The Mental Health Crisis in Rural Kwazulu-Natal: A Call for Transdisciplinarity and Task-Shifting

Objectives: According to the World Health Organization (WHO), mental illness accounts for 14% of the global
disease burden. The treatment gap for mental disorders is undeniable with between 76% and 85% of people in
low- and middle-income countries not receiving any form of treatment. In Africa, the disease burden of mental
illness accounts for 19% of all disability. South Africa (SA), a middle income country with a population of 52
million people, has severe mental health workforce challenges, especially in the public health sector (PHS) that
70,6% of the population uses. SA has less than 0, 5 psychiatrists per 100,000 population. Of the almost 37
million people using the public health sector, 61, 2% of households make use of PHS clinics, placing a massive
burden on the primary health care (PHC) system. Kwazulu-Natal (KZN) is a South African province where the
majority of its 10,3 million people are regarded as living in “rural” areas. Little is known about SA’s rural mental
health services and in this paper we conducted an audit to determine the mental health workforce in KZN’s
rural areas with the purpose to inform policy making in SA’s efforts of integrating rural mental health (MH) into
PHC.
Methods: The KZN district and medical managers of all 32 rural PHC hospitals were interviewed. Triangulating
data collection methods to include recorded telephonic interviews, as well as follow-up online questionnaires
limited non-response bias.
Results: The audit revealed that less than 0, 1 psychiatrists per 100,000 population are practicing in rural KZN’s
PHC areas, and that 75% of facilities do not have mental health multidisciplinary teams.
Conclusions: The MH workforce challenges in rural KZN suggest that transdisciplinarity and task shifting will be
essential to improve access to MH care and alleviate the languishing specialist medical MH workforce in rural
PHC facilities.
Bibliography:
1. Day, C., & Gray, A. (2014). South African Health Review 2013/14. In A. E. Padarath, R. (Ed.): SA Health
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2. Mental health services funding and development in KwaZulu-Natal: a tale of inequity and neglect. South
African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde, 100(10), 662-666.