This article summarizes the findings of a consultation process initiated at the 25th congress of the Psychological Society of South Africa in September 2019 to submit a response to the national public participation process on the National Health Insurance Bill, 2019. While the Psychological Society of South Africa supports the overall purpose of the Bill, to provide universal health coverage in South Africa, this article critically discusses eight core concerns related to the Bill, including the need to: (1) integrate mental health more effectively into the National Health Insurance Bill; (2) ensure equitable access to health services for all people; (3) improve human resources for mental health; (4) clarify accreditation standards and contractual conditions for service providers; (5) improve utilization of private practitioners within an integrated health system; (6) include mental health expertise in the advisory structures of the National Health Insurance Bill; (7) set out a robust accountability framework within the National Health Insurance Bill; and (8) include mental health indicators in the National Health Insurance information system. Taken together, this article contributes to the ongoing deliberations about strengthening the National Health Insurance system to ensure that it is responsive to mental health care needs.

The investigators aimed to understand the unmet needs of adults with cerebral palsy (CP) living in urban South Africa and to ascertain similarities or differences to typically developing (TD) adults in the same community. Participants were interviewed with an adapted version of the Southampton Needs Assessment Questionnaire (SNAQ). Non-parametric statistical analysis was utilised for quantitative data and qualitative data were analysed using free coding to identify themes. Thirty adults with CP (median age 34.8 years; GMFCS levels I/II/III/IV/V: n = 6/6/5/7/6; socio-economic status (SES) low/average/high: n = 8/17/5) were matched for gender, age, and SES. Adults with CP reported a higher unemployment rate and lower level of satisfaction with access to health services than TD peers. Core themes identified by the participants with CP that made community participation more difficult were physical capacity, poor access to accommodation, transport and health services, lack of socialising opportunities, poor universal design, and lack of financial independence. Adults with CP reported experiencing many challenges in their communities. Improved access to health care services and transport, and the universal design of housing and community buildings to accommodate individuals with a disability should be made a priority.

This study investigated strategies for people with intellectual disabilities to self-advocate for inclusion of their priorities in social policy processes in South Africa. Method: Self advocacy strategies were identified through a scoping literature review, a review of self advocacy toolkits and semi structured interviews with people with intellectual disabilities and other stakeholders working at non-governmental and disabled people’s organisations. These data sources were triangulated to identify strategies to upskill and support young adults with intellectual disabilities to share their opinions and perspectives to deepen the diversity of voices engaged in social policy advocacy. Results: Data triangulation identified three core strategies for self advocacy, in person, written strategies and engagement through social media. Discussion: Inclusion of people with intellectual disabilities in civic and political life is crucial, and will only be achieved if self advocates are accepted into the policy-making arena. The cycle of perpetuating exclusion needs to be disrupted, to give people with an intellectual disabilities a say in policy decisions that have an impact on their lives. Conclusion: Adopting strategies which enable the inclusion of the voices of people with intellectual disabilities in civic activities holds potential for diversifying perspectives brought to public participation in policy development and implementation, which is currently primarily the domain of non-disabled citizens.

Aim: This paper synthesises the latest evidence on child and adolescent mental health in South Africa, arguing that early investments therein are essential for breaking the inter-generational cycle of violence, poverty, discrimination, and mental ill-health, and identifying opportunities for intervention and systems-strengthening both within and outside the healthcare system. Method: The paper draws on a range of evidence to explore the epidemiology of child and adolescent mental disorder and its social determinants. It emphasises the need to support children and families across the continuum from prevention and early intervention through to specialised mental health services, and examines how to enhance the use of schools and health facilities to support children and families. Findings: Fifty per cent of mental disorders have their onset before the age of 14, so it is vital to intervene early in the life-course to promote optimal mental health. An estimated 17% of South Africa’s children have a diagnosable and treatable mental disorder, yet only one in 10 are able to access care, with specialist child and adolescent mental health services being concentrated in a handful of urban centres. Therefore, innovative approaches, such as the Western Cape’s child and adolescent mental health service-strengthening project, are required to bring services and support closer to home. Conclusion: Outreach, training and task-shifting have the potential to build the capacity of frontline workers at primary care level and should be rendered with a child- and family-centred approach, including adult services, to focus attention on the vulnerability and care needs of children of parents with mental disorders. It is also essential to strengthen support for children and families through improving access to social assistance, parenting programmes and health-promoting schools.