South Africa faces a high burden of mental health disorders driven by a range of factors, including childhood trauma, poverty, unemployment, the ongoing impact of HIV, and a history of political and social violence.
Research shows that 30.3% of South Africans experience a mental disorder in their lifetime, yet most of them won’t get the care they need.
“There’s clear epidemiological evidence that 16% of South Africans experience a mental health condition in any given year. But more than 90% of people living with mental health conditions don’t receive the care that they need, despite clear evidence of cost-effective interventions,” says Professor Crick Lund, co-Director of the Centre for Global Mental Health at King’s College London.
At the heart of the issue seems to be a lack of investment and failure to implement policy.
South Africa spends only 5% of its health budget on mental health, and most of this is allocated to inpatient psychiatric and not community mental health services.
“We completed a national mental health investment case for the Department of Health and National Treasury. It clearly shows the economic return on investment through improved labour market participation and productivity as a result of receiving mental health care,” says Lund.
He provides an example: for every R1.00 invested in treating adult depression, there is a R4.00 return over 15 years. “Investing in care for perinatal depression yields an even higher return of R4.70. So, from an economic standpoint, investing in mental health care is a sound decision that will benefit the South African economy in the long run.”
Mental health policy
Cassey Chambers, from the South African Depression and Anxiety Group tells Health-e News that while South Africa has progressive mental health legislation, implementation remains a significant challenge.
“The biggest issue is that we can have these documents that outline an overall vision for mental health, but if they are not budgeted for, not implemented, and if there is no task team to drive them, they fall short.”
She points out that since the 2016 Life Esidimeni tragedy which left over 140 mental health care users dead after they were transferred to unlicensed NGOs in Gauteng, many of the promised reforms which include increased staffing and training, improved mental health infrastructure and stronger oversight and regulations have yet to materialise.
“We’re still not seeing meaningful change for the average patient. So one has to ask what something like the Mental Health Policy Framework and Strategic Plan achieves for the person on the ground,” she adds.
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The 2023-2030 National Mental Health Policy Framework and Strategic Plan highlights key areas that need to be addressed to improve mental health care. These include better funding and planning, and making mental health part of regular healthcare.
However, stakeholders have raised concerns about the lack of urgency in turning policy into action. For example, key recommendations in the 2013-2020 mental health strategic plan have still not been implemented.
Bharti Patel, National Executive Director of the South African Federation for Mental Health, says the mental health strategic plan clearly states that community-based mental health services will be prioritised to ensure that care and services will be accessible in communities.
“However provincial health departments have not increased funding towards community-based mental health services provided by NGOs. Government funding has been cut in many instances leaving community-based NGOs to source alternate funding so that communities are not left destitute,” Patel says.
Factors contributing to poor mental health
Lund says that there is good evidence that poverty and mental illness are linked in a negative cycle.
“On the one hand living in circumstances of poverty increases one’s risk for mental health conditions through stress of financial insecurity and food insecurity as well as increased exposure to violence and increased risk for other health conditions.”
He says living with a mental illness increases one’s risk of drifting into or remaining in poverty because of the cost of healthcare, and the disability and stigma associated with mental illness exclude people from work.
To break the cycle, it is important to improve financial and food security and provide appropriate timely and evidence-based mental health care.
“Fortunately there is growing evidence of the effectiveness of interventions addressing both pathways. For example, poverty reduction interventions like cash transfers have been shown to reduce common symptoms of depression and anxiety,” Lund says.
Steps to ensure successful policy implementation
Lund highlights three critical aspects of the 2023-230 mental health strategic plan that must be implemented urgently:
- First, district mental health teams need to be established to coordinate and plan the local delivery of mental health care through primary care clinics and community-based facilities.
- Second, national training and supervision of general healthcare workers in mental health competencies should be rolled out across all primary care settings and facilities,
- Third, it is important to implement mental health promotion and prevention programmes in schools, particularly targeting adolescents, who are at a crucial developmental stage. – Health-e News
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