Cop­ing with the rise in men­tal ill­ness


IS SOUTH Africa in the grip of a men­tal health cri­sis? 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 a life­time preva­lence of 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 where de­pres­sion con­trib­utes to over 40% of men­tal health con­di­tions. It puts a strain on the health care sys­tem, as pointed out by Dr Jo­han­than Broomberg, chief ex­ec­u­tive of Dis­cov­ery Health.

“There’s pro­found frag­men­ta­tion in pri­vate health care de­liv­ery,” he notes when re­fer­ring to Dis­cov­ery Health claims for last year. The pri­vate med­i­cal aid provider paid out R2bn 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. The model has al­ready been suc­cess­fully im­ple­mented in the UK.

Ex­perts be­lieve the rise in men­tal health con­di­tions is due to our change in life­style which in­cludes less sleep, more stress and trauma.

With re­cent ad­vance­ments made in the dig­i­tal field, the use of apps were also found to help re­duce de­pres­sion.

Apps like Big White Wall, which pro­vide ad­vice to peo­ple with anx­i­ety, debt, stress, or work prob­lems, have reached over 35 000 users and seen a 20% im­prove­ment rate.

Broomberg says the strides made in the tech­no­log­i­cal realm is cre­at­ing new op­por­tu­ni­ties for those who are not able to con­sult a pro­fes­sional, but he also adds that “apps are no sub­sti­tute for med­i­ca­tion or con­sul­ta­tion”.

So if apps aren’t a sub­sti­tute for treat­ing men­tal ill­ness and pa­tients don’t have ac­cess to med­i­cal aid, what then? Men­tal health dis­or­ders af­fect 10% of the global pop­u­la­tion – 20% are chil­dren, and 80% come from low in­come com­mu­ni­ties. Where does this leave the ma­jor­ity of SA’s pop­u­la­tion af­fected by men­tal ill­ness?

Pro­fes­sor Gabriel Ivbi­jaro, pres­i­dent of the World Fed­er­a­tion for Men­tal Health (WFMH) thinks he may have the an­swer. Ivbi­jaro says that men­tal health de­serves more. “There’s some­thing about men­tal health that you no longer ex­ist, but it is com­ing out of the shad­ows,” he notes.

Ivbi­jaro’s plan is to trans­form pri­mary health­care by in­te­grat­ing men­tal health into the pri­mary struc­ture.

But will it work in SA where ac­cess to health care fa­cil­i­ties are few and far be­tween?

Dr Mvuy­iso Talatala be­lieves it is pos­si­ble. The for­mer pres­i­dent of the South African So­ci­ety of Psy­chi­a­trists (Sa­sio), Talatala says that there are chal­lenges fac­ing men­tal health, in­clud­ing our re­liance on big state fa­cil­i­ties to treat psy­chi­atric pa­tients. These are: med­i­cal stu­dents not be­ing ex­posed to psy­chi­a­try; no men­tal health di­rec­torates in all our prov­inces and no beds for ad­mis­sions for in­vol­un­tary care in state hos­pi­tals.

Dr Les­ley Robert­son, a state psy­chi­a­trist and na­tional con­vener of Sa­sop’s pub­lic sec­tor group, is an ad­vo­cate for com­mu­nity psy­chi­a­try and com­mu­nity men­tal health. Ac­cord­ing to her, the govern­ment has a frame­work in place in the form of the Na­tional Men­tal Health Pol­icy (2013-2020).

The plan is to im­ple­ment com­mu­nity-based care for the men­tally ill and pro­vide long stay spe­cialised ser­vices in the pub­lic health sec­tor. “SA is try­ing to de­velop pri­mary health care ser­vices with an in­te­grated men­tal health plan,” states Robert­son.

On pa­per, plans for in­te­grated men­tal health care seem like a life­saver for those who re­ally need it. Putting it into ac­tion is an­other story al­to­gether.


Pro­fes­sor Gabriel Ivbi­jaro wants to trans­form pri­mary health­care

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