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South African mental health care service user views on priorities for supporting recovery: implications for policy and service development

Purpose: The paper documents the views of South African mental health care service users on policy directions and service developments that are required to support their recovery. Method: Semi-structured interviews were conducted with forty service users and service user advocates. A framework analysis approach was used to analyse the qualitative data. Results: Service user priorities included addressing stigma, discrimination and disempowerment, and the links between mental health and poverty. They suggested that these challenges be addressed through public awareness campaigns, legislative and policy reform for rights protection, development of a national lobby to advocate for changes, and user empowerment. Users suggested that empowerment can be facilitated through opportunities for improved social relatedness and equitable access to social and economic resources. Conclusions: This study suggests three strategies to bridge the gap between mental health care service users rights and needs on one hand, and unsupportive attitudes, policies and practices on the other. These are: giving priority to service user involvement in policy and service reform, creating empathic alliances to promote user priorities, and building enabling partnerships to effect these priorities. Implications for Rehabilitation People living with psychosocial difficulties have a right to involvement in policy and service development, and their involvement has value for their recovery. The range of priorities people living with psychosocial difficulties identify as policy and service priorities to support their recovery requires policy makers and practitioners to work within a development, not an illness-focused approach. Policy implementers and practitioners need support to transform their ideological and practice framework from that of expert to that of enabler of service user involvement in treatment decisions, and public policy research and service development.