Comprehensive integrated primary mental health care for South Africa. Pipedream or possibility?

While the vision for restructuring health care in South Africa is based on a comprehensive primary health care system, care at the primary level remai ns largely biomedical in orientation. Given this, I argue that whilst addin g mental health care to primary level care may increase accessibility of ps ychiatric care, it will not, however, provide for comprehensive integrated primary mental health care as planned. This would require a paradigm shift towards a comprehensive discourse of care which includes mental health care . While efforts towards reorienting health care personnel in South Africa t owards the primary health care approach have been initiated, an examination of the primary health care system in one sub-district in South Africa, rev eals that the delivery of biomedical care is sustained by a number of facto rs within the primary health care system as well as within the macro-contex t. A shift in the paradigm of care provided would therefore require the tra nsformation of the system on many fronts. Of central importance would be th e restructuring of the primary health care system to be supportive of emoti onal labour, health promotion, empowerment of service users and of care whi ch takes the subjectivity of the illness experience for the patient into ac count. (C) 2000 Elsevier Science Ltd. All rights reserved.