If I become suicidal?
is packed with children running around and hospital staff pointing bewildered visitors in different directions.
Far away from the busy ground floor, Tish White sits up in a hospital bed working on a laptop on an overbed table. White (27) is genderqueer and uses the gender-neutral pronoun “they”.
“When I was 12 years old, I was suicidal and self-harming. I needed to get some support. The school psychologist referred me to a psychiatrist and they put me on an antidepressant called Zoloft. At that point medical aids didn’t cover Zoloft in full,” they says.
The added cost put a lot of strain on White and their parents. They can’t remember how much the tablets cost, but according to South Africa’s medicines price list a packet of 30 50mg Zoloft tablets costs R540.42.
“When you’re raising a child, I know that it can get quite expensive very quickly,” White says softly. “I’ve gone through about 10 psychiatric hospitalisations in my life thus far.”
They was admitted to Milpark because of an asthma attack, but also suffers from bipolar disorder, post-traumatic stress and attention deficit and hyperactivity disorder.
“If my health declines I call my psychiatrist who calls my health team [a team of experts] and I get admitted, but I can’t stay in a hospital longer than 21 days a year.
“What if you’re somebody who is suicidal? You go to hospital and 21 days later you are forced to leave, but you still want to kill yourself? What are your options?”
The burden of mental health is one of the main cost drivers of care, says Patel. “If you have a significant proportion of the population that has mental health problems, that’s going to drive up the cost of care.”
According to the South African Stress and Health study of 2009 — the most recent survey available — one in three South Africans will experience a mental illness in their lifetime, of which anxiety disorders are the most common.
The high cost of mental healthcare is fuelled by the fragmented nature of the private health sector, in which patients often do not receive holistic care, says Patel.
“One of the drivers of mental health costs is the escalating number of hospital admissions specifically for conditions like depression and bipolar mood disorder,” says Nematswerani. “There is no firm evidence to suggest what factors are driving the increase, but it is reasonable to speculate that levels of stress are higher at present than they were in the past, and that these are a contributor