Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Rondebosch, Cape Town, South Africa.
Cape Mental Health, Observatory, Cape Town, South Africa.
PLoS One. 2023 Aug 28;18(8):e0290712. doi: 10.1371/journal.pone.0290712. eCollection 2023.
In the context of an already large treatment gap in South Africa, this study aimed to examine how Covid-19 and the related lockdown measures affected the availability, accessibility, quality, and continuity of mental health services in the Western Cape province in South Africa. A mixed-methods design was employed, using narrative surveys, quantitative surveys, and qualitative semi-structured interviews, with 17 public mental health providers, and secondary data from the District Health Information System. We analysed and combined the data using descriptive statistics, template analysis and methodological triangulation. Results showed that Covid-19 and the lockdowns had negative impacts on mental health service provision at all levels of care, such as reduced access to services, increased stigma and discrimination, disrupted medication supply, increased workload and stress for providers, and the closure of psychosocial and therapeutic services. Innovations used by providers to mitigate these impacts included telehealth, online training, peer support groups, and community outreach. The study concludes that Covid-19 and the lockdowns exposed and exacerbated the existing gaps and challenges in mental health service provision in South Africa. Key recommendations for policy formation and response to future pandemics in the public mental health sector include: classifying psychological treatments as essential services, establishing an intersectoral mental health emergency response plan, involving mental health care users in the development of pandemic responses, creating policies for managing health emergencies in psychiatric facilities, and increasing resources for the mental health sector in South Africa. These recommendations are relevant for South Africa and other LMICs in ensuring adequate mental health care during public health emergencies.
在南非已经存在巨大治疗缺口的背景下，本研究旨在探讨新冠疫情和相关封锁措施如何影响南非西开普省的心理健康服务的可及性、质量和连续性。采用混合方法设计，使用叙述性调查、定量调查和定性半结构式访谈，对 17 名公共心理健康服务提供者进行了调查，同时利用从地区卫生信息系统获取的二级数据。我们使用描述性统计、模板分析和方法三角测量对数据进行了分析和组合。结果表明，新冠疫情和封锁对各级医疗保健的心理健康服务提供产生了负面影响，例如服务可及性降低、污名化和歧视增加、药物供应中断、提供者的工作量和压力增加、心理社会和治疗服务关闭。提供者为减轻这些影响而采用的创新措施包括远程医疗、在线培训、同伴支持小组和社区外展。研究得出结论，新冠疫情和封锁暴露并加剧了南非心理健康服务提供中现有的差距和挑战。为公共精神卫生部门制定政策和应对未来大流行病的关键建议包括：将心理治疗归类为基本服务、制定跨部门精神卫生应急响应计划、让精神卫生保健使用者参与大流行病应对措施的制定、制定精神病院卫生紧急情况管理政策以及增加南非精神卫生部门的资源。这些建议对于南非和其他中低收入国家/地区在公共卫生紧急情况下确保足够的精神卫生保健具有相关性。
