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An Evaluation of the Health System Costs of Mental

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An Evaluation of the Health System Costs of Mental SEPTEMBER 2019 SEPTEMBER AN EVALUATION OF THE HEALTH SYSTEM COSTS OF MENTAL HEALTH SERVICES AND PROGRAMMES IN SOUTH AFRICA SUMAIYAH DOCRAT, DONELA BESADA AND CRICK LUND THIS PUBLICATION WAS SUPPORTED BY THE ALAN J. FLISHER CENTRE FOR PUBLIC MENTAL HEALTH DEPARTMENT OF PSYCHIATRY AND MENTAL HEALTH UNIVERSITY OF CAPE TOWN SOUTH AFRICA AUTHORS SUMAIYAH DOCRAT1 DONELA BESADA2 CRICK LUND1,3 1. Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa 2. Health Systems Research Unit, South Africa Medical Research Council, Cape Town, South Africa 3. Centre for Global Mental Health, King’s Global Health Institute, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom 1 DISCLAIMER Information presented in this Report is based on best available data derived from primary and secondary sources. Discrepancies between different sources reflect the current quality of mental health systems data. All data should therefore be interpreted carefully and with recognition of potential inaccuracy. The information contained in this publication may be freely distributed and reproduced, provided that the source is acknowledged. Sumaiyah Docrat is a staff member of the University of Cape Town and is supported by the South African Medical Research Council through its Division of Research Capacity Development under the SAMRC National Health Scholars Programme from funding received from the South African National Treasury. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy or views of the University of Cape Town, the South African Medical Research Council or the funders. Suggested citation for this report Sumaiyah Docrat, Crick Lund, & Donela Besada. (2019). An Evaluation of the Health System Costs of Mental Health Services and Programmes in South Africa. University of Cape Town. https://doi.org/10.25375/UCT.9929141 Suggested citation for the accompanying open-access publication Docrat, S., Besada, D., Cleary, S., Daviaud, E., Lund, C. 2019. Mental health system costs, resources and constraints in South Africa: a national survey. Health Policy and Planning. Advance article. Available at: https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czz085/5572608 2 Table of Contents ACKNOWLEDGEMENTS .......................................................................................................... 6 LIST OF ACRONYMS AND ABBREVIATIONS ......................................................................... 7 EXECUTIVE SUMMARY ............................................................................................................ 9 INTRODUCTION ...................................................................................................................... 16 MATERIALS AND METHODS ................................................................................................. 20 Setting ............................................................................................................................................................. 20 Approach and Design ..................................................................................................................................... 20 Data Collection and Data Sources .................................................................................................................. 20 Secondary Data Sources ................................................................................................................................ 24 Data Management and Analysis ..................................................................................................................... 25 Cost Analysis Approach .................................................................................................................................. 25 Analysis of Mental Health Human Resources, Medication AvailaBility and Infrastructure .............................. 29 Ethical and Governmental Approval ............................................................................................................... 30 Assumptions & Limitations .............................................................................................................................. 31 RESULTS ................................................................................................................................. 33 Health System Costs of Mental Health Services and Programmes ................................................................ 33 Per capita mental health spending ................................................................................................................. 36 Proportion of Provincial and National health Budgets spent on Mental health ............................................... 36 Inpatient and Outpatient Mental Health Costs ................................................................................................ 37 Mental Health Readmission Rates and Costs ................................................................................................ 40 Disorder-specific Average Length of Inpatient Admission .............................................................................. 42 Mental Health care Utilization among Adults, Adolescents and Children ....................................................... 45 Mental Health Human Resources ................................................................................................................... 46 District Hospital Infrastructure for Mental Health ............................................................................................ 47 Mental Health Medication AvailaBility ............................................................................................................. 48 MNS Disorder Prevalence and Modelled (Crude) Estimates of Access to Care ............................................ 51 Discussion and Recommendations ...................................................................................... 53 ResuLts and FaciLity-LeveL Data: Eastern Cape ..................................................................... 59 Inpatient and Outpatient Mental Health Care ................................................................................................. 59 Transfers to Contracted Hospitals for Mental Health Care ............................................................................. 60 Transfers to NGOs for Mental Health Care .................................................................................................... 60 Mental Health Medication AvailaBility ............................................................................................................. 62 Facility-level Costing Results 65 Eastern Cape: Inpatient Costs of Mental Health Services By Service Level .................................................. 65 Eastern Cape: Outpatient Costs of Mental Health Services By Service Level ................................................ 70 Eastern Cape: Total Mental Health Inpatient and Outpatient Costs By Service Level ................................... 74 Eastern Cape: Summary Mental Health Inpatient and Outpatient Costs ........................................................ 75 Eastern Cape: Child and Adult Inpatient and Outpatient Costs By Service Leve ........................................... 75 Eastern Cape: Inpatient Costs of Readmission By Service Level ................................................................... 76 ResuLts and FaciLity-LeveL Data: Free State .......................................................................... 77 Inpatient and Outpatient Mental Health Care ................................................................................................. 77 Transfers to Contracted Hospitals for Mental Health Care ............................................................................. 78 Transfers to NGOs for Mental Health Care .................................................................................................... 78 Mental Health Medication AvailaBility ............................................................................................................. 79 Facility-level Costing Results 81 3 Free State: Inpatient Costs of Mental Health Services By Service Level ........................................................ 81 Free State: Outpatient Costs of Mental Health Services by Service Level ..................................................... 84 Free State: Total Mental Health Inpatient and Outpatient Costs By Service Level ......................................... 87 Free State: Summary Mental Health Inpatient and Outpatient Costs ............................................................. 87 Free State: Child and Adult Inpatient and Outpatient Costs By Service Level ............................................... 88 Free State: Inpatient Costs of Readmission By Service Level ........................................................................ 88 ResuLts and FaciLity-level Data: Gauteng ............................................................................. 89 Inpatient and Outpatient Mental Health Care ................................................................................................. 89 Transfers to Contracted Hospitals for Mental Health Care ............................................................................
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