Around 30.3% of South Africans experience a mental disorder in their lifetime – and about 16% of them in any given year – but most will never get the care they need, thanks to a lack of investment and failure to implement policy, say experts.
There’s clear epidemiological evidence of these high rates, yet, more than 90% of these people will not receive care, according to Professor Crick Lund, co-director of the Centre for Global Mental Health at King’s College London, who adds that South Africa spends only 5% of its health budget on mental health.
And most of this, writes Yoliswa Sobuwa for Health-e News, is allocated to inpatient psychiatric services and not community mental health services.
“We completed a national mental health investment case for the Department of Health and National Treasury which clearly shows the economic return on investment through improved labour market participation and productivity as a result of receiving mental health care,” Lund said.
He provides an example: for every R1 invested in treating adult depression, there is a R4 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.”
Cassey Chambers, from the South African Depression and Anxiety Group, said 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 referenced the 2016 Life Esidimeni tragedy, saying that many of the promised reforms, which included increased staffing and training, improved mental health infrastructure and stronger oversight and regulations, had 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 patients,” she added.
The 2023-2030 National Mental Health Policy Framework and Strategic Plan highlights priority areas needing urgent reform – like 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, said provincial Health Departments have still not increased funding towards community-based mental health services provided by NGOs. In fact, government funding has been cut in many cases, leaving these NGOs scrambling to find alternative financial support to avoid communities being left destitute.
Factors contributing to poor mental health
Lund said there was good evidence that poverty and mental illness are linked in a negative cycle.
“On the one hand, living in poverty increases the 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.”
Conversely, living with a mental illness increases the 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 timely and evidence-based mental health care.
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 must be established to co-ordinate 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.
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