A systematic review of mental health care access in disadvantaged communities in South Africa

Abstract

Background: Access to mental healthcare in disadvantaged rural communities in South Africa faces numerous challenges, particularly due to cultural beliefs that impact help-seeking behaviours. Systematic reviews provide critical insights into the barriers and facilitators of healthcare access in such contexts. This review aims to evaluate the available literature on mental healthcare access in rural South African communities, with a specific focus on the influence of cultural beliefs on help-seeking behaviours. Methods: A systematic search was conducted across databases, including PubMed, Scopus, and Web of Science, to identify studies published between 2010 and 2023. Studies were included if they examined barriers to mental healthcare access in rural South African settings and involved culturally relevant factors. Screening, selection, and appraisal of studies were carried out using PRISMA guidelines, with data extracted and synthesized through qualitative thematic analysis. Results: A total of 24 studies met the inclusion criteria. Key findings identified barriers such as financial constraints, scarcity of mental health facilities, stigma, long distances to services, language barriers, and cultural beliefs. Cultural practices, such as attributing mental distress to witchcraft or ancestral displeasure, were found to influence perceptions of mental health and discourage professional intervention, with traditional healers and community elders frequently being the preferred resource. Some community members, despite limited knowledge, utilized smartphones for mental health applications, while others relied on traditional practices and community support networks. Conclusion: This review underscores the need for a culturally sensitive, integrated approach to mental healthcare in rural South Africa, blending traditional and modern practices. Recommendations include conducting rural needs assessments, fostering collaboration between mental health practitioners and traditional healers, and enhancing teacher training.