Utilising clinical associates to address mental health service provision challenges in South Africa : the views of healthcare managers and providers

Abstract

BACKGROUND : A constraint in South Africa’s mental health system is the human resources required to provide services. Given the shortage of specialist mental health professionals, the use of non-specialists such as clinical associates in mental health task-sharing is essential. The study aimed to explore the views of health managers, doctors, and nurses in four districts of South Africa on the scale of mental illness seen in their health services, their human resources challenges, and their attitudes towards mental health task-sharing involving clinical associates. METHODS : Focus group discussions were conducted in one district in each of the four provinces where clinical associates were known to be employed. Focus group participants were purposively sampled to ensure that each focus group consisted of a combination of managers and healthcare professionals from hospital and primary health care levels. Audio recordings were transcribed, and thematic analysis was conducted. RESULTS : A total of 29 individuals participated. Four themes emerged from the focus group discussions. The first theme to emerge was ‘mental illness is not going away’ with substance use, increasing numbers of younger patients, and high rates of relapse and readmission accounting for this. The second theme identified was ‘the health system cannot cope with mental illness’ as mental health had not been prioritised and this had resulted in a lack of mental health units and beds, deficiencies at primary health care level, and human resources for mental health challenges. The third theme was ‘clinical associates could be part of the remedy’ based on past experience in other disciplines but constraints such as their scope of practice would need to be addressed. The final theme identified was ‘specialised clinical associates could help mend the mental health system’ but this would require a review of employment policies and a clarification of their roles. CONCLUSIONS : Mental health is a significant and expanding concern. Clinical associates could help alleviate human resource constraints in mental health with enhanced undergraduate and advanced training. However, overcoming structural barriers such as scope of practice, regulatory issues, and creation of posts will be crucial to realise their potential contribution.