Hospitals expect increased mental health caseload
Growing concerns that many diagnosed with the disease will require more mental-health care.
The long-term effects of Covid-19 are starting to be felt widely, with hospitals, health-management providers and even life assurers reporting that mental health-related numbers are climbing and are expected to continue doing so.
There is growing concern that many of those hospitalised for Covid-19 are not able to return to their former level of functioning and require ongoing healthcare. Ongoing patient monitoring across the globe and via various studies shows that 34% of Covid-19 patients discharged from hospital have been diagnosed with neurological or psychiatric symptoms within six months of their acute infection, of which 12.8% were diagnosed for the first time with such a disorder, mostly depression and anxiety.
“These disorders are significantly more common in Covid-19 patients in comparison to groups of people who have recovered from flu and other respiratory conditions,” says psychiatrist Dr Ingrid Williamson.
The Bhekisisa Centre for Health Journalism says one in four people reported anxiety and fear of infection and excessive worry over the pandemic. And Kreshnee Govender, a senior consultant at Alexander Forbes (AF) Health Management Solutions, says the most common mental and behavioural disorders for which referrals are received for disability and incapacity management are depression, bipolar disorder, post-traumatic stress disorder, and anxiety.
According to the South African Depression and Anxiety Group, as many as one in six South Africans present with anxiety, depression or substance abuse. Yet fewer than 16% of sufferers receive treatment, suggesting a constrained mental healthcare system.
These findings tie in with hospital provider Netcare’s interim results to the end of March, which revealed that mental health occupancy levels increased sharply, climbing from 41% in the second half of last year to 60.6% in the first half of 2021.
Netcare’s group chief executive officer, Dr Richard Friedland, says despite the onset of the second wave, the easing of lockdown measures this year allowed for the resumption of group therapy sessions, resulting in higher admissions.
Dr Gerrit de Villiers, chief clinical officer of Mediclinic Southern Africa, confirmed that a generally increasing burden of mental illness and need for treatment has been exacerbated by the effects of the pandemic. He mentions fear of the virus, grief, anxiety, continued physical distancing, and related social isolation as additional barriers to treatment that could be compounded in the long term.
“Moving forward, we will likely experience an increase in the number of people experiencing acute mental or behavioural health problems, both those with new symptoms and those with existing conditions, and requiring access to mental health services,” he says.
Elzette van Dyk, senior manager for complementary services at Life Healthcare, says the hospital group has nine dedicated mental-health facilities across four provinces offering general psychiatry, treatment for substance dependence or other addictions associated with mental health conditions. Treatments offered include evidence-based drug therapy, individual psychiatric consultations and psychotherapy, group therapy and, where needed, physical therapy.
“We have started to see a steady increase in admissions as per our interim 2021 results, indicating that people are once again prioritising their mental health,” she says.
Van Dyk notes that many people living with mental-health conditions are finding it challenging to manage their care while ensuring their safety during this unprecedented time. “During the Covid-19 pandemic, many delayed or postponed their routine check-ups and treatments due to the fear of visiting specialists at healthcare facilities.
“Chronic mental-health conditions require routine check-ups coupled with well-managed treatment plans. This makes it critical to diagnose and treat these conditions as quickly as possible.
“Follow-up assessments may also be necessary to evaluate the efficacy of treatment regimens and postponing your appointments may negatively impact health and treatment outcomes,” she says.
Contributing factors
According to Dr Gert Bosch, a psychiatrist in private practice at Denmar Specialist Psychiatric Hospital, multiple factors contributing to mental-health issues include the impact of school and university closures, loss of employment, financial strain, and the aftermath of severe illness in survivors.
“Poor general health [both mental and physical] may also contribute to increased levels of anxiety and/or depression in comparison to those in good general health. Further barriers to access include reduced income, loss of income and job uncertainty due to companies cutting back on costs and reducing their workforce during the pandemic,” he says.
Friedland says mental-health problems tend to be of a chronic nature and there are often complex psychological and social elements when it comes to successfully reintroducing the patient to the stresses of a work environment.
Govender agrees, saying work stress is often a precipitating or perpetuating factor for many employees who are referred for incapacity management. “Often individuals are not referred to an appropriate specialist such as a psychologist or psychiatrist and as a result they do not receive adequate treatment, and this may arise in excessive utilisation of sick leave or even a disability claim. At times, employees are just too scared to advise their managers that they have a mental or behavioural condition for fear of losing their job,” she says.
Benefits of working from home
Govender says that within the AF Health Management Solutions’ client base, 60% of companies reported an increase in claims for incapacity leave and disability on the basis of mental illness last year, whereas other companies recorded a 40% reduction in these claims. She says the reduction in claims could potentially be linked to the positive mental-health-related benefits of working from home. Benefits could include less emotional exhaustion and cognitive stress, more online support from colleagues, less travel and a less stressful office environment.
“It is important to be aware of the signs and symptoms of these conditions as we face the psychological strain of the Covid-19 pandemic and a new norm with altered work environments and personal circumstances,”” she says.
Often individuals are not referred to
an appropriate specialist such as a psychologist or psychiatrist and as a result they do not receive adequate
treatment