted to any of the three psychiatric hospitals in the Western Cape from February 2007 to January 2008 were interviewed. Data on demographic characteristics, psychiatric history, service utilization, and pathways to care were gathered from service users, their relatives or associates, and hospital files. Univariate and multivariate analyses examined differences between high- and low-frequency service users. RESULTS Of the total sample (N=152) most were first seen at the primary care level (62%). However, very few received treatment at this level (26%), and many (22%) were admitted directly to the psychiatric hospital, bypassing other treatment options. These service utilization patterns differ from the requirements listed in the recently adopted Mental Health Care Act (2002), which states that unless a patient has been recently discharged, he or she should be admitted for 72 hours of observation before referral to psychiatric hospitals. Compared with low-frequency service users, high-frequency users were younger, had lower income, tended to rely more on disability benefits, and were more likely to bypass other levels of care and be admitted directly to the psychiatric hospital. Poor medication adherence was the most likely precipitant for the episode of illness among all users. CONCLUSIONS The study highlights the inadequacy of current community mental health services in providing for the needs of people with severe mental illness. In South Africa, as in many other middle-income countries, there is an urgent need to develop community-based care.