Delivering mental health care through community health workers in South Africa: A review of the main challenges

Abstract

This study examines the challenges that community health workers face when delivering mental health care to people with severe mental health disorders in South Africa. Method of study This study is conducted as a desk study by firstly generalising a review of the literature to identify factors that are already known to have affected community heath workers in delivering mental health care and a further analysis to identify possible strategies that can be used to alleviate the identified challenges. A thematic approach was used for data analysis. Findings Three broad challenges; health system challenges, community related challenges and CHWs' day to day challenges are the main factors that affect community health workers in delivering mental health care. Health system challenges Resources for mental health are in short supply in South Africa given the health and social needs of the population. The health system is burdened by diseases and exacerbated by poverty, trauma due to violence and road accidents, mental health disorders and prevalent maternal deaths. Although resources for health in general are above World health Organisation's recommendations in South Africa, health outcomes are affected by the uneven distribution of resources between health sectors within different geographical areas. Community related challenges Mental health literacy remains a cause for concern in South Africa and those enduring severe mental health disorders are often stigmatised. South Africa, a multicultural society with 11 official languages, often uses interpreters from other ethnic minorities causing interpretation problems which affect health outcomes. Community health workers are mandated to diagnose, treat and refer complicated cases to specialist health workers but often lack understanding of psychiatric disorders and the referral process in South Africa. Furthermore, patient's explanatory models which influence health seeking behaviours result in western treatment options being taken when other options have failed. Community health worker day to day challenges Lack of transport is one of the factors that affect health workers to access and transport patients with severe mental health disorders to clinics and referral hospitals. Often community health workers cover large geographical areas, taking large caseloads in the background of little remuneration and support. Recommendations Training and supervision is a crucial aspect that specialised health workers should undergo for the effectiveness of programmes that involve community health workers. Identifying factors that impact community health workers' delivery of mental health care, the level of support community health workers may need and policy makers to implement policies based on service need are vital aspects for service improvement. Both traditional and western treatment options for mental illness are equally used by service users in South Africa and their collaboration with a referral system is encouraged.