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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, Rochelle Ann (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. ISSN 1363-4615

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Identification Number: 10.1177/1363461516679056


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.

Item Type: Article
Official URL:
Additional Information: © 2016 The Author
Divisions: International Development
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Date Deposited: 27 Oct 2017 13:51
Last Modified: 16 May 2024 02:23
Projects: MDR179139
Funders: Canadian Institute of Health Records

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