Lack of access, investment hampers mental health care
STAFF REPORTER
One in three South African adults will experience mental illness in their lifetimes - but with only 1 000 psychiatrists to serve the country’s almost 60 million people, the quest for equal access to better mental health for all is hampered by a severe lack of treatment facilities and mental health professionals.
World Mental Health Day was 10 October 2020 and the South African Society of Psychiatrists (SASOP) has joined the global call by the World Health Organisation (WHO) and partner organisations to scale-up investment to improve access to mental health as one of the most neglected areas of public health worldwide.
SASOP has called on the South African government and health authorities to increase training for mental healthcare workers and professionals and improve geographic distribution of mental healthcare facilities to ensure better and more equitable access to treatment for mental health conditions.
South Africa starts on the back foot, said SASOP President-elect Dr Seboleloseape, with the availability of psychiatrists at 0.5 per 100 000 people well below the global average of 1.3 psychiatrists per 100 000 population, a ratio that varies widely from 0.51 in low income countries to 12 in high income nations. She said the lack of professionals was worsened by structural barriers to achieving universal mental health coverage, including treatment costs and limited medical aid cover for mental illness, while a lack of public sector treatment facilities and professionals is felt in both high-density urban areas and South Africa’s more rural provinces.
“This indicates that from the get-go, South Africa is not in a position to deliver services adequately to its population.
“The 2020 World Mental Health Day theme is ‘Mental health for all – Greater Investment, Greater Access. For Everyone.everywhere.’ This is a noble principle which we should all strive hard to achieve and sustain but, sadly, there are serious barriers to achieving this in South Africa,” Seape said.
Costs to the economy
Mental disorders are a leading cause of ill-health and disability worldwide, affecting 30.3% of South African adults at some point in their lifetimes, with significant impact on quality of life, relationships and earning ability, and there are costs to the economy in loss of productivity and treatment costs. “Despite the high prevalence, mental illness remains largely unknown and unrecognised as a medical condition, leaving the afflicted undiagnosed and untreated, to the distress of family and community and negative economic, cultural and social impacts. The reasons for this are many and as diverse as the economic, cultural and social landscape of South Africa.”
While the Covid-19 pandemic has seen increased levels of stress, anxiety, fear, emotional distress, feelings of isolation and other mental health impacts due to lockdowns, physical distancing and precautions against infection, she said the pandemic had also further reduced access to mental health care. For example, face-to-face meetings have been limited, people’s mobility has been restricted and risks of infection put people off seeking help for non-emergency conditions, while some healthcare facilities have had to close temporarily.
Mental health literacy
Seape said a lack of knowledge of mental health, social stigma and a belief that mental illness is a sign of weakness, as well as the risk of discrimination in the workplace by disclosing a mental disorder, were among the attitudinal barriers to achieving good mental health for all.
Treatment dropout is a further concern, she said, due to negative interactions with mental healthcare providers, lack of personal or medical aid funding for maintenance or follow-up care, and lack of support from employers in allowing employees the time to seek help and complete treatment.
Substance abuse
Substance abuse and mental health conditions are closely linked, Seape said, with either one often leading to the other.
“Government should also be making a serious effort to increase the number and availability of substance abuse treatment facilities because the lack of these has an enormous effect on the outcomes of mental health and other medical conditions, which together have a major cost to the economy.”
SASOP’S appeal to the government is to make funding available to increase the number of professionals, including nursing, occupational therapists, social workers, psychologists, psychiatrists and others involved in mental healthcare delivery.
Public mental healthcare facilities need to be increased and distributed to ensure geographic accessibility across urban and rural areas, along with community education campaigns on mental health conditions and accessing treatment.
Seape said universal mental healthcare coverage would eliminate structural barriers like financial accessibility. Employers should be encouraged to facilitate employees accessing help, in turn improving productivity.