Objective. To develop, implement and evaluate a referral system to facilitate access to and co-ordination of care in a restructured mental health system designed to provide comprehensive, integrated and community-based mental health care.Setting. The study was conducted in the semi-rural area of KwaDedangendlale, KwaZulu-Natal.Subjects. Participants in this study comprised both formal and 'informal' service providers within the existing mental system of the KwaDedangendlale area.Design. In order to develop the system an analysis of the existing mental health system was conducted using a variety of methods, including focus group interviews, individual interviews and file audits. Participants were involved in the development of a restructured mental health system which identified community health workers as being well placed to perform the triad function of case identification, referral and co-ordination of community-based care of the mentally ill. A file audit of referral books developed for community health workers was used to evaluate the efficacy of the referral system that was implemented to facilitate this triad function.Outcome measures. The number of referrals made by community health workers and back-referrals from health professionals as well as how adequately the referral forms were filled out were used as outcome measures.Results and conclusions. The efficacy of the referral and information management system implemented to facilitate the identified triad function of community health workers was hampered by a lack of co-operation by health care professionals at other points within the system as well as poor motivation on the part of community health workers themselves. This was attributed, in part, to the lack of clarity at a provincial level on the roles and functions of community health workers within the health care system. Furthermore, this study highlighted the need to sensitise health professionals to the importance of community health workers and other community care-givers in the provision of a community-based mental health care system, especially in rural and semi-rural areas.
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