Nation cannot ignore mental health crisis

When I was little and growing up in what was then Umtata, my friends used to scare the life out of me by threatening to take me to the lunatic asylum near Queenstown if I didn’t behave.

It was called Komani and came up throughout my childhood.

It was one of the reasons I never wanted to go to Queen’s College. It is still one of the reasons I find it hard to talk or write about mental illness.

Komani is still there, I’m told. It is a “psychiatric hospital” now and it was one of the first things that came into my mind when I first heard about the tragic decision by Gauteng health MEC Qedani Mahlangu to move a large group of mentally ill patients out of a Life Healthcare facility near Johannesburg and to disperse them among a range of what were called nongovernmental organisations but seemed often to be little more than private homes eager for an income from the provincial government.

I’ve met Mahlangu and I liked her. So it is hard not to feel for her when the consequences of what she probably thought was a reasonable decision become clear. As a result of their move from Life’s professional facility, dozens of those patients are now dead.

But they were people like you and me. With the right diagnosis and the right medication, many mental diseases and illnesses can be managed. An official report by the health ombudsman is about to be published. It is thought likely to say that nearly 90 of the patients have died following the move.

The fact is that Mahlangu’s response to mental health is probably common in SA. It is just not a priority. It’s a private thing. I was right in there, too, until about a year ago. But then people close to me were struck down by miseries so unexpected and so shocking I still cannot easily cope with what has happened.

All I know is that I am different. I have no ego. I make no judgments and my heart goes out daily to the almost 17-million (ja, 17,000,000!) South Africans — one in every three of us — who suffer a range of mental disorders from depression, addictions and substance abuse to anxiety, bipolar disorders and schizophrenia.

You can carve up the numbers a thousand ways. Of the 17-million, about 5-million have conventional psychiatric disorders and many of the others will be addicted to drugs, alcohol, pornography, sex and gambling. Addiction of any kind is itself a mental disease.

As a society we seem incapable of comprehending the scale of the problem.

Some are lucky. Some have money and live in cities with great doctors. What happens to a schizophrenic in deep rural SA? Who cares for her? Who medicates her? Who makes her feel safe? And as our people get older, more and more will develop debilitating dementias such as Alzheimer’s. Who cares for them, especially the poor?

I know I’ll get into trouble with Africa Check but I bet there are way more mentally ill South Africans than HIV-positive ones.

But depression and addictions aren’t sexy. There’s no political win in them. They’re irritating and disturbing. Many doctors are still telling depressed patients to pull themselves together! Bipolar disorder is everywhere and the first recourse is always to treat it with antidepressants (because the manic depressive is always more depressed than manic), which makes things worse.

And as for drug addiction and alcoholism, this country is a production line and the only recourse is careful and thoughtful rehabilitation, which takes time and money.

The public health system can’t cope at all. In the private system there are about 33,000 people per practising psychiatrist. That number rises to 440,000 in public health.

Mental illness, were we ever capable of taking it seriously as a public health and a political issue, has a far greater chance of uniting us than HIV/AIDS ever did. Mental health and addictions cross racial boundaries far more effectively than the AIDS virus.

I’ve been sitting twice a week for months now in groups of concerned friends and family talking about loved ones who are in trouble. We are diverse and in the same pain.

Overall, it is reckoned that about 75% of all mentally ill South Africans will never get any help — and that surely has to change. The national Department of Health spends about 4% of its budget on mental health. Medical aids are shocking, too. Most will cover three weeks of addiction rehabilitation. Three weeks is barely time for an addict or alcoholic to figure out they’re not waking up in the same bed they used to.

Picking yourself up from these dreadful falls takes enormous courage and character. I am constantly amazed at the resources, fortitude and progress the people I know and love have made. They’re fighting back and it is riveting to watch.

It would help to have, perhaps, a second deputy minister in the Department of Health responsible for picking up all the maladies that slip through the system. And with a budget to make a difference.

Mental health, addictions, autism, learning difficulties, attention disorders. We can’t build a healthy society together without caring about people who can’t help themselves.

THE NATIONAL DEPARTMENT OF HEALTH SPENDS ABOUT 4% OF ITS BUDGET ON MENTAL HEALTH. MEDICAL AIDS ARE SHOCKING, TOO