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Policy, power, stigma and silence: Exploring the complexities of a primary mental health care model in a rural South African setting

Burgess, RA; (2016) Policy, power, stigma and silence: Exploring the complexities of a primary mental health care model in a rural South African setting. Transcultural Psychiatry , 53 (6) pp. 719-742. 10.1177/1363461516679056. Green open access

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Abstract

The Movement for Global Mental Health’s (MGMH) efforts to scale up the availability of mental health services have been moderately successful. Investigations in resource-poor countries like South Africa have pointed to the value of an integrated primary mental health care model and multidisciplinary collaboration to support mental health needs in underserved and underresourced communities. However, there remains a need to explore how these policies play out within the daily realities of communities marked by varied environmental and relational complexities. Arguably, the lived realities of mental health policy and service delivery processes are best viewed through ethnographic approaches, which remain underutilised in the field of global mental health. This paper reports on findings from a case study of mental health services for HIV-affected women in a rural South African setting, which employed a motivated ethnography in order to explore the realities of the primary mental health care model and related policies in South Africa. Findings highlighted the influence of three key symbolic (intangible) factors that impact on the efficacy of the primary mental health care model: power dynamics, which shaped relationships within multidisciplinary teams; stigma, which limited the efficacy of task-shifting strategies; and the silencing of women’s narratives of distress within services. The resultant gap between policy ideals and the reality of practice is discussed. The paper concludes with recommendations for building on existing successes in the delivery of primary mental health care in South Africa.

Type: Article
Title: Policy, power, stigma and silence: Exploring the complexities of a primary mental health care model in a rural South African setting
Open access status: An open access version is available from UCL Discovery
DOI: 10.1177/1363461516679056
Publisher version: http://doi.org/10.1177/1363461516679056
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: ethnography, global mental health, primary health care, South Africa, women’s mental health
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
URI: https://discovery.ucl.ac.uk/id/eprint/10055796
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