The sad state of psychiatric care in SA

Recent figures released by the South African Society of Psychiatrists show that currently, psychiatric disorders represent 10% of all diseases worldwide and in South Africa it is estimated that between four and a half to five million people are suffering from a psychiatric disorder. If you include alcohol and drug abuse in this figure, it rockets to a frightening 15 million people.

An estimated 20% of children in South Africa suffer from a mental illness due to the levels of violence and family problems that we have in this country and that eventually a quarter of the entire population will have suffered from a depressive disorder. 50% of visits to general practitioners are usually due to some sort of mental problem.

Apart from the immense human suffering, psychiatric illness is costing the country millions of rands each year in lost working days and lowered productivity. In South Africa about ten thousand people commit suicide yearly and most of those are young people with economically active lives.

And yet only 10 to 15% of people worldwide with mental disorders seek help. To make matters worse, in our country, many of those seeking help find it is not available.

In a recent paper, presented at the first World Anti-Stigma Congress, South African psychiatrist, Dr Eugene Allers states: "The lack of psychiatrists in South Africa presents a huge problem. At the moment there are about 320 practising psychiatrists in South Africa, giving a ratio in general of about 150 000 people per psychiatrist. 15% of the population belong to medical aid and 200 of the psychiatrists work in the private sector."

The ratio of psychiatrist to population in this sector is about 33 000 patients per private psychiatrist. Only 120 psychiatrists work in the state sector, giving a ratio of about 440 000 people per state psychiatrist, 13 times more than in the private sector."

In rural areas, a lot of the workload is carried by psychiatric nurses in clinics that are visited by a psychiatrist either weekly or monthly. Recently though, a lot of these clinics have been closed down in preference of primary healthcare clinics, which is a problem due to the specialised nature of psychiatry and the specialised care psychiatric patients need. Dr Allers states: "There is a severe lack of long-term institutional care facilities and there is a major problem getting dedicated psychiatric beds in general hospitals."

The problem though, is not limited to state hospitals. Dr Allers also commented that in the private sector, some private clinics refuse to have special dedicated psychiatric wards for psychiatric patients, because medical aids pay less for patients with psychiatric disorders in psychiatric wards than in other wards and this leads to a loss of income for the clinic.

According to Dr Allers' research, sheltered workshop subsidies have also been stopped and community clinics are being closed down due to a lack of government funding in favour of primary healthcare, leaving chronically disabled patients without care or work.

The lack of Government commitment to improved mental health care in South Africa is also seen when looking at the proposed Essential Drug List, which are the drugs the state is prepared to supply in State Hospitals. The medications for the treatment of psychiatric disorders are severely limited, making the job of psychiatrists even more difficult than it already is, and the recovery of some patients less likely.

Although it clearly states in the South African Constitution, Act 108 of 1996, Chapter 2, Article 93, under the clause "Equality", that the state may not unfairly discriminate, directly or indirectly, against anyone on one or more grounds including race, gender, sex, pregnancy, marital status, ethnic or social origin, colour, sexual orientation, age, disability, religion, conscious belief, culture, language and birth, with psychiatric problems falling under disability, it seems that a large portion of our population is indeed being discriminated against.

South Africa, a country that has seen decades of basic human rights violations and unspeakable violence caused by fear and a lack of tolerance for differences, should understand the pain this causes and be committed to ensuring the injustices of the past are not continued.

The Depression and Anxiety Support Group, Africa's largest non-profit patient advocacy support group, is committed to fighting the stigma attached to mental illness and to lobbying for improved treatment for people with mental disorders. The Group also offers counselling by trained counsellors, referrals to mental health professionals and over 160 support groups in Southern Africa. They can be contacted Monday to Friday 8am to 7pm, Saturday 8am to 5pm, and on Sundays 9am to 1pm.

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