ORIGINAL ARTICLES

‘Mental health is an integral and essential component of health.’1 Neuropsychiatric disorders contribute significantly to disability and health care cost in society,2 and rank third in their contribution to burden of disease in SA.3 To ensure adequate access and treatment for mental health care users (MHCUs), human, social and financial resources are necessary.4 Internationally, 32 % of 191 countries surveyed did not have a specified budget for mental health,5 and 36% of countries spent less than 1 % of their total health budgets on mental health.6 Scarce resources, inequity of distribution and inefficiency of resource use characterise mental health services in low- and middle-income countries.1 Mental health was a low priority on South Africa’s public health agenda, the lack of an action plan being one of the shortcomings.7 Historically, mental health services in KwaZulu-Natal (KZN) had been centred on a few large mental hospitals and stand-alone clinics. The Mental Health Care Act No. 17 of 2002 (the Act)8 introduced radical changes. Selected regional and district public hospitals were designated under the Act to perform 72-hour observations on involuntary and assisted MHCUs. These ‘designated hospitals’ (DHs) would ensure increased accessibility and availability of mental health care services locally and reduce the need for premature or unnecessary transfers to psychiatric hospitals, as well as allowing screening for medical conditions presenting as psychiatric disorders, which could be as high as 24.2%.9 KZN has 8 specialist psychiatric and 63 district and regional hospitals; 50 (70.4%) of the district and regional hospitals have been designated to provide mental health services and admit involuntary and assisted MHCUs for 72-hour observations. Local stakeholders have raised concerns that this ‘designation’ has not been accompanied by a dedicated budget, implementation plan or increase in staff and facilities. Petersen expressed concern that de-institutionalisation and comprehensive integrated mental health care in South Africa were hampered by a lack of resources for mental health care as well as the inefficient use of existing mental health resources.10 In KZN, 0.03 % of the total health budget is spent on mental health, a figure that has not increased in the last decad