/ 30 April 2023

SA depressingly low on mental health

Morally bereft leadership raises questions of trust
(John McCann/M&G)

Our world faces a mental health pandemic as serious as the one that changed our lives forever in 2020. According to the 2022 World Mental Health Report, there were 970 million people living with mental disorders globally in 2019, including 14% of the world’s adolescents. 

Suicide accounted for more than one in 100 deaths; 58% of suicides occurred before the age of 50 and is the fourth-highest cause of death among 15- to 29-year-olds. An estimated 82% of the people living with mental disorders reportedly reside in low- and middle-income countries, including ours. 

South Africa ranks low on mental health, according to the report. This is because our country is beset by living conditions that fuel poor mental health, including social and structural drivers, such as high levels of violence, poverty, unemployment and inequality.

Combined, these factors result in mental health disorders, such as psychological distress, inability to concentrate, depression, anxiety, suicide, hopelessness and feelings of worthlessness. 

These in turn make it hard to build social cohesion, foster civic-minded action and encourage the emergence of a united citizenry, committed to community and national upliftment.  

South Africa’s history of apartheid, including its migrant labour models that destroyed the family structure, particularly among African communities, continues to have a negative impact on the mental health of women and children. 

This is evident in our phenomenon of absent fathers, which deprives children of the opportunity to be brought up by both parents, which has been shown to confer a massive developmental advantage. 

In addition, it places extra strain and stress on women to bring up children alone, while coping with broader gender discrimination. 

In addition, this history has led to the unfortunate phenomenon of child-headed households. 

In the fight to promote mental wellness, the first enemy is our very history as a country. 

The social conditions engendered by colonial exploitation, the violent entrenchment of apartheid, the enforcement of a policy of deliberate underdevelopment of large parts of the population over many decades, the social and economic disruption of our communities and the enduring scars of our struggle against all of these have left us with a bitter legacy of morbid symptoms for which we are, sadly, ill prepared and poorly equipped. 

Mental health services in South Africa are inadequate, both in the public and private sector. 

Of the increasing numbers of our people succumbing to mental health illness, it is estimated that only 27% are receiving treatment. This is unacceptably low and means three-quarters of the people who need critical care are not receiving it. 

This hampers the vision of improving mental health among South Africans as espoused in the National Mental Health Policy and Strategic Framework 2013 – 2020. 

Only a small proportion of our health budget goes to mental health, with most of the available mental health funding allocated to psychiatric hospitals, leaving very little for community-based services. 

Community-based care is the frontline defence of any healthcare system and South Africa has to find the will and financial wherewithal to strengthen care at community level. 

By the time mental health disorders require psychiatric hospitalisation, we have usually failed in our duty of care to the patient at primary, community-based interventions. 

We must change this picture. 

In addition, there is a shortage of mental health specialists, such as psychologists and psychiatrists. Most of the available specialists are concentrated in the private health system and people who have medical aids, with few available to the broader population that is dependent on the public health system. 

Moreover, South Africans in poorer areas struggle to access healthcare for socio-economic reasons. 

Finally, the Covid-19 pandemic and the related rise in morbidity and mortality, as well as the corruption that took place during the pandemic, exacerbated the challenges of mental health, negatively affecting the well-being of South Africans. 

The pandemic is estimated to have increased the prevalence of depression and anxiety around the world by between 25% and 27%.

These are our challenges and this week the first steps in a long but determined journey to find lasting solutions were taken. About 600 participants, including policymakers, scientists, mental health practitioners and people with lived experience in South Africa and in the region met in Gauteng under the theme “Join the movement — Time to talk about mental health”. 

The conference sought to mobilise society and create a movement of stakeholders to promote mental health awareness, as well as increase access to mental health care.

The aims of gathering these experts and participants together were, among others, to: 

• Share experiences and research to assist in assessing the state of mental health in the country, including structural, social and behavioural drivers; services required; policies as well as human and financial resource needs, and 

• Share ideas on what can be done to address the drivers of poor mental health in the country. 

The conference was also in part driven by the imperatives defined in the recently launched National Strategic Plan for HIV, TB and STIs and the new five-year mental health policy, both of which seek to integrate mental health services into primary healthcare and community-level care, to address the severe mental health crisis in our country at its roots. Both recognise mental healthcare as part of the broader public health matrix. 

Last, but not least, it is my fervent hope that the media and other influencers in our society will partner with us to propagate this message and will join us in the fight against unhelpful and destructive stigmas around mental health disorders. 

The World Health Organisation has observed that, in many countries, stigma still plays a large role in deaths related to mental health and diminished access to treatment. 

We are no different but we should be. We can do better. 

Paul Mashatile is the deputy president of South Africa.

The views expressed are those of the author and do not necessarily reflect the official policy or position of the Mail & Guardian.