Mental health conditions, disorders and diseases
are rarely on the frontline of health regulations and international health
agendas. But global institutions such as the World Health Organisation have been engaging with governments
to improve mental health systems.
Research shows there are several barriers
blocking improving mental health care. These include diminished civil society
support, a lack of global consensus on mental illness and its treatment, missed
policy opportunities and limited evidence on the delivery of mental health
But in the
last two decades increased attention has been given to mental health as a
global priority. Civil society has become more active. In addition, high impact
journals such as PLoS Medicine and The Lancet have raised the profile of mental
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sustainable development goals have also put mental health and wellbeing firmly
on the agenda, although there has been criticism that the goals fall short of their true
estimated that globally between 12% and 48% of people suffer from mental disorders. Over 70% of this burden lies in low
and middle income countries.
African, as in many developing countries, mental health doesn’t feature as a
public health priority. In rural communities mental health is not supported
One of the
consequences is that trauma is common in South African society. This is evident
from unusually high interpersonal violence, including homicide, rape and domestic
Low levels of care
At least 15%
of those interviewed for the South African Stress and Health Study – the first nationally representative survey of psychiatric disorders in an
African country – said they suffered from anxiety disorders.
include obsessive compulsive disorder, post traumatic stress disorders and
suffered from mood disorders such as depression or bipolar disorders. Another
9% suffer from substance abuse disorders. Nearly a third of the respondents
reported a lifetime history of at least one psychiatric disorder.
about a quarter of those who needed treatment were getting access. This is
partly because expenditure on mental health is pitiful.
provinces spend less than 3% of their health budgets on mental health, mostly
on psychiatric hospitals which, in any case, should be the last resort in the
chain of treatment.
several other reasons for this dismal provision. These include:
- Vast distances to access specialised services
- The chronic stigma
barrier in public health facilities
and poverty. People suffering from mental illness are caught in a “cycle of poverty”, which leaves little prospect of escape.
Where are the carers?
South Africa’s mental health
workforce is woefully inadequate. There are only 0.3 psychiatrists, 0.3
psychologists and 0.4 social workers for every 100 000 residents. Brazil has
3.07 psychiatrists, 9.60 psychologists and 1.02 social workers for every 100
000 residents. South Africa has 800 registered psychiatrists and nearly 8 000
psychologists, mostly working in private health.
Although the government has
made significant strides creating policy and passing legislation to provide
mental health services, implementation has been a problem. This is because:
- Most of the groups supporting people with mental disorders are non-profit
organisations that survive on shoestring budgets.
- A shortage of state resources for
the specialised and complex needs of psychiatric disorders.
- There should be strong collaboration between the service providers,
particularly non-profit organisations, and the private sector. This does not
developments are not promising. The Gauteng Department of Health announced it will end its contractual
relationship with Life Healthcare – South Africa’s largest and longest running
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result in more than 2000 patients with chronic mental illness being
discharged from Life Esidimeni, which means “place of dignity”.
absence of proper community care, people who need care often end up homeless or
in jail as has been shown in the US.
In addition, pressure increases on under-funded non-profit organisations.
Glimmers of hope
some promising initiatives in the pipeline to strengthen mental healthcare in
the country and in parts of the continent.
includes groups that empower practitioners and policy makers enabling them to lobby for
mental health services. There are also consortia that investigate cost
for mental health disorders, how to scale up mental health services and enhance the health systems
to deliver mental health services adequately.
has a responsibility to provide mental illness treatment and to promote mental
health. But the reality is that it will need to tap into human resources from
non-profit organisations as well as private sector funding.
collaboration can only happen if the state renews its focus on how it can
deliver mental health services.
André Janse van Rensburg is a researcher at the
Centre for Health Systems Research & Development, University of the Free State.
was originally published on The Conversation. Read the original article.
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