Integrating services, marginalizing patients: psychiatric patients and primary health care in South Africa

In keeping with international trends, South African health policy is moving towards comprehensive primary health care, with mental health care offered as integral to this service. This move is consonant with other moves towards integration in a formerly divided country. We consider some ideological bases for the move towards integration and the consequences for psychiatric patients. We show how the specialist terrain of the mental health nurse has been recast as focusing primarily on violence, substance abuse and HIV/AIDS rather than on psychiatric care. Using case material to illustrate our argument we suggest that integrating mental health care into primary health care system may have unintended negative consequences for patients. The argument has implications for services in other poorly resourced and post conflict societies.