The plan’s goal is to integrate mental healthcare into general healthcare services in order to reduce the burden caused by untreated mental conditions. The project also aims at transforming the system in order to provide mental health services that are comprehensive, accessible, and equitable, especially for community-based mental healthcare.

However, there are significant gaps in information that have hindered the ability of the country to implement a sustained mental health response. The most recent estimates of mental disorder prevalence based on population data date back to 2003/4.

Mental health patients were admitted to district hospitals for twice as long as the average patient. Their admissions at regional and tertiary hospitals lasted 6 to 8 times longer. In central hospitals, their entrances lasted almost five times as long. Mental health patients spend an average of 157 days in psychiatric hospitals per admission. Nearly one in four mental health patients was readmitted to a hospital within three months after being discharged. Only readmissions accounted for 18% of South Africa’s total mental healthcare spending.

This is a sign of a system that is inefficient and fails to assist patients in transitioning to community care. Cost savings can be achieved by providing continuity of care to patients and helping them live in their community after they leave the hospital.

Additional findings include:

In the public sector, only three provinces have child psychiatrists.

The shortage of psychiatrists, auxiliary workers, and other critical personnel for rehabilitation and supportive service was extreme.

The national database of licensed NGOs by the Department of Health did not match the data collected through primary data collection.

Several drugs that are critical to the treatment of chronically debilitating conditions, such as bipolar disorders and depression, weren’t available on a regular basis.

The Mental Health Care Act requires district hospitals to conduct 72-hour assessments and then refer patients for treatment, rehabilitation, and further care.

Look forward

For the first time in South Africa, a national representative reflection is available on the current state of mental healthcare spending. This allows for a better understanding of the constraints and inefficiencies that result from the existing investments. This study has one of the largest sample sizes for any costing studies conducted in low and middle-income countries.

The results of our study suggest that there are some obvious areas for improvement. This includes stronger service delivery on the community and primary care levels. Better referral pathways may reduce the number of unnecessary readmissions. It would also reduce hospital stays.

Next, the government must accelerate the country’s progress in meeting the goals outlined in the strategic plan. It should also implement the recommendations made by the South African Human Rights Commission report. The government can now begin planning rationally based on the study results.

The government has asked us to develop a mental investment case for the nation. This comes at an important time in the country’s mental health response due to the recent passage of the NHI Bill. This will require a constant and intensive dialogue with all the players involved in mental health research and services across the country.