Mental Health and Poverty Project, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, South Africa.
Health Policy Plan. 2009 Sep;24(5):342-56. doi: 10.1093/heapol/czp027. Epub 2009 Jun 26.
Mental health is increasingly acknowledged as a crucial public health issue in South Africa (SA). However, it is not given the priority it deserves on policy agendas in this and many other low- and middle-income countries. The aim of this analysis is to describe the content of mental health policy and the process of its development in SA.
Quantitative data regarding SA's mental health system were gathered using the World Health Organization (WHO) Assessment Instrument for Mental Health Systems. The WHO Checklist for Mental Health Policy and Plans was completed for SA's 1997 mental health policy guidelines. Semi-structured interviews provided understanding of processes, underlying issues and interactions between key stakeholders in mental health policy development.
There is uncertainty at provincial level regarding whether the 1997 policy guidelines should be considered national policy. At national level the guidelines are not recognized as policy, and a new policy is currently being developed. Although the guidelines were developed through wide consultation and had approval through national policy development processes, difficulties were encountered with dissemination and implementation at provincial level. The principles of these policy guidelines conform to international recommendations for mental health care and services but lack clear objectives.
The process of mental health policy implementation has been hindered by the low priority given to mental health, varying levels of seniority of provincial mental health coordinators, limited staff for policy and planning, varying technical capacity at provincial and national levels, and reluctance by some provincial authorities to accept responsibility for driving implementation.
These findings highlight the importance of national leadership in the development of new mental health policy, communication between national and provincial levels, the need for provincial structures to take responsibility for implementation, and capacity building to enable policy makers and planners to develop, monitor and implement policy.
心理健康在南非（SA）日益被视为一个重要的公共卫生问题。然而，在这个国家和许多其他中低收入国家的政策议程中，它并没有得到应有的重视。本分析旨在描述南非心理健康政策的内容及其制定过程。
使用世界卫生组织（WHO）心理健康系统评估工具收集有关南非心理健康系统的定量数据。完成了 WHO 心理健康政策和计划清单，以评估 1997 年南非心理健康政策指南。半结构化访谈提供了对心理健康政策制定过程中关键利益相关者的过程、潜在问题和相互作用的理解。
在省级层面，对于 1997 年政策指南是否应被视为国家政策存在不确定性。在国家层面，该指南未被视为政策，目前正在制定新的政策。尽管该指南是通过广泛协商制定的，并通过国家政策制定过程获得批准，但在省级层面传播和实施方面遇到了困难。这些政策指南的原则符合国际精神卫生保健和服务建议，但缺乏明确的目标。
心理健康政策实施过程受到对心理健康重视程度低、省级心理健康协调员的职级差异、政策和规划人员有限、省级和国家各级技术能力差异以及一些省级当局不愿意承担实施责任等因素的阻碍。
这些发现强调了国家领导层在制定新的心理健康政策、国家和省级层面之间的沟通、省级结构承担实施责任的必要性以及政策制定者和规划者发展、监测和实施政策的能力建设的重要性。
