Bed/population ratios in South African public sector mental health services

Background In post-apartheid South Africa, mental health service planners face critical decisions regarding appropriate and affordable inpatient care. Before a fashion of deinstitutionalisation is followed blindly in South Africa, effective community services should be in place and sufficient psychiatric beds should remain in hospitals for those who cannot be catered for in the community. In order to maintain the delicate balance between hospital and community-based services, it is essential that useful indicators of inpatient care are established. This study documents current bed/population ratios per 100000 population in public sector mental health services in South Africa. Method A questionnaire was distributed to provincial mental health coordinators requesting psychiatric bed numbers in acute and medium-long stay facilities across all service levels. The information was supplemented by consultations with mental health coordinators in each of the nine provinces. Population data were obtained from preliminary findings of the 1996 census. Results For acute facilities, the mean bed/population ratio was 13 (provincial range: 6-18) per 100000 population. For medium-long stay facilities, it was 16 (provincial range: 0-29) excluding contracted facilities, and 35 (provincial range: 0-83) including contracted facilities per 100000 population. Conclusions There were low levels of inpatient service provision in South Africa, and there was considerable variability between provinces. This study gives further support to the need to develop acute inpatient psychiatric services, reduce levels of chronic care where appropriate, and redirect resources towards the development of community-level residential and day-care services. It is crucial to develop accurate indicators to monitor this process.