31/07/2017 13:50 SAST | Updated 31/07/2017 14:19 SAST

Being Poor and Mentally Ill In South Africa Equals Being Pretty Much Screwed

Professionals say there is a crisis in mental healthcare provision - and nothing is improving after the Life Esidimeni tragedy.

Health Minister Aaron Motsoaledi during a media briefing by the Health Ombudsman to announce the final report on the Life Esidimeni psychiatric patients.
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Health Minister Aaron Motsoaledi during a media briefing by the Health Ombudsman to announce the final report on the Life Esidimeni psychiatric patients.

An estimated 80 percent of people with mental health conditions come from lower to middle-income countries. Yet, there is no evidence of treatment for at least half of these people in the past year. That's according to the World Federation for Mental Health's President, Professor Gabriel Ivbijaro, who was speaking at the Mental Health Summit in Johannesburg in June.

In South Africa alone, one in three people will suffer from a mental health-related condition at least once in their lives and the rate of depression amongst South African men is at an all-time high, HuffPost SA previously revealed.

Yet, mental health care support, in general, is very limited in the country. Psychiatrist Dr Mvuyiso Talatala, who also spoke at the summit, described the situation as a "crisis".

Here's the sorry state of affairs:

  • Mental health care is underfunded. Less than five percent of the health budget in South Africa is spent on mental healthcare.
  • In five of the nine provinces in South Africa, there are no mental health directorates. Mental Health Review Boards are also said to be in a problematic state.
  • There aren't nearly enough mental healthcare professionals, especially in the public sector. Even in urban areas, there is a shortage. Ekurhuleni in Gauteng has one full-time state psychiatrist, for example.
  • In many rural communities, there is no mental health support at all. In Limpopo and the Eastern Cape, there is no child and adolescent psychiatric care.
  • No new mental healthcare facilities have been built since 1994 in the country.

So if you're part of the estimated 80 percent of South Africans who are not on private healthcare and therefore have to primarily rely on state healthcare facilities, you are unemployed, you live in a remote village in KwaZulu-Natal, and you suspect you have a mental health condition -- what do you do?

Go to your nearest public hospital. A lot of general hospitals in cities and regional areas are still the first stop for emergency and mental health care cases, says the President of the South African Society of Psychiatrists, Professor Janse van Rensburg. Although this places a big burden on public healthcare facilities, it is the best place to start, says Talatala.

A general practitioner can also refer you to a specialist. This may be problematic if you live in an area where there is also a shortage of GPs, or if there is a misdiagnosis, or if there is no nearby mental healthcare facility to be referred to. Never mind if the public clinic or hospital itself is too far from where you stay.

There have been no new mental healthcare facilities have been built since 1994 in the country.

"We need more mental healthcare specialists in rural areas," van Rensburg tells HuffPost SA. "It's urgent."

"The reality is that the health system still does not cater adequately for the thousands of people who continue to live with mental illness within the community," adds van Rensburg.

This echoes the Health Ombudsman report released earlier this year, following the Life Esidimeni tragedy, which recommended that the whole mental health system should include resourced community-based primary and specialist multi-disciplinary teams.

The Health Ombud's report also recommended some action to be completed within 45 days, but van Rensburg believes some 150 days later, no comprehensive remedial strategy has yet been tabled in Gauteng, or elsewhere. And this is where the main problem is, argues van Rensburg.

Talatala and van Rensburg believe there are some good government policies but the problem has been implementation. There is a lack of political will, Talatala says, and until this changes, South Africa will sit with the crisis in mental health care for some time to come. Talatala also believes there is a poor understanding of mental healthcare by those who are supposed to lead, and until this also changes, the problems will persist.

Increase funding to healthcare and be prepared to pay, he recommends. "If you develop primary healthcare, it will cost you," says Talatala.

Further, integrate mental healthcare at primary healthcare facilities. This will improve access, and help reduce the stigma still associated with mental health illness, advises Talatala.

The government must also not overlook collaboration between non-profit organisations and the private sector. "It can be a multi-pronged approach. For instance, community and faith-based organisations can help supplement the healthcare system with proper resources," concludes van Rensburg.