Poor quality, high costs characterise mental health care
DOES South Africa have a mental health problem? This was the question when a group of journalists were presented with the latest stats at a mental health summit held in Joburg recently.
According to a global study, mental disorders have increased by 22.7%. In South Africa, 30% report life-long psychiatric disorders, while 1 in 3 will be affected by a mental illness in their lifetime.
The figures don’t bode well for a nation in which depression contributes to over 40% of mental health conditions. It puts a strain on the health-care system, as pointed out by Dr Jonathan Broomberg, chief executive of Discovery Health.
“There’s profound fragmentation in private health care delivery,” he notes when referring to Discovery Health claims for 2016. The private medical aid provider paid out R2 billion in claims last year.
But he also alluded to the poor quality of care and high costs: “We need to change the structure of delivery by creating teams who work together.”
Broomberg suggests taking a holistic approach when treating mental illnesses by enlisting a group of specialists to treat a patient.
Experts believe the rise in mental health conditions is due to our change in lifestyle which includes less sleep, more stress and trauma. Broomberg refers to a massive study that was undertaken in 2011 and published in the Journal of Clinical Psychology.
The study found that physical activity decreased the signs of depression and that exercise could be almost as effective as medication. With recent advancements made in the digital field, the use of apps was also found to help reduce depression.
Apps like Big White Wall, which provides advice to people with anxiety, debt, stress, or work problems, has reached over 35 000 users and has seen a 20% improvement rate.
74% of people diagnosed with depression experience trouble concentrating, indecisiveness and forgetfulness.
50% of those who have been diagnosed with depression have taken time off work.
18 days on average is the time taken off work due to depression.
25% of managers feel they have good support in dealing with an employee with depression.
1 in 4 respondents have been diagnosed with depression by a health-care professional.
1 in 10 don’t know how to react to a colleague with depression.
32% of employees who take time off for depression do not tell their employer the reason why.
Broomberg also adds that “apps are no substitute for medication or consultation”.
Mental health disorders affect 10% of the global population – 20% are children, and 80% come from low income communities. Professor Gabriel Ivbijaro, president of the World Federation for Mental Health says that global funding for mental health is on the decline, especially when it comes to the severely mentally ill.
Ivbijaro’s plan is to transform primary health care by integrating mental health into the primary structure.
But will it work here, where healthcare facilities are few and far between? It’s not all gloomy. Dr Lesley Robertson, a state psychiatrist and national convener of the South African Society of Psychiatrists’ public sector group, is an advocate of community psychiatry and community mental health. She says the government has a framework in place in the form of the National Mental Health Policy (20132020).
The plan is to implement community-based care for the mentally ill and provide long stay specialised services in the public health sector.
She believes adding mental health units to general public hospitals, will destigmatise mental illnesses and make them mainstream. Plans are also afoot to have community based psychiatric teams in place that will form part and parcel of primary health care facilities and work in tandem with GPs and clinics.
On paper, plans for integrated mental health care seem like a lifesaver. Putting it into action is another story. Our public health sector is stretched, specialised staff are leaving in their droves, and patients often complain of little or no help.