PMID- 28317469
OWN - NLM
STAT- MEDLINE
DCOM- 20180131
LR  - 20180306
IS  - 1461-7471 (Electronic)
IS  - 1363-4615 (Linking)
VI  - 53
IP  - 6
DP  - 2016 Dec
TI  - Policy, power, stigma and silence: Exploring the complexities of a primary mental 
      health care model in a rural South African setting.
PG  - 719-742
LID - 10.1177/1363461516679056 [doi]
AB  - 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.
FAU - Burgess, Rochelle Ann
AU  - Burgess RA
AD  - London Metropolitan University; University of Kwa-Zulu Natal; London School of 
      Economics.
LA  - eng
GR  - CIHR/Canada
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Transcult Psychiatry
JT  - Transcultural psychiatry
JID - 9708119
SB  - IM
MH  - Adult
MH  - Health Policy/*legislation & jurisprudence
MH  - Humans
MH  - Mental Disorders/*ethnology/therapy
MH  - Mental Health Services/*organization & administration
MH  - Primary Health Care/*organization & administration
MH  - *Rural Population
MH  - *Social Stigma
MH  - South Africa/ethnology
MH  - Women's Health/*ethnology
OTO - NOTNLM
OT  - South Africa
OT  - ethnography
OT  - global mental health
OT  - primary health care
OT  - women's mental health
EDAT- 2017/03/21 06:00
MHDA- 2018/02/01 06:00
CRDT- 2017/03/21 06:00
PHST- 2017/03/21 06:00 [entrez]
PHST- 2017/03/21 06:00 [pubmed]
PHST- 2018/02/01 06:00 [medline]
AID - 10.1177/1363461516679056 [doi]
PST - ppublish
SO  - Transcult Psychiatry. 2016 Dec;53(6):719-742. doi: 10.1177/1363461516679056.