SA mental health underfunded, ‘huge gaps’ in coverage

PROVINCIAL health departments across the country have inadequate budget allocations for mental health, a hearing into the status of mental health care in South Africa has been told.

The South African Human Rights Commission (SAHRC) is holding national investigative hearings into the status of mental health care in the country over two days.

Making presentations at the commission’s offices in Braamfontein, Johannesburg, the national Department of Health admitted to this.

Deputy director-general for primary health care, Jeanette Hunter, said: “The assessment we did in the nine provinces in terms of the extent to which the policy framework and strategies implemented in the nine province – this assessment we did in May – showed a number of gaps.

“What we have discovered is that provinces do not have a mental health care budget in one place so that you can determine what is being spent on mental health… Provinces have to determine what exactly they are currently spending on mental health on all levels.”

Hunter said provincial departments would also have to determine whether the gap could be “overcome by correcting inefficiencies in the system or whether a larger budget is required”.

The hearings come after the deaths of more than 140 psychiatric patients removed from Life Esidimeni Healthcare facilities and placed in unlicensed NGOs last year, when former health MEC Qedani Mahlangu allegedly terminated the contract to “cut costs”.

The SAHRC said its decision to convene the hearings was informed by “the potential for vulnerable mental health care users to be affected by compounded human rights violations, the need to identify structural issues that hamper mental health care, and the duty of the SAHRC and to provide recommendations to address systemic non-compliance with human rights standards”.

Rural Rehab South Africa chairperson Shannon Morgan said 43% of the country’s population lived in rural areas yet they did not receive health care services they needed. Only one in four people with mental disorders has access to treatment.

“Rural areas account for almost half of the country’s population yet remain at the margin of political, economic and social power centres... The neglect of mental health rural populations often results in a burden on the limited resources in urban centres,” Morgan said.

She said there was no budget for mental health.

“Frequent drug stock-outs lead to high relapse rates… How do you check that one person is coming back again and again and again? How do we monitor that,” she said, adding that there was a lack of human resources for mental health.

Morgan said there was prevailing stigma and discrimination.

She asked whether the country could “do with mental health care what we did with HIV?”

“Deinstitutionalisation and bringing mental health care services closer to where people live is a priority of the national mental health policy framework. We have all witnessed the devastating effects on patients and their families when this is done without adequate planning and co-ordination,” she said.

“Events (at Life Esidimeni) in Gauteng are only the tip of an iceberg. All over the country, and especially in rural areas, mental health care users have little or no access to the services that they need, resulting in some devastating effects on individuals and families. That is why we say that the Life Esidimeni tragedy is not an aberration. It simply places in the spotlight what is happening everywhere,” Morgan said.

The hearing continued yesterday with officials from the nine provincial health departments expected to make presentations