The South African Society of Psychiatrists (Sasop) has appealed to the government to up its mental healthcare spend, raising concern that mental healthcare was again underfunded in the 2023 Budget, delivered last week by Finance Minister Enoch Godongwana.
Sasop recommended increased expenditure on community psychiatry by hiring psychiatrists, psychiatric medical officers and experienced mental health nurses; enabling clinics to accommodate mental health departments, and focusing on more community-based mental health facilities for the treatment/rehabilitation of children, among other measures.
After the reading of the 2023 budget, Sasop it was concerning that mental healthcare was still underfunded while common mental health conditions, including anxiety and depression, kept rising.
“Mental healthcare continues to be allocated only 5% of the national public health budget and, since the health budget itself is declining in real terms, the mental health portion is actually declining in monetary terms,” said Sasop public sector national convener Dr Kagisho Maaroganye.
Maaroganye said mental healthcare professionals had seen a notable increase in common mental health problems since the start of the pandemic: one in three South Africans suffers from mental illness, with 75% unable to access treatment, reports TimesLIVE.
Common and treatable mental health disorders had overtaken physical illnesses and injuries as the country’s leading cause of medical disability claims, he added, with the social isolation, job losses, illness and threats to people’s physical health, as well as loss of loved ones, contributing to widespread emotional distress and mental illness.
Despite this, the mental healthcare system’s focus was skewed towards more severe mental health conditions affecting less than 1% of the population.
“Treatment rates dropped due to lack of access to mental healthcare facilities during lockdowns and patients may have had relapses, while those who previously had no issues now suffer from anxiety, depression and sleep disorders.”
Maaroganye said the underfunding hampered prevention and diagnosis of mental illness and limited access to treatment.
“Shortages of mental health clinicians, a lack of experienced practitioners, insufficient resources to follow up and ensure compliance with treatment, all contribute to a persistent treatment gap.”
SA’a mental healthcare budget, as a percentage of the overall health budget, was at the lower end of international recommendations for mental health spending, and was also misdirected.
“They are hospital-centric and reactive, with 86% allocated to inpatient care and almost half that to specialised psychiatric hospitals,” he said.
“The focus is on treating the most severe conditions, which have a prevalence of less than 1%, rather than preventing or providing early intervention and treatment for widespread and common mental health conditions of anxiety and depression before they escalate into more serious mental illness.
“Almost 20% of the mental healthcare budget is spent on hospital readmissions. This ‘revolving door syndrome’ is a costly reflection of a highly inefficient system with an inability to optimise care at primary and community level.”
Community psychiatry offers the best prospects of optimal care for a stabilised mental healthcare patient in the community and preventing the expensive “revolving door”.
“While specialised psychiatric hospitals and psychiatric wards in general hospitals do serve a purpose, a healthcare system’s success ultimately depends on the extent to which we can prevent illness and on treating illness effectively to prevent relapse,” he added.
Sasop recommended several more appropriate investments:
• Develop IT systems that hold and distribute psychiatric information between community-based psychiatric facilities and psychiatric units and hospitals.
• Expand the substance abuse helpline in Gauteng giving people access to human and physical resources to help manage their substance use disorders.
• Improve mental healthcare for expectant/new mothers by investing in the mental health care education of all primary care nurses and healthcare workers, not only antenatal care nurses and midwives, to bolster early detection and treatment of depression and other psychiatric conditions with a high prevalence during pregnancy and after childbirth.
• Facilitate the training of generalist clinical staff to manage patients’ mental illness independently or with psychiatric clinicians’ support.
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