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Clinical Psychology > Context of mental health in SA > Flashcards

Context of mental health in SA Flashcards

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1
Q

In public health, reliable data on prevalence and risk factors is needed to…

A

inform interventions and allocation of resources

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2
Q

A critique of the levels of MH data available in SA

A

Covid 19 saw insane levels of data readily available and updated daily. This is highly contrasted with the data available on MH in SA.

Why might this be? (priorities, difficulty assessing/diagnosing?)

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3
Q

7 sources of MH data

A

1.National Prevalence studies
2. NGOs
3. Schools
4. Provincial prev studies
5. Community prev studies
6. Clinic studies (look at clinic records, but this is therefore limited to help-seeking populations)
7. Other practitioners and studies

*each data source has benefits and limitations, best to put them together

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4
Q

The SASH study in SA assessed ….. using the ….. which is based on ….. diagnoses

A

-Common mental disorders
-CIDI (Composite International
Diagnostic Interview)
- DSM-IV

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5
Q

The most key stats discovered by the SASH study (learn some stats for essays etc)

A

-One lifetime mental illness = 30%
-Anxiety disorders = 16%
-Substance abuse disorders = 13%
-Major depressive disorders = 10%

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6
Q

Problems with the SASH study (3 marks)

A
  • still don’t know prevalence rates of serious disorders
  • presumed the western common MDs applicable to SA
  • stigmatized natures of MDs in SA may have encouraged soc des bias in survey
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7
Q

The SASH study found that there was a …. treatment gap in SA. This treatment gap was irrespective of…

A

75%
severity of mental illness or socio-demographic factors

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8
Q

The SASH study found a ….% treatment gap in uninsured adults

A

92

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9
Q

List 4 of the 6 structural barriers reported by SASH

A
  1. lack of proximity to health clinics
  2. Lack of community-based services after hospital discharge
  3. Absence of referral pathways after MI is detected
  4. Inadequate training of primary HC staff of MI detection
  5. Long waiting lines at clinics
  6. Costs of accessing treatment
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10
Q

List 4 of the 6 non-structural/Attitudinal barriers

A
  1. Perceived ineffectiveness of treatment
  2. lack of integration between traditional and western approached
  3. distrust/discomfort with pyschs (linked to race, class, language, culture)
  4. Lack of knowledge about resources/services
  5. Stigma of mental illness
  6. Poor mental health literacy (or diff cultural understandings/interpretations of MIs)
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11
Q

Even if one overcomes the attitudinal/social structures to obtaining MH care, the…. are still there

A

structural

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12
Q

MI often seen as a…..

A

“white thing” (receiving help from a white psychologist could also been seen as having to be helped “by the oppressor”)

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13
Q

Name 3 things that defines MHC under the apartheid regime

A
  1. Emphasis on INSTITUTIONAL care and MEDICAL treatment for mentally ill
  2. Protection of society > individual human rights
  3. Segregation of services, inequitable distribution of resources (black people often used as forced labour and experiment subjects)
    These inequalities still persist today
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14
Q

Describe the 2 big shifts in MHC policy that came post apartheid

A
  1. move from institutional care to community based care
  2. Integrate MHC to general health care (though community health care clinics rather than specialized psychiatric hospitals)
    *clinics provide support networks closer to community rather than big central hospital
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15
Q

In what way was the 2002 Menth Health Care Act consistent with international human rights standards

A
  • legal protection of mentally ill from abuse, discrimination etc, with review boards to monitor treatment of patients
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16
Q

Though the 2002 MHC act was good in theory, and inline with international standard, give an example of when these guidelines were clearly not followed

A

the 2016 Life Esidimeni Tragedy

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17
Q

The 2002 MHC Act was poorly implemented due to shortcomings in 4 key areas. What were those 4 key areas?

A
  1. Guidelines never distributed to provinces
  2. Lack of plan to implement the policy
  3. Lack of staff to monitor implementation
  4. Low priority to MHC at provincial level
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18
Q

In which policy framework was task-shifting introduced into the South African MHC landscape? And when was this plan to be implemented?

A

The National Mental Health Policy Framework and Strategic Plan (MHPF) which was to be to implemented between 2013 and 2022

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19
Q

Name the three policy developments outlined in the MHPF

A
  1. Task shifting used to increase community MHC services (primary care nurses and community MH workers)
  2. Greater emphasis on prevention of MIs and MH promotion
  3. Increased MHC financing (to reflect role of MI in national burden of disease)
20
Q

In 2016, only …% of the Health Care budget was allotted to Mental Health Care. This despite evidence that MI is the ….. largest contributor to the National Burden of Disease

A

5
third

21
Q

The SASH study found that the indirect cost (lost earnings etc) of MIs was R….. per year. This is …. times larger than that cost would be to treat these MIs

A

28 billion
6 times

22
Q

In 2016, there lessthan … psychiatrists and psychologists per 100 000 uninsured people in SA. Meanwhile …. people per 100 000 had a CMD

A

1
16 500

23
Q

There is an average of … beds in a psychiatric hospital per 100 000 people in SA

A

18

24
Q

Where does the vast majority of the national MHC budget go?

A

To psychiatric hospitals (86% of national budget)

25
Q

What percentage of the National MHC budget goes to the primary care level?

A

8%

26
Q

Considering the amount of money allocated to psychiatric hospitals in SA, comment on their effectiveness on treating individuals

A

Psychiatric hospitals seemingly have very poor levels of effectiveness. Average hospital stays are very long (2-5 times longer than other types of health care admissions) and re-admission rates are very high (up to 75% re-admitted within three months of being discharged)

27
Q

There is an NGO that provides about half of all community residential and day treatment facilities. Which NGO is this?

A

The South African Federation for Mental Health (SAFMH)

28
Q

NGOs are generally staffed by … and supervised by …

A

volunteers
mental health professionals

29
Q

There are currently far more ….. in SA than there are …. in the public health care system.

A
  • Traditional Healthcare Practitioners (THPs)
  • mental health professionals
30
Q

Most people who visit clinics seeking MHC have visited a THPs (many people use both models). Despite this, there is

A

little to no collaboration between state mental health care and THPs

31
Q

What about our current public MHC requires us to be more flexible and open in our approach?

A

Almost all of our MHC budget goes to large psychiatric hospitals that do not treat that many people - lots of people falling through the cracks

32
Q

The big question behind the three-tier MH model is…

A

When to intervene?

33
Q

Which level of intervention is the current focus of MHC in SA (in practice, even if not in policy)?

A

The Tertiary Prevention level

34
Q

When does tertiary prevention intervene and what its the aims?

A

It intervenes when MH difficulties have already dully developed, and its aim is to limit their impact and reduce risk of relapse

35
Q

List three requirements when choosing the form of tertiary intervention to use

A
  1. appropriate to state resources (i.e needs to be short term due to capacity limits)
  2. evidence-based (but, in an SA context, what is evidence?)
  3. interventions need to be culturally appropriate
36
Q

Describe a way in which we could expand our tertiary prevention capacity?

A

Looks for groups of people suffering from the same MIs and offer group interventions (school/universities/support groups etc). Or even a level been individuals and groups => families

37
Q

Tertiary prevention is NB as people need treatment but….

A

it is a problem if we are ONLY treating people once they are sick

38
Q

List the 2 goals of Secondary Prevention

A
  1. Early ID - of those who are at risk of MDs
  2. Early intervention - to slow ot halt symptoms
39
Q

Where can secondary interventions best take place (Early ID and Intervention)?

A
  • Schools, work, communities, Dr’s offices etc
  • IDing kids at risk in school is a key step in achieving these goals
  • People in high risk jobs may also need to be screened regularly (Police, EMS etc)
40
Q

Who can assist in Secondary interventions goal of early ID?

A
  • People already in the system of working with people that can be trained to ID people at risk (teachers, DRs, nurses etc)
41
Q

What methods of ID are effective in secondary interventions?

A
  • targeted screening (this may need to happen in addition to general screening by those in the system)
42
Q

Name the 2 aims of Primary prevention

A
  1. Reduce number of new cases of MI (preventing exposure to risk factors
  2. Promote mental health - actively promote psychological well-being, empowerment etc
43
Q

What SHOULD be the base of our MHC model but in reality falls to the wayside

A

Primary prevention (almost all effort, money and expertise is put into emergency tertiary prevention, when the horse is already outside the barn)

44
Q

Give three examples of primary prevention programs

A
  1. Improving maternal health (housing, nutrition, employment etc)
  2. Violence prevention (GBV, child maltreatment etc)
  3. Developing resilience (mindfulness and emotion regulation skills etc)
45
Q

Briefly describe Universal prevention, selective prevention and indicated prevention

A

Universal prevention – aimed at a whole population (regardless of their level of risk) (Eg whole university campus)

Selective prevention – aimed at high-risk groups (eg children who have experienced maltreatment)

Indicated prevention – aimed at individuals who show signs of difficulties (more specific than selective intervention)

46
Q

Give an example of a Tertiary, Secondary and Primary intervention

A

Tertiary - Counselling
Secondary - Programs to ID abused children and provide support
Primary - Parenting programs to reduce likelihood of child maltreatment

47
Q
A

Clinical Psychology (6 decks)

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