Standards for the mental health care of people with severe psychiatric disorders in South Africa: Part 2. Methodology and results

Objective: Mental health care standards have been developed to describe what is an acceptable and adequate quality of mental health care for service users in South Africa. Part two describes the standards development methods, the range of standards developed and, as an example, the rights and protection standards domain. Methods: a systematic literature review and broad consultation to develop a set of normative- based standards. Consultation included widespread draft document distribution/feedback, in-depth provinical workshops, and focus groups. Structually, detailed criteria and sub-criteria were developed for measurability and adequate detail in key service areas. Results: Three types of standards were developed: core standards, standards for service delivery and for specific settings. Standards to ensure the rights and protection of varied service users within a range of contexts are described. Conclusion: A standards document is an essential component of a quality improvement process, within the context of a supportive legislative, political and managerial framework.Keywords: standards, mental health care, South Africa, methodology, results South African Psychiatry Review Vol. 8(4) 2005: 146-15

Conducting Epidemiological Research in South Africa: Challenges in the Data Collection Process

This article addresses the challenges faced by research supervisors and research assistants while collecting data to explore the prevalence of psychiatric disorders among children and adolescents in South Africa. The article focuses on budgetary constraints, interviewee expectations, moral issues, limited confidentiality, fatigue factors and racial issues that threatened the completion of the project. These challenges are examined from the emic-etic theoretical paradigm and the interactions between the research supervisors, the research assistants and the research participants are analyzed. The authors propose recommendations that can serve to prepare researchers who embark on conducting research in similar socio-cultural environments

Standards for the mental health care of people with severe psychiatric disorders in South Africa: Part 1. Conceptual issues

Part one describes conceptual issues underlying the development of South African standards for people with severe psychiatric disorders. Mental health care standards seek to describe what is an acceptable and adequate quality of mental health care for service users. A focus on service quality is especially crucial in resource constraint contexts. Standards are essential tools for quality assurance, advocacy and rights protection, capacity and management development and dialogue. They should be appropriate, useful and patient-centred, and operationalise local policy and legislation. Mental health standards are a challenge to define, and need to combine both a consumer and rights based approach. International and local standards and views were adapted and included in order to develop these standards which should be applicable, measurable and gradable across all South African contexts. Keywords: standards, mental health care, South Africa, conceptual South African Psychiatry Review Vol. 8(4) 2005: 140-14

Urbanisation and adolescent risk behaviour

Objective. To investigate whether there is an association between the length of time lived in an urban area and selected adolescent risk behaviours.Design. Cross-sectional survey in which students completed an anonymous, confidential questionnaire.Setting. Four high schools in black communities in the Cape Peninsula, South Africa.Participants. A sample of 1 296 students obtained by multistage cluster sampling.Main outcome measures. Selected risk behaviours.Results. There is a relationship between urbanisation and certain risk behaviours. The following risk behaviours were associated with urbanisation: use in the previous month of alcohol, cannabis, and cannabis mixed with Mandrax; being a victim of violence; perpetration of an act of violence; and suicidality. Conversely, participation in sexual intercourse and solvent sniffing in the previous month were not associated with urbanisation.Conclusion. Urbanisation is associated with an increase in the prevalence rates of some risk behaviours. Mental health promotion efforts may be informed by further research aimed at the identification of: (z) the characteristics of risk behaviour that determine whether it is associated with urbanisation; and (iz) where applicable, the specific aspects of the urbanisation process that contribute to an increase in risk

The school as a setting for child and adolescent mental health interventions

How important are mental disorders in childhood and adolescence? One way of addressing this question is to examine prevalence rates for this age group. In South Africa, we do not yet have valid or reliable prevalence data from samples that are representative of any large populations. This is unfortunate, as such data are useful for service planning and for making the case that mental disorders are important. To fill this gap, an expert task team was convened in the Western Cape to compile estimates of prevalence rates of mental disorders for children, adolescents and adults in that province.1 Co-morbidity adjusted annual prevalence rates were derived by consensus. This process was informed by a systematic literature review, and estimates of rates were adjusted to take account of the extent to which risk factors for each disorder were assessed to be present in the province. The overall prevalence rate was assessed to be 17%. The rates for selected disorders were as follows: agoraphobia – 3%; attention deficit hyperactivity disorder – 5%; bipolar disorder – 1%; conduct disorder – 4%; enuresis – 5%; major depressive disorder and dysthymic disorder – 8%; oppositional defiant disorder – 6%; schizophrenia – 0.5%; separation anxiety disorder – 4%; and simple phobia – 3%. It should be borne in mind that these prevalence rates include only children and adolescents in whom the presence of the disorder was combined with functional disability to the extent that intervention was indicated

HIV/AIDS and psychiatry: Towards the establishment of a pilot programme for detection and treatment of common mental disorders in people living with HIV/AIDS in Cape Town

As the roll-out of antiretrovirals (ARVs) to people living with HIV / AIDS (PLWHA) continues to increase in South Africa, so too does the need to integrate mental health services into HIV care. In this editorial, we argue that the role of mental health in ARV programmes is central. The prevalence of mental disorders in PLWHA is higher than in the general population, and the impact of these conditions is substantial. Screening tools for mental disorders are both available and feasible. These should be incorporated into routine ARV care, with support from dedicated HIV mental health services

Secular trends in risk behaviour of Cape Town grade 8 students

Objective. To compare prevalence rates of selected risk behaviours and age of first intercourse of grade 8 students in Cape Town between 1997 and 2004. Design. Cross-sectional surveys in 1997 and 2004. Survival analysis was used to estimate the cumulative incidence of first intercourse. The log-rank statistic was used to compare the survival distributions. When comparing data from the two studies we used a logistic regression model with the factors year, race and age group to test the difference in reported risk behaviours between 1997 and 2004 within each gender. Setting. Public high schools in Cape Town. Subjects. Multistage cluster samples of 1 437 and 6 266 grade 8 students in 1997 and 2004 respectively. Outcome measures. Ever having had sexual intercourse; for those that had, whether any method was used to prevent pregnancy or disease at last intercourse, and (if so) what was used; use of tobacco, alcohol and marijuana; violence-related behaviours; and suicidal behaviour. Results. There was a significant delay in first intercourse in 2004 compared with 1997. For males, levels of condom use were lower in 2004 than in 1997, while for females levels of injectable contraceptive use were lower. There were significant increases in past month use of cigarettes for males and marijuana for both genders. Rates of perpetration of violence behaviour remained stable or decreased from 1997 to 2004, while the rate of suicidal behaviour for males increased. Conclusions. School-based interventions that address sexual risk behaviours should be expanded to include other risk behaviours

Mental health is integral to public health: a call to scale up evidence-based services and develop mental health research

The Global Burden of Disease studies documented the challenges posed by mental illness. Mental illness comprised an estimated 12% of the global burden of disease in 2000, and is predicted to rise to 15% by 2020. Mental disorders comprise 5 of the 10 leading causes of health disability; it is predicted that, by 2030, unipolar depression will be the world's second most disabling health condition

Sexual behaviour of Cape Townhigh-school students

Objectives. To document prevalence rates for selected aspects of sexual behaviour among Cape Town high-school students and to conduct a survival analysis of age at first intercourse. Design. Cross-sectional survey. Setting. State high schools in Cape Town. Subjects. A multistage cluster sample of 2 740 grade 8 and 11 students at 39 schools. Outcome measures. Ever having had sexual intercourse; for those who had, age at first intercourse, number of partners during the previous 12 months, time since last intercourse; and, at last intercourse, whether the partner had been known for more than 7 days, whether any method was used to prevent pregnancy or disease, and (if so) what was used. Results. Overall, 29.9% had participated in sexual intercourse, with a higher proportion among males and those in grade 11. By the age of 14 years, 23.4% of males and 5.5% of females had participated in sexual intercourse. By the age of 19 years, these proportions were 71.8% and 58.2% respectively. The median time since last intercourse was 4 weeks, the median number of partners in the past year was 1, and 78.4% had known their most recent partner for more than 7 days. At their last coital episode, 65.4% had used contraception, and the most common methods were condoms and injectable steroids, which were used by 67.7% and 43.2% respectively. Conclusions. The proportion of sexually active students has increased since 1990. Intervention programmes should commence in primary school. Large numbers of students are at risk for pregnancy and sexually transmitted infections