The makings of madness: how is the ‘problem’ of mental health represented in South African health policy?

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Stellenbosch : Stellenbosch University
ENGLISH ABSTRACT: This study critically analyses the problem representations found within South African mental health policy documents. It provides insight as to how mental health is problematised in South African public policy. The study makes explicit the embedded assumptions within the policy, and reveals the context in which mental health is conceptualised. The policy documents used for analysis are: The White Paper for the Transformation of the Health System in South Africa of 1997; the National Mental Health Care Act 17 of 2002; the National Child and Adolescent Mental Health Policy Guidelines of 2003; and the National Mental Health Policy Strategic Framework for 2013-2020. Carol Bacchi’s ‘What’s the problem represented to be?’ (WPR) approach is used as the analytical tool with which to identify the dominant problem represen- tations of mental health. Problem representations are referred to by Bacchi as the explicit and implicit statement of a ‘problem’ in any policy. This analytical tool is based upon Foucauldian, post-structuralist principles that centre around the construction of meaning through discourse and social practices. These principles direct the study in the process of analysing how mental health is shaped by discourse and interventions. The thesis considers the various conceptuali- sations of mental health that frame the context in which mental health is understood. The con- ceptualisation of mental health will greatly influence how it is framed and managed in policy. A review of the research already conducted on South African public policy shows that the focus of the literature is invariably centred around the implementation of the policies and the resulting service delivery gaps. The literature does not examine how mental health is conceptualised and constructed in mental health policy, revealing a gap in the research that this study fills. The critical analysis of the four policy documents reveals five dominant problem representations, namely: the separation of mental health services from general health services; poor intersec- toral collaboration in mental health care services; the disconnect between communities and mental health care services; the link between poverty and mental health problems; and the rights of those with mental health problems being infringed upon. The dominant problem rep- resentations are expressed both explicitly and implicitly. The identification of the dominant problem representations reveals the assumptions that underpin how mental health is problem- atised. The study emphasises the understanding of mental health as a socio-economic problem, providing solutions centred around poverty alleviation and economic development.
AFRIKAANSE OPSOMMING: Hierdie studie ontleed die probleemvoorstellings wat gevind word binne die Suid-Afrikaanse beleidsdokumente oor geestesgesondheid. Hierin word insig verskaf in die manier waarop geestesgesondheid geproblematiseer word in Suid-Afrikaanse openbare beleidsdokumente. Die studie lig die ingeslote aannames binne die beleidsdokumente uit, en onthul die konteks waarin geestesgesondheid begryp word. Die beleidsdokumente wat gebruik word vir ontleding is as volg: The White Paper for the Transformation of the Health System in South Africa of 1997; the National Mental Health Care Act of 2002; the National Child and Adolescent Mental Health Policy Guidelines of 2003; and the National Mental Health Policy Framework for 2013-2020. Carol Bacchi se benadering, ‘What’s the problem represented to be?’ (WPR), is die analitiese instrument wat gebruik is om die oorheersende probleemvoorstellings van geestesgesondheid te ontleed. Probleemvoorstellings word deur Bacchi beskryf as die eksplisiete en implisiete voorstelling van 'n probleem in enige beleid. Hierdie analise instrument is gebaseer op Foucault se poststrukturalisme beginsels wat betekenis deur redevoering en sosiale gewoontes saamstel. Hierdie beginsels rig die studie in die proses van ontleding in hoe geestesgesondheid deur redevoering en ingrypings gevorm word. Die tesis oorweeg die verskeie voorstellings van geestesgesondheid wat die raamwerk verskaf vir die konteks waarby geestesgesondheid verstaan word. Die voorstelling van geestesgesondheid beinvloed in ‘n hoe mate hoe die beleid bestuur en beraam word. 'n Oorsig van die beleide wat reeds op Suid-Afrikaanse beleidsdokumente gedoen is het daarop aangedui dat die brandpunt van die literatuur gesentreer is op die uivoering van die beleide asook die uitlopende probleme in dienslewering. Die literatuur ondersoek nie hoe geestesgesondheid voorgestel en saamgestel is in die beleid nie, en sodoende word ‘n leemte uitgelig in die navorsing wat hierdie studie vul. Die kritiese analise van die vier beleidsdokumente openbaar vyf oorheersende probleemvoorstellings, naamlik: die skeiding van geestesgesondheidsdienste en algemene gesondheidsdienste; die swak intersektorale samewerking in die sorg van geestesgesondheidsdienste; die ontbinding tussen gemeenskappe en geestesgesondheidsdienste; die verband tussen armoede en geestesgesondheidsprobleme; en die regte wat oortree word van hulle wie geestesgesondheidsprobleme het. Die dominante probleemvoorstellings word eksplisiet en implisiet uitgedruk. Die identifisering van die oorheersende probleem openbaar die vooropgestelde idees wat die probleme in geestesgesondheid ondersteun. Hierdie studie beklemtoon die verstandhouding van geestesgesondheid as 'n sosio-ekonomiese probleem, en verskaf oplossings rondom die verligting van armoede asook die ontwikkeling van die ekonomie.
Thesis (MA)--Stellenbosch University, 2021.
Mental health policy -- South Africa, National health services -- South Africa, Public health -- South Africa, Mental health services -- Social aspects -- South Africa, Mental health services -- Economic aspects -- South Africa, UCTD