Health and Demographic Research Unit, Department of Sociology, Ghent University, Ghent 9000, Belgium.
Department of Political Science, Stellenbosch University, Stellenbosch 7600, South Africa.
Health Policy Plan. 2018 May 1;33(4):516-527. doi: 10.1093/heapol/czy017.
The Life Esidimeni tragedy in South Africa showed that, despite significant global gains in recognizing the salience of integrated public mental health care during the past decade, crucial gaps remain. State and non-state mental health service collaboration is a recognized strategy to increase access to care and optimal use of community resources, but little evidence exist about how it unfolds in low- to middle-income countries. South Africa's Mental Health Policy Framework and Strategic Plan 2013-20 (MHPF) underlines the importance of collaborative public mental health care, though it is unclear how and to what extent this happens. The aim of the study was to explore the extent and nature of state and non-state mental health service collaboration in the Mangaung Metropolitan District, Free State, South Africa. The research involved an equal status, sequential mixed methods design, comprised of social network analysis (SNA) and semi-structured interviews. SNA-structured interviews were conducted with collaborating state and non-state mental health service providers. Semi-structured interviews were conducted with collaborating partners and key stake holders. Descriptive network analyses of the SNA data were performed with Gephi, and thematic analysis of the semi-structured interview data were performed in NVivo. SNA results suggested a fragmented, hospital centric network, with low average density and clustering, and high authority and influence of a specialist psychiatric hospital. Several different types of collaborative interactions emerged, of which housing and treatment adherence a key point of collaboration. Proportional interactions between state and non-state services were low. Qualitative data expanded on these findings, highlighting the range of available mental health services, and pointed to power dynamics as an important consideration in the mental health service network. The fostering of a well-integrated system of care as proposed in the MHPF requires inter-institutional arrangements that include both clinical and social facets of care, and improvements in local governance.
南非的 Life Esidimeni 悲剧表明，尽管在过去十年中，全球在认识到综合公共精神卫生保健的重要性方面取得了重大进展，但仍存在关键差距。州和非州精神卫生服务合作是增加获得护理和最佳利用社区资源的公认策略，但关于其在中低收入国家的运作方式的证据很少。南非的《精神卫生政策框架和 2013-20 年战略计划》（MHPF）强调了合作性公共精神卫生保健的重要性，尽管尚不清楚这是如何发生的以及在何种程度上发生。该研究的目的是探讨南非自由州曼加翁大都会区州和非州精神卫生服务合作的程度和性质。该研究涉及平等地位、顺序混合方法设计，包括社会网络分析（SNA）和半结构化访谈。SNA 结构访谈是与合作的州和非州精神卫生服务提供者进行的。半结构化访谈是与合作伙伴和主要利益攸关方进行的。使用 Gephi 对 SNA 数据进行描述性网络分析，并在 NVivo 中对半结构化访谈数据进行主题分析。SNA 结果表明，该网络呈碎片化、以医院为中心，平均密度和聚类低，一家专业精神病院的权威和影响力高。出现了几种不同类型的合作互动，其中住房和治疗依从性是合作的关键点。州和非州服务之间的比例互动较低。定性数据扩展了这些发现，突出了可用精神卫生服务的范围，并指出权力动态是精神卫生服务网络中的一个重要考虑因素。正如 MHPF 所提议的，要培养一个良好整合的护理系统，需要有包括护理的临床和社会方面的机构间安排，并改善地方治理。
