Mental illness costs SA billions
Shame and stigma, as well as the lack of facilities, are barriers healing, experts say
South Africa’s economy suffers an estimated R61.2 billion in lost earnings annually due to mental illnesses, such as depression and anxiety, but stigma is still preventing many people from accessing healthcare.
On Tuesday, the country joined others in commemorating World Mental Health Day.
The US’ Centers for Disease Control and Prevention defines mental health as the state of a person’s emotional, psychological and social well-being, which affects how they think, feel, and act. Good mental health allows a person to better handle stress, relate to others and make healthy choices.
Factors such trauma, abuse, experiences related to chronic medical conditions, such as cancer or diabetes, substance abuse and feelings of loneliness and isolation can contribute to the risk of mental illness.
The National Health Information System says the total number of patients treated for mental healthrelated illness in South African psychiatric hospitals for the first six months of this year was 45486.
However, health experts believe this vastly under-represents the true number of people struggling with mental illness across the country.
Speaking to the Mail & Guardian, Chris van Straten, a global health adviser at health and security service firm International SOS, said this is largely due to the fact that many people do not seek help because of the stigma attached to mental illnesses and because, in many cases, mental health support is not available in public medical facilities.
People are reluctant to admit they are anxious or depressed because society associates mental struggles with weakness, Van Straten said.
“I think it is really important that all of us can acknowledge these different feelings and, really, it is on a spectrum. All of us at some point will be down or feel anxious. That’s okay,” he said.
The department of health’s revised national mental health policy framework and strategic plan for 2023 to 2030 states that, at societal level, lost income associated with mental illness far exceeds public sector expenditure on mental health care.
“In other words, it costs South Africa more to not treat mental illness than to treat it,” it says.
“There is growing evidence, from the national investment case for mental health in South Africa, commissioned by the department of health and the national treasury, that there is a potentially significant return on investment for scaling up mental health care.”
Iyanda Nyoni, a registered counsellor at Kena Health, said unaddressed mental conditions cost the economy R161 billion annually, citing data from the Mental State of the World 2022 report, which was published earlier this year.
Violent society
“Citizens are particularly susceptible to poor mental health because they live in a violent society with high levels of unemployment, as well as the legacy of racism, which includes familial breakdown caused in large part by the migrant labour system,” Nyoni said.
“The result of these societal pressures is high levels of psychological distress, manifesting as an inability to cope with daily stressors, depression and anxiety and even escalating to suicide.”
Speaking at a World Mental Health Day panel discussion on Tuesday, hosted by financial and health services group Discovery, the chief medical officer of its subsidiary Discovery Life, Maritha van der Walt, said people should see depression as a disease and realise that something can be done about it, ideally through a holistic approach that treats it as a whole-body condition.
“When it comes to mental illness, for prevention to be possible, we need people to be aware of everything from the risk factors for depression to the signs and symptoms people might experience and the help that they can access,” Van der Walt said.
Covid-19, load-shedding, a toxic work environment and the failure of small businesses are also factors contributing to the risk of people developing mental disorders.
The impact of Covid-19 and load-shedding
The World Health Organisation says the Covid-19 pandemic had a significant impact on mental health globally, with reports of increased anxiety, depression and other mental health problems.
“The pandemic disrupted many aspects of life, including economic activities, education and social interactions. These disruptions resulted in increased stress, anxiety, and depression, which contributed to the overall increase in mental health disorders,” the global health agency said.
In March, the South African Depression and Anxiety Group conducted a survey into the impact of load-shedding on mental health.
Many of the respondents reported feelings of helplessness.
“Load-shedding has made me feel that I cease to exist; basically my life feels like it is at a standstill. What can I do? What must I do? I hate the feeling of pressure it puts on me,” one said.
International SOS’S Van Straten urged companies to invest in looking after the mental wellness of their employees by making the necessary tools accessible.
“Give them access, for example, via Zoom or an app, to a psychologist or bring wellness sessions into the workplace,” he said.
“We have seen those businesses actually become more productive and have higher financial returns.
“If people feel good, then they are healthy, physically.
“What we have seen is that there is less absenteeism and the quality of work tends to improve.”
Johannesburg resident Amanda
Dlamini told the M&G that she has been employed by a security company for over two years and described it as the worst place she had ever worked.
“I am overworked but I cannot even complain because I fear for my job. Times are tough and I cannot afford to lose my job.
“I have been in and out of hospital because of stress and depression. My manager is not a good person,” Dlamini said.
The founder of Property Point, Shawn Theunissen, said over the last 15 years of working with entrepreneurs, it was evident that mental health issues had a significant impact on small business owners.
“Small businesses have confronted immense challenges, compounded by the effects of the Covid-19 pandemic,” he said.
“Economic downturns and business disruptions due to factors such as load-shedding, looting, flooding and recent explosions in Johannesburg have all significantly impacted the revenue of small and medium-sized enterprises.
“These external pressures have intensified mental health challenges among entrepreneurs.”
He said entrepreneurs often had huge responsibilities, bearing the weight of managing a business and meeting financial goals.
“Neglecting self-care, including sleep, nutrition and relaxation, can exacerbate these stressors, leading to burnout and reduced mental resilience,” Theunissen said.
To address this, he advised business owners to take regular breaks.
“This allows entrepreneurs to recharge their mental and emotional batteries, reducing stress levels and preventing burnout.” Furthermore, Theunissen said the pressure to project an image of success can lead entrepreneurs to hide their struggles, fearing that admitting their weaknesses could harm their reputations.
“This facade perpetuates shame and the stigma surrounding mental health issues. Advocating for authenticity and emphasising that seeking help is a sign of strength can break down these barriers,” he said.
Substance abuse
The National Institute of Mental Health says people with mental disorders, such as anxiety, depression and post-traumatic stress disorder, sometimes use drugs or alcohol as a form of self-medication.
However, although some drugs might temporarily help with some symptoms of mental disorders, they make them worse over time.
“Additionally, brain changes in people with mental disorders may enhance the rewarding effects of substances, making it more likely they will continue to use the substance,” it said in a report.
This, it said, often leads to substance use disorder (SUD), a treatable mental disorder that affects a person’s brain and behaviour, leading to their inability to control their use of substances like legal or illegal drugs, alcohol or medications.
“Symptoms can be moderate to severe, with addiction being the most severe form of SUD. This contributes to the development of other mental disorders. Substance use may trigger changes in brain structure and function that make a person more likely to develop a mental disorder,” the institute said.
‘In other words, it costs South Africa more to not treat mental illness than to treat it’