Licensing and regulation of the mental health residential care facilities: A case study from the Sedibeng district, South Africa

The World Health Organization advocates for the regulating of mental health accommodation services to ensure that they use a person-centered approach and promote human rights. However, many low-middle-income countries still face challenges that prevent them from delivering services according to such regulations. In this study, we explore the experiences of regulating mental health residential facilities in one district of South Africa. We conducted a qualitative study using in-depth interviews and observations from October 2022 to June 2023. Our participants were district governance and compliance team members, and managers, staff, residents and their families of three residential facilities. The governance team tried to ensure facilities complied with regulatory standards, assisting them where possible to meet those standards. Managers and family members understood that enforcing regulation will help improve service delivery. However, managers reported that some regulatory standards were more appropriate for hospitals than residential facilities. Facility staff felt neglected and undervalued by the governance team. Residents found the inspection process intrusive. Managers reported that their experience of providing residential services was undervalued in the regulatory process and that the funding for their facilities was insufficient for them to meet current standards. The governance team were aware there was a shortage of residential care facilities so had to decide which facilities to license even when they did not meet current standards. Current inspection, licensing and regulation of mental health residential facilities in South Africa is not yet fit for purpose and may hinder residents to achieve independency and quality of life. Involvement of service users and providers in mental health care planning may help align the licensing regulations to residential care services that are truly community-based.