Government spends only 3% of the total healthcare budget on mental health, leaving patients, doctors and caregivers with scant resources
Chances are, in South Africa, if you’re suffering from a serious mental illness you will struggle to see a psychiatrist.
Not because there aren’t any, but because there aren’t enough.
At 1.52 psychiatrists per 100 000 population, the reality is that many patients will rarely be seen by one.
If you’re a parent of a child who needs psychiatric evaluation, you will struggle even harder because, according to the newly released World Health Organisation (WHO) country profiles on mental health, there are only 0.08 child psychiatrists per 100 000 population.
Added to that, despite there being policy framework on mental health – the Mental Health Act 17 of 2002, as well as the National Mental Health Policy Framework and Strategic Plan 2013/2020 – there is still no suicide prevention strategy, according to the profile.
This is despite the number of high-profile suicide deaths in the country last year alone.
With a total expenditure of less than R100 per person per year on mental health and government spending only 3% of the total healthcare expenditure on mental health, experts agree that these figures point to a dire need for the renewal of focus and a change in strategy.
“There are definitely not enough psychiatrists and even more so not enough child psychiatrists. The reality is that many patients rarely see a psychiatrist, unless they are admitted to a psychiatric ward [of a public facility],” Bonga Chiliza, a professor and president of the SA Society of Psychiatrists, told City Press.
“It also means that many people with complex illnesses will not be managed as they should be and that is why we find so many who are undertreated or ‘missed’ in terms of diagnosis.”
More than 150 country profiles of mental health resources were published by the WHO, based on data given by the member states.
They are intended to provide a national-level snapshot of the existence of policies, plans and laws for mental health, human and financial resources available and the type of facilities that provide care.
The South African profile reflects that per 100 000 people, there are 16.56 mental hospital beds and 4.33 general hospital psychiatric beds.
While the profile noted that it did not have the total number of healthcare workers specifically tied to mental health in both governmental and non-governmental facilities as it wasn’t reported, the SA Federation for Mental Health (SAFMH) said those “blank spaces” pointed to poor record-keeping, as well as monitoring and evaluation on the part of government.
Nicole Breen, spokesperson for SAFMH, said: “Unfortunately a large portion of the profile is accurate. The plight of mental healthcare patients in our country is severe. Underresourcing, in particular, is a problem, as well as an astounding lack of qualified professionals.”
“The profile illustrates the low numbers of beds, wards and forensic units in relation to the number of people it captures as having a mental illness, [which is] a challenge for many mental healthcare patients who require urgent and intensive attention.
“The profile, however, fails to note the contributions made by non-governmental organisations (NGOs), which play an important role in caring for people with mental illnesses and intellectual disabilities within community care settings.”
While Chiliza was loathe to criticise the fact that the country didn’t have a suicide strategy, Breen said having a policy would be important as it would set out a road map towards effectively tackling the issue of suicide and diminishing its prevalence.
“Policies generally bring law to life, making it implementable. Enacting a policy that is issue-specific and in line with other national and international imperatives, and steeped in research will enable state departments, NGOs, citizens and other parties to understand what their role is in ameliorating the plight of those who are suicidal, as well as in supporting those left behind when a loved one has committed suicide.
“Suicide is a specialised issue that requires a specialised response,” she explained.
On this basis, she said, a separate strategy or policy would be extremely positive.
Both, however, agreed, that a lot still needed to be done in the country in so far as mental health is concerned.
“What we are pushing for is a mental health programme fund, wherein which money will be set aside by government just for mental health,” Chiliza said, adding that “they did it for HIV and it worked very well. We would like something similar … right now.”
“I think the provinces themselves aren’t even sure how much they spend towards mental health. We think they spend even less than 1%, so a lot more can really be done.”
Breen said there also needed to be a concerted effort in investing in community-based care, alongside the hospital setting.
“Quality community-based care is out of reach for the vast majority of mental health patients. Facilities are often unable, owing to more effort being put towards funds for food and operational costs, to offer proper rehabilitation programmes or equip their residents with skills so that they can either live completely independently or in a less restrictive environment. This becomes another form of warehousing.
“Investment is needed to ensure that mental health patients are able to not only survive in these facilities, but thrive, leading lives of dignity and accessing all of the services they need.”