Mental health - the orphan of SA's healthcare system

2018-10-18 14:47

It has never been more important for our communities to pull together and ensure that our mental ill members are receiving the care and support they need. As we commemorate the mental health month intended to educate people about mental health and reduce the stigma around mental health, the Life Esidimeni saga springs to my mind.

The truth is that mental illness affects people’s lives. A number of new research findings highlight the need for increased understanding of, empathy for, and respect of people facing mental health issues. More than 17 million people in South Africa are dealing with depression, substance abuse, anxiety, bipolar disorder and schizophrenia — illnesses that round out the top five mental health diagnoses, according to the Mental Health Federation of South Africa. Despite the high number, the Department of Health annually spends only 4% of its budget to address the crisis. This has incited the South African Depression and Anxiety Group to refer to mental health as "the orphan" of the healthcare system.

The South African Depression and Anxiety Group estimates that as many as one in five people will or does suffer from a mental illness in their lives. Mental health problems, such as depression, anxiety, substance abuse and job stress are common, and have a huge effect on the wider community. An estimated 400 million people worldwide suffer from mental or neurological disorders or from psychosocial problems. These include disorders related to alcohol and drug abuse.

There is no health without mental health – it is just as important as physical health since one’s mind and body are inseparable. Even though many mental health problems can be treated at clinics and hospitals, very few South Africans with mental health problems get the help they need. The Mental Health Care Act. Act 17 of 2002 states that mental health services should be provided as part of primary, secondary and tertiary health services.  In practice, this clearly does not always happen.

In the country there are no enough psychologists to meet the needs of poorer communities. South African psychologists need to become more engaged in advocating for social justice to respond to the challenges faced by the majority of people living in South Africa.

The majority of the South Africa’s socio-economically disadvantaged people still do not have access to adequate psychological services despite a clear demand. Mental healthcare services remain centralised in large urban hospitals, while rural communities and smaller urban areas are essentially public mental healthcare wastelands.

Mental, physical and social health are important strands of life that are closely interwoven, and deeply interdependent, and mental health is crucial to the overall well-being of individuals, and our society.

Mental healthcare in the country continues to be under-funded and under-resourced compared to other health priorities, despite the fact that neuropsychiatric disorders are ranked third in their contribution to the burden of disease in South Africa, after HIV&AIDS and other infectious diseases.

There is enormous inequity between provinces in the distribution of mental healthcare services and resources. There is a lack of public awareness of mental health and widespread stigma against those who suffer from mental illness. There is also a lack of accurate routinely collected data regarding mental health service provision in our country.

In terms of policies the situation has improved quite a bit in the last decade. Several are now in place to take care of people with a mental health conditions. These include:

• The National Mental Health Policy Framework and Strategic Plan

• The Mental Health Care Act

• White Paper on the rights of people with disabilities

The country is still experiencing shortage of trained mental healthcare professionals. In 2010, South Africa had 1.58 psychosocial providers for every 100,000 people. The World Health Organisation recommends that South Africa increase its psychosocial professionals by 2937.

There has been a heavy reliance on psychiatric hospitals to care for and manage mentally ill patients. But public sector mental healthcare services are not accessible to the country’s most vulnerable populations. The hospitals also don’t have enough trained mental healthcare professionals. This means there is a large treatment gap. About 75% of people with mental health illness do not access mental healthcare. More generally, mental healthcare management and treatment is not integrated into other health care programmes.

The goals of better understanding mental health diagnoses and improving societal empathy should not be limited to the month of October, but it's certainly a good time to refocus our efforts.

- Tshepo Seloana, editor at HPCSA, writing in his personal capacity


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