A Scoping Review of Mental Health Needs and Challenges among Medical Students within South African Universities

The mental health of medical students is a growing concern worldwide, with studies indicating high levels of stress, anxiety, and depression among this population. In a South African context, this review aims to review the existing literature on mental health needs and challenges among medical students in South Africa. The rationale for this review is crucial to identify gaps, understand unique contextual factors, and inform the development of targeted interventions and support tailored to the specific needs of South African medical students. This review followed a scoping review framework by Arksey and O'Malley which consists of five stages. The review was initiated in December 2023. The search process was conducted on the following electronic databases: PubMed, Psych-info, Scopus, Google Scholar, and Science Direct. The search terms of this review were "Medical students" OR "Mental health", OR "Challenges", OR "South Africa", OR "Universities" OR "Needs", OR "Support systems", OR "Mental health interventions". This study included articles published in English between 2010 and 2023. After a thorough review of the literature, only eight articles met the inclusion criteria. This study excluded articles that were not published in English, articles published before 2010, full-text articles that could not be retrieved, and studies that did not address the mental health needs and challenges faced by medical students and risk factors contributing to mental issues among South African medical students. The review yielded only three themes utilizing Creswell's Tesch method of data analysis. (1) Prevalence of mental health disorders, (2) risk factors contributing to poor mental health, and (3) available university support systems and interventions. Therefore, the unique aspect of our review lies in shedding light on the underexplored intersections between mental health and the unique context of medical education in South Africa. This includes examining the impact of historical, cultural, and institutional factors on the mental health and well-being of medical students, which has not been comprehensively addressed in previous literature in terms of the South African context. The findings of this review highlight the importance of implementing comprehensive mental health support programs within medical education institutions to address the needs of students and promote their well-being.

Looking back to move forward: a scoping review of counselling psychology in South Africa

Despite that counselling psychologists represent a substantial group of registered psychologists in South Africa, literature specifically on the sub-speciality within the country is limited. The aim of this scoping review was to provide a comprehensive summary of the literature available on counselling psychology in South Africa and examine the extent to which literature is available from a lifespan or career-stage perspective. Three electronic databases (EBSCOhost, Sabinet®, and PubMed) were searched for articles published between 2000 and 2021. Titles and abstracts were reviewed, and data extracted and synthesised thematically. Of 507 citations identified, 10 met the inclusion criteria. Findings indicate that literature on counselling psychology in South Africa is scarce, subject to methodological limitations, and dominated by a small number of authors conducting multiple analyses on the same sets of data. Furthermore, literature on counselling psychologists at key career stages across the professional lifespan is largely missing from the professional discourse. Emphasis is instead placed on counselling psychology as embedded in the sociopolitical history of South Africa, professional identity, the contemporary status of the profession, professional threats and challenges, and the profession’s future promise. Our review highlights the need for more empirically informed studies making use of different methodologies, involving multiple authors with diverse backgrounds, tracking employment trends, and soliciting first-person accounts of counselling psychologist’s experiences at key career stages. Without doing so, ideas about how best to support and utilise this particular group of practitioners may be misguided, in turn compromising the successful provision of mental health care within the country.

The experiences and perceptions of mental health service provision at a primary health centre in the Eastern Cape

Background

Since 1994, the South African healthcare system has undergone several changes to meet the needs of contemporary South Africa. Yet the state of mental healthcare, especially in low-resource areas, remains in a precarious state.

Aim

This study aimed to explore how persons diagnosed with a mental disorder experience and perceive mental health services in a low-resource community in the Eastern Cape, South Africa.

Setting

The study was conducted at a primary care clinic in a low resource community setting in the Eastern Cape, South Africa.

Method

Semi-structured interviews were conducted with eight participants diagnosed with mental illness who had been accessing treatment for at least the past 6 months from a primary health clinic. Thematic analysis was used to analyse and identify pertinent themes.

Results

The following themes emerged from the data: (1) perceptions of mental disorders – role of culture, (2) experiences of having mental disorders – loss of employment, (3) problem of stigma – social rejection and labelling, (4) experience of distress – sadness and frustration and (5) challenges in accessing treatment – transport fee and shortage of staff.

Conclusion

This study yielded several lived experiences and perceptions in relation to participants’ feelings, opinions and interpretations of persons living with mental disorders and accessing mental health treatment in their local context. Future interventions should consider provision of more extensive professional help in the form of counsellors and social workers at the clinics, more efficient service delivery and future interventions regarding stigma should incorporate community members into the learning process.

Sociopolitical, Cultural, and Historical Contexts That Influence Counseling Practice in Four Countries

In this article, we provide examples of how historical and sociopolitical events have shaped the development of psychology and psychological services in Iceland, South Africa, Thailand, and Turkey. These examples are offered to (a) enhance international competencies related to the countries’ cultures, ecological system, and subsystems, and (b) inspire counseling psychologists to collaborate with colleagues around the world on efforts to indigenize psychology paradigms and promote accessible service delivery systems. Common themes across these countries indicated that (a) provision of psychological services is highly influenced by the biomedical model of mental health, (b) access to mental health care is influenced by cost and stigma, and (c) a limited connection exists between traditional healing practices and Western-based diagnostic and mental health services. In all countries there was a struggle for greater recognition of psychological services; in Iceland, Thailand, and Turkey, counseling psychology is not recognized as a legally sanctioned profession. Suggestions are offered for internationally competent counseling psychologists who intend to promote the provision of culturally responsive psychological services worldwide.

Comparing clinical and counselling psychologists’ practitioner demographics, key activities, theoretical orientations, values, and career satisfaction: a contribution to the Scopes of Practice debate

This article conducts a secondary analysis of combined survey data collected from clinical and counselling psychologists in South Africa with a view to contributing to the debate about their respective Scope of Practice. A comparison of clinical and counselling psychologists’ activities, where and how they are doing these activities and with what emphasis, as well as the similarities and differences between these categories with respect to demographic variables of their practitioners, values and career satisfaction, and views of their respective Scopes of Practice should provide guidance for the future regulation of both categories. In total, 1105 participants’ (comprising 877 registered clinical psychologists and 228 registered counselling psychologists) survey responses were analysed. Findings suggest that counselling and clinical psychologists are more similar than they are different, with responses indicating shared demographic characteristics, areas of overlap in terms of their key activities and theoretical orientations, and their satisfaction with their training and careers. Significant differences, where they did occur, included the race and gender of practitioners; time spent on assessment and research; emphasis on psychodynamic orientations; endorsement of values; views on the Scopes of Practice regulations that were promulgated in 2011; and in each specialties sense of distinctiveness. Findings are discussed in the context of vigorous contestation over the Scopes of Practice in South Africa, where access to mental health services remains poor and the profession largely untransformed.

Counselling Psychology in South Africa

The origin and development of counselling psychology in South Africa has been profoundly influenced by the country's socio-political history and the impact of apartheid. As a result of this, counselling psychologists in the country face a number of challenges and opportunities for the future. In this paper we provide a portrait of counselling psychology in South Africa by describing the current character of the specialty and the context in which South African psychologists work. We critically discuss the challenges that the specialty faces to meet the country's mental health care needs, contest the current Scope of Practice; affirm multiculturalism without essentializing or reifying race and ethnicity, and build an evidence base for community interventions in the country. We also consider how, in the future, counselling psychologists in South Africa may make a more meaningful contribution within public health and the country's health care and education systems.