State and non-state mental health service collaboration in a South African district: a mixed methods study

• Published in: Health policy and planning 2018-05, Vol.33 (4), p.516-527
• Main Authors: van Rensburg, André Janse, Petersen, Inge, Wouters, Edwin, Engelbrecht, Michelle, Kigozi, Gladys, Fourie, Pieter, van Rensburg, Dingie, Bracke, Piet
• Format: Article
• Language: English
• Subjects: Clinical governance; Clustering; Collaboration; Community mental health services; Community resources; Computer networks; Cooperative Behavior; Data; Density; Governance; Health administration; Health care; Health care access; Health care policy; Health planning; Health policy; Health services; Health Services Accessibility; Housing; Housing authorities; Humans; Influence; Integrated care; Interviews; Interviews as Topic; Low income groups; Mental disorders; Mental health; Mental health care; Mental health policy; Mental Health Services; Mixed methods research; Network analysis; ORIGINAL ARTICLES; Poverty; Power structure; Primary Health Care; Public health; Public-Private Sector Partnerships; Qualitative analysis; Research methodology; Social network analysis; Social networks; Social organization; South Africa; Tragedy; Treatment compliance
• ISSN: 0268-1080; 1460-2237
• 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. Semistructured 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 semistructured 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. La tragédie de Life Esidimeni en Afrique du Sud a montré que, malgré des progrès significatifs réalisés au niveau mondial dans la reconnaissance de l’importance des soins de santé mentale axés sur la collaboration au cours de la dernière décennie, de graves lacunes subsistent. La collaboration entre les services étatiques et non-étatiques de santé mentale est une stratégie re