South Africa’s rural mental health human resource crisis: a situation analysis and call for innovative task-shifting

Background
These data provide national estimates of the human resources and services available to address the mental health (MH) needs of over 17 million rural South Africans, reliant on public rural primary healthcare (PRPHC) facilities. With personnel regarded as the most valuable resource for service delivery within an MH system, this review’s aim was to inform policy on bridging the mental illness treatment gap that is as high as 85% in low- and middle-income countries (LAMICS).

Objectives
The findings of three MH audits comprising 160 (98%) of South Africa’s (SA) PRPHC facilities are synthesised here to provide a situation analysis of SA’s PRPHC MH human resources and services.

Material and methods
The review was based on the analysis of both primary and secondary data. Primary data were collected by interviewing the clinical heads of PRPHC facilities during the audits, while secondary data comprised a desk review.

Results
Results indicate that MH nurses (MHNs), clinical psychologists, MH medical doctors (MHMDs) and psychiatrists are practicing in PRPHC areas at rates of 0.68, 0.47, 0.37 and 0.03 per 100 000 population, respectively; 96% of facilities do not have psychiatrists employed, while 81% have no MHMDs, 64% do not have clinical psychologists, and 61% have no MHNs; 69% do not receive specialist MH outreach services, while 78% do not have MH multidisciplinary teams.

Conclusions
The MH workforce shortages in PRPHC areas are discussed in terms of the evidence based approaches of task-shifting and transdisciplinarity.