Understanding the local context for the application of global mental health: a rural South African experience

Received 16 August 2012; revised 23 November 2012; accepted 10 December 2012Background: The global mental health movement has supplied ample evidence of treatment gaps for mentalhealth care in low and middle-income countries. It is also clear that substantial progress has been made indeveloping an evidence base for innovative treatments which have been shown to work. It is only throughrich and detailed understandings of local contexts and individual experiences that the challenges globalmental health faces can be fully appreciated.Methods: In this article, we use a single, qualitative case study from one context and of one family affected bymental disorder. This is to elucidate core issues which we regard as key to further developments in the globalmental health agenda.Results: Core issues are poor mental health literacy, transport and lack of outreach, limitations of formal healthcare, challenges at the interface with indigenous health care and lack of follow-up and rehabilitation.Conclusion: We propose shifting the focus of mental health care from cure to promotion and prevention, usingan interdisciplinary team of lay and trained health workers from the professional, folk and popular sectors. Thechallenges are complex, as this small study shows, but it is only by looking closely at local conditions that it ispossible to develop interventions which are contextually appropriate and make optimal use of local resources.Keywords: Mental disorder, Mental health service, Rural, Poverty, South Africa, Community mental health