Closing the mental health treatment gap in South Africa: a review of costs and cost-effectiveness

Abstract

BackgroundNearly one in three South Africans will suffer from a mental disorder in his or her lifetime, a higher prevalence than many low- and middle-income countries. Understanding the economic costs and consequences of prevention and packages of care is essential, particularly as South Africa considers scaling-up mental health services and works towards universal health coverage. Economic evaluations can inform how priorities are set in system or spending changes.ObjectiveTo identify and review research from South Africa and sub-Saharan Africa on the direct and indirect costs of mental, neurological, and substance use (MNS) disorders and the cost-effectiveness of treatment interventions.DesignNarrative overview methodology.Results and conclusionsReviewed studies indicate that integrating mental health care into existing health systems may be the most effective and cost-efficient approach to increase access to mental health services in South Africa. Integration would also direct treatment, prevention, and screening to people with HIV and other chronic health conditions who are at high risk for mental disorders. We identify four major knowledge gaps: 1) accurate and thorough assessment of the health burdens of MNS disorders, 2) design and assessment of interventions that integrate mental health screening and treatment into existing health systems, 3) information on the use and costs of traditional medicines, and 4) cost-effectiveness evaluation of a range of specific interventions or packages of interventions that are tailored to the national context.

Mental Health in low-and middle income countries (LMICs): Going beyond the need for funding

“…Most people with psychiatric problems or serious mental illness who seek care and are able to access mental health services are hospitalised in LMICs, accounting for the high demand of a limited number of psychiatric hospital beds [31,32]. There have been reports of inhumane treatment of mental health service users particularly with isolation, detention [33].…”

Access and rational use of psychotropic medications in low- and middle-income countries

“…Psychotropic medications however, often may not fulfil the criteria for emergency or life-threatening treatment. The decision for governments to fund medications in low-and middle-income countries can also frequently be a difficult one, due to the lack of local evidence regarding their costeffectiveness compared with research in higher-income countries (Patel et al 2007b;Jack et al 2014).…”

The effect of cash transfers on mental health – new evidence from South Africa

“…Our findings of strong positive effects of a UCT on mental health in South Africa have important implications for policies in LMICs. Firstly, UTCs have strong potential to reduce depressive symptoms among poor populations which is important in settings such as South Africa where unipolar depression is the main contributor among mental diseases to the overall burden of disease [21]. Secondly, in the South African context, population wide improvements in mental health could show significant effects on HIV-prevalence, due to the strong positive correlation between the two [29].…”

“…The CSG is South Africa's largest social cash transfer programme and a long-term UCT programme. We focus on South Africa in the analysis for the high prevalence of mental health disorders in the country, with one in six of the population suffering from depression or anxiety [35].Unipolar depression has the highest prevalence of all mental illnesses among the South African population contributing to 5.8% of the overall burden of disease, which is 1.5 times higher compared to other Low-and Middle-Income Countries (LMICs) [21].…”