Health Systems Performance Monitoring of Mental Health Services in South Africa Using Routine Public Sector Data
1
Research and Implementation Sciences, Health Systems Trust, Durban, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A1785
ABSTRACT
BACKGROUND:
Mental disorders and suicidal behaviour contribute substantially to South Africa’s disease burden, yet mental health service utilisation remains low. Despite high prevalence of mood, anxiety, and substance use disorders, public sector service use is limited and varies provincially.(1) District Health Barometer (DHB) data capture key mental health indicators, including visits, involuntary admissions, caseloads, and suicide attempt presentations,(2,3) providing insights into workload, access, and utilisation. However, their use for district-level performance assessment is under-explored, and data quality limitations constrain planning and evaluation.(2) This study examined mental health system performance across districts over five years.
METHODS:
We analysed mental health indicators from 2018/19–2024/25, including adult and child/adolescent visits, involuntary admissions, caseloads, and suicide attempt presentations (<18 and ≥18 years). Indicators were standardised to population denominators and analysed by district. League tables and trend graphs assessed rankings and change over time. Age-stratified analyses compared children/adolescents and adults. Performance patterns were interpreted using a health systems framework emphasising access, equity, and capacity.
RESULTS:
Substantial variation was observed across districts. Caseloads remained below 5%, with slight increases in Mangaung (FS) and Capricorn (LP). Most districts served fewer than 50 000 clients, while higher volumes were seen in eThekwini (KZN), Cape Town (WC), Nelson Mandela Bay (EC), Ekurhuleni, Johannesburg, and Tshwane (GP). Suicide data were limited; adult rates exceeded child/adolescent rates, with increases in Mopani (LP), Ehlanzeni (MP), and OR Tambo (EC). Involuntary admissions remained under 200 per district, increasing in JT Gaetsewe (NC) and uMkhanyakude (KZN) independent of caseload, and declining in Capricorn (LP) alongside reduced caseload.
CONCLUSIONS:
Between 2018/19 and 2024/25, mental health service utilisation increased slowly but remained concentrated and inequitable. Persistent age- and geography-related disparities, particularly among children and adolescents, and uneven suicide-related outcomes highlight ongoing inequities and the uneven distribution of services, indicating urgent policy attention.
Mental disorders and suicidal behaviour contribute substantially to South Africa’s disease burden, yet mental health service utilisation remains low. Despite high prevalence of mood, anxiety, and substance use disorders, public sector service use is limited and varies provincially.(1) District Health Barometer (DHB) data capture key mental health indicators, including visits, involuntary admissions, caseloads, and suicide attempt presentations,(2,3) providing insights into workload, access, and utilisation. However, their use for district-level performance assessment is under-explored, and data quality limitations constrain planning and evaluation.(2) This study examined mental health system performance across districts over five years.
METHODS:
We analysed mental health indicators from 2018/19–2024/25, including adult and child/adolescent visits, involuntary admissions, caseloads, and suicide attempt presentations (<18 and ≥18 years). Indicators were standardised to population denominators and analysed by district. League tables and trend graphs assessed rankings and change over time. Age-stratified analyses compared children/adolescents and adults. Performance patterns were interpreted using a health systems framework emphasising access, equity, and capacity.
RESULTS:
Substantial variation was observed across districts. Caseloads remained below 5%, with slight increases in Mangaung (FS) and Capricorn (LP). Most districts served fewer than 50 000 clients, while higher volumes were seen in eThekwini (KZN), Cape Town (WC), Nelson Mandela Bay (EC), Ekurhuleni, Johannesburg, and Tshwane (GP). Suicide data were limited; adult rates exceeded child/adolescent rates, with increases in Mopani (LP), Ehlanzeni (MP), and OR Tambo (EC). Involuntary admissions remained under 200 per district, increasing in JT Gaetsewe (NC) and uMkhanyakude (KZN) independent of caseload, and declining in Capricorn (LP) alongside reduced caseload.
CONCLUSIONS:
Between 2018/19 and 2024/25, mental health service utilisation increased slowly but remained concentrated and inequitable. Persistent age- and geography-related disparities, particularly among children and adolescents, and uneven suicide-related outcomes highlight ongoing inequities and the uneven distribution of services, indicating urgent policy attention.
| eISSN: | 2654-1459 |
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