Abstract
M.A. (Clinical Psychology)
The delivery of mental health care services is a serious public concern worldwide, with South Africa being no exception. In South Africa, under-resourced primary health care (PHC) facilities remain an obstacle in the provision of mental health care services, particularly concerning the referral and continuation of care for mental health care users’ (MHCU). The Mental Health (MH) Policy and Strategic Framework 2013-2020 is the most recently disseminated policy that advocates for a stepped approach in the delivery of mental health care services. According to this framework, MHCUs should seek help first at the PHC level. However, it would appear that there is a tendency to seek help first at the secondary hospital level, which suggests poor access to mental health services and policy implementation at PHC level. This research therefore aimed to explore referral pathways; both into care and then for follow-up on discharge. A quantitative retrospective chart review design was used in this study to examine referral pathways among inpatient MHCUs at a tertiary medical hospital rendering secondary mental health care services. Using a purposive sampling method, a total of 465 inpatient record files were used in this study. An excel spreadsheet, specifically, designed for this study was used as the data collecting tool. Descriptive analyses were performed to describe the socio-demographic characteristics and referral pathways of the MHCUs at a specific secondary level hospital. Chi-squared tests were performed to establish whether psychiatric diagnosis, employment status and discharge action were associated. This study found that while a majority of the MHCUs accessed secondary mental health care services without a referral from primary health care facilities, a downward referral to these facilities was the most common referral route on discharge from the psychiatric unit. The results also indicated that psychiatric diagnosis was significantly associated with employment status and discharge to PHC clinic. Results of this study also suggested poor implementation of the MH Policy Framework guidelines in the central Gauteng - Johannesburg region. In essence, findings of this study confirmed that the mental health system is fragmented in the area of investigation, wherein the results indicated that the bulk of mental health services are currently provided by hospitals...