Medscheme Mental Health Programme

Introduction: Roughly 30% of the South African population will suffer from a mental disorder in their lifetime (1). Between 76% and 85% of people with severe mental disorders receive no treatment for their disorder in low-income and middle-income countries (2), such as South Africa. The bulk of mental health care delivery in South Africa has historically been separated from general health care and centered on specialist care provided at psychiatric hospitals, with little attention to mental health care in the primary setting (3). This is currently perpetuated by the hospicentric Prescribed Minimum Benefits, a legislated private sector funding package with inadequate coverage for mental health care in community-based settings. With only 1.2 psychiatrists to every 100 000 people (4) in South Africa, and fewer than 400 psychiatrists practicing in the private health care sector which services nearly 9 million people, specialist care is not a viable solution to this growing problem with far-reaching health and social consequences. The lack of access to good quality ambulatory mental health care ultimately leads to complications, poorly controlled comorbidities, and costly hospitalisations, which increase the strain on health care funding resources.Short Description of Practice Change Implemented: The Medscheme Mental Health Programme follows an internationally successful model of integrating mental health care into the primary care setting through effective collaboration between general practitioners, specialists, and auxiliary caregivers, and the introduction of a care manager to help coordinate the process. This, along with general practitioner training, decision support, an alternative reimbursement model, and additional insured benefits for ambulatory care, creates the necessary structure to allow the busy general practitioner to deliver and coordinate good quality, patient-centered care, which includes mental health care. Often the first port of call for sufferers of mental illness who do present for care, the general practitioner is ideally placed at the coalface of primary care delivery to promote the integration of mental health care. There is, however, under-recognition of mental illness in the primary care setting (5) (6), and a general inertia to objectively review and change treatment plans in general practice (7) (8). The concept of treatment-to-target in mental health care employs the use of validated symptom score trackers to monitor response to