**2. Mental health care status of rape survivors diagnosed with PTSD and depression in South Africa**

PTSD and depression are common among survivors seeking health care in Thuthuzela Care Centres post-rape experiences in South Africa [5, 9]. Several studies reported poor integration of mental health care services for rape survivors seeking treatment in Thuthuzela Care Centres in South Africa [5, 17, 18]. Many factors affect the integration of mental health services for rape survivors seeking help in Thuthuzela Care Centres. One of the factors is a significant mismatch in South Africa between the scope of the Childhood Sexual Abuse (CSA) problem and the expected psychological and the availability of services for children [9]. Despite this, the Republic of South Africa documented that all children survivors of CSA are required to get therapeutic care under the Children's Amendment Act [19]. Nevertheless, data suggest that very few children have access to or are referred to specialized services to mitigate the possible detrimental impacts of abuse [11, 20]. Furthermore, one study reported that adult rape survivors who reported rape in Thuthuzela Care Centres were not given follow-up care to screen and manage PTSD post-rape experiences [10].

Apart from that, mental health care management for rape survivors diagnosed with PTSD and depression requires about 12 sessions with the therapist when using treatment modalities such as cognitive behavioral therapy (CBT), exposure therapy (ET), and cognitive processing therapy (CPT), etc. [7, 8]. This type of care is mostly given in specialized care services such as hospitals [12]. Hence, it is impossible to manage rape survivors diagnosed with these disorders in Thuthuzela Care Centres. Most rape survivors live in poverty, are unemployed, and depend on the government to provide them with social grants [21]. Additionally, most rape survivors stay in rural areas far from Thuthuzela Care Centres because they are stationed in urban areas [21]. Hence, the need for decentralization and integration of mental health care services in the primary health care setting is to promote access to the health care system. Furthermore, while decentralized and integrated primary mental health care is at the heart of many low- and middle-income countries' (LMICs) mental health policies, implementation remains a challenge, particularly for victims of violence [22, 23]. This is also the case for rape survivors diagnosed with PTSD and depression.

Previous studies indicated that the high frequency of trauma and sexual assault in South Africa might necessitate a more extensive approach to rape management, particularly mental health consequences, to be included in existing policy [24]. The extensive approach to mental health care management among rape survivors diagnosed with PTSD and depression is the decentralization and integration of follow-up care of these services into primary health care. Primary health cares are accessible to everyone, because most villages have a nearby clinic where one can go for a consultation. In post-apartheid in South Africa, a deinstitutionalized and integrated primary health care system was crucial for enhancing access, improving service quality within a human rights framework, and reorganizing mental health services [18]. These initiatives were also outlined in the Department of Health's White Paper system

Transdoemation [25] and the new Mental Health Act (MHCA), No. 17 of 2002 [26]. Despite this, the integration and decentralization of management of rape survivors diagnosed with PTSD and depression are not implemented in South Africa.
