Searching for people with psychosis in the global south: mapping and establishing a case surveillance system in South Africa (PSYMAP-ZN study).

PURPOSE: Relatively little epidemiological evidence on psychosis from diverse settings in the Global South exists, where many people with untreated psychosis seek help outside of formal health service settings. Here, we report a preliminary mapping study of formal and informal community resources within a catchment area in South Africa that established an infrastructure that could be used to detect a representative sample of individuals with untreated psychosis.

METHODS

PSYMAP-ZN is a 3-year study of incidence, clinical presentation and associated risk factors for untreated psychosis in Msunduzi Municipality in South Africa. We conducted a preliminary mapping study of the region in which we aimed to document all potential providers of care (gatekeepers) in both formal (health services) and informal (folk) sectors, with the purpose of enrolling them in a collaborative case surveillance system. We drew on official sources, local knowledge from key stakeholders and utilised snowballing techniques.

RESULTS

We established a surveillance system which included (a) all secondary mental health and primary care services (b) the majority of informal providers (including traditional health practitioners, religious institutions) and (c) a wide range of key informants.

CONCLUSION

Expanding the global knowledge base on psychosis to diverse settings in the Global South requires a surveillance and case-detection method that includes (in addition to formal health settings) informal settings and local key informant knowledge in the community. This preliminary 'mapping' process established a platform for the ongoing PSYMAP study of untreated psychosis in South Africa.