Implementation of the mental health care act in psychiatric hospitals

dc.contributor.authorMulutsi, Eva Nkeng
dc.descriptionA thesis submitted to the School of Governance, Faculty of Commerce, Law and Management, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Doctor of Philosophy, 2017en_ZA
dc.description.abstractIntroduction Mental illness is prevalent in all regions of the world and contributes significantly to premature mortality, high morbidity and loss of economic productivity (Baxter, Whiteford, Vos, & Norman, 2011; Charlson, Baxter, Cheng, Shidaye, & Whiteford, 2016). In South Africa, the Mental Health Care Act (No 17 of 2002) was promulgated in 2004 in response to the high burden of mental illness and to improve mental health service delivery, within a human rights framework. Aims and Objectives: The overall aim of this PhD study was to examine the implementation of the Mental Health Care Act in psychiatric hospitals in South Africa. The specific objectives were to: explore stakeholders’ involvement in the implementation of the Act; examine the policy processes followed in the implementation of the Act; determine whether Mental Health Review Boards execute their prescribed roles and functions; examine the implementation of legal procedures for involuntary admissions of psychiatric patients; and identify factors that influenced the implementation of the Act. Methods: The study was approved by the Human Research Ethics Committee of the University of Witwatersrand, Johannesburg. Sixteen psychiatric hospitals were selected in nine provinces, through stratified random sampling. Using an adapted conceptual framework with policy implementation theory as its foundation, the overall study approach was qualitative in nature, complemented with a record review of involuntary patient admissions in the selected hospitals. The qualitative component consisted of 35 in-depth interviews with: the drafter of the Act (n=1); provincial mental health coordinators (n=9); a psychiatrist at each of the selected hospitals (n=16); and the chair of a Mental Health Review Board in each of the provinces (n=9). At each selected psychiatric hospital, five patient records were selected randomly (n=80), focusing on compliance with the legal procedures for involuntary admissions. The qualitative data were analysed using thematic content analysis and MAXQDA® 11 while STATA® 12 was used to analyse the data from the record reviews. Results: South Africa’s political transition created a window of opportunity for the implementation of the Act. Wide-spread stakeholder support for the spirit and intention of the Act, advocacy for human rights, the broader transformation of the health system, and the need for enhanced governance and accountability in mental health, facilitated the implementation of the Act. However, implementation was hindered by: the relatively low prioritisation of mental health; stigma and discrimination; poor planning and preparation for implementation; resource constraints; and suboptimal stakeholder consultation. The study found that the majority of involuntary psychiatric patients admitted during (the year) 2010 were single (93.8%), male (62.5%), and unemployed (85%), predominantly black African (80%), with a median age of 32.5 years. The primary diagnoses were schizophrenia (33/80), substance-induced psychosis (16/80), bipolar mood disorders (15/80) and acute psychosis (9/80). There was poor compliance with the prescribed procedures for involuntary psychiatric admissions, exacerbated by suboptimal governance by, and functioning of, the Mental Health Review Boards, thus resulting in de facto illegal detention of patients. Conclusion and Recommendations: The Mental Health Care Act is an important policy lever to address the burden of mental illness and ensure quality mental health service delivery in South Africa. However, the enabling potential of the Act can only be realised if the following issues are addressed: improved, and dedicated resources for mental health; training and capacity building of health professionals and hospital managers on key aspects of the Act; improved governance, leadership and accountability through well-functioning Mental Health Review Boards; and improving mental health infrastructure and community-based services.en_ZA
dc.facultyFaculty of Commerce, Law and Management
dc.format.extentOnline resource (xvi, 294 pages)
dc.identifier.citationMulutsi, Nkeng Eva (2017) Implementation of the mental health care act in psychiatric hospitals, University of the Witwatersrand, Johannesburg, <>
dc.rights.holderUniversity of the Witswatersrand, Johannesburg
dc.schoolWits School of Governance
dc.subject.lcshPsychiatric hospitals
dc.subject.lcshMental health laws--South Africa
dc.subject.lcshPsychiatric hospital patients--South Africa
dc.subject.otherSDG-3: Good health and well-being
dc.titleImplementation of the mental health care act in psychiatric hospitalsen_ZA
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