South Africa’s Never Ending Struggle with Mental Health Care

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x1461868764808.jpg.pagespeed.ic.I8dCKVYwxTImage Credit: The Rand Blog

In February of 2017, over 94 mental health patients under the Gauteng Department of Health’s care perished after being subjected to  neglect and abuse. Patients were severely malnourished and had been subjected to conditions likened to living in a concentration camp. These findings highlight the extensive work that remains to be done in regards to mental health care in South Africa.

Although national statistics estimate that  30.3% of South African adults suffer from a mental illness during their lifetimes, mental health remains a taboo subject in the nation. Cape Mental Health attributes this stigma to traditional beliefs and a lack of knowledge on what mental health care entails. 

In 2002, South Africa enacted the Mental Health Care Act  which was meant to:

  • Prohibit the unfair discrimination of those suffering from mental health disorders.
  • Ensure the dignity and privacy of patients during treatment.
  • Support mental health care services that promote the well-being of its users.

Although supported by many stakeholders, the Act has largely failed to achieve its goals due to the stigmatization of mental patients by health professionals, improper training, and a lack of resources in mental health care facilities.

As such, it is imperative that the South African government increases the funding and stresses the implementation of the Mental Health Care Act of 2002. The government should increase the funding of mental health care facilities so that they are able to expand their resources. Workshops and training programs on mental health care should be made mandatory for health care personnel, and programs that educate patients on coping strategies should also be enacted.

South Africa’s problem isn’t a faulty policy initiative, it is faulty implementation. By expanding on the resources available to mental health centers, the nation will be able to ensure that the events of February 2017 are never repeated.

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6 Responses to “South Africa’s Never Ending Struggle with Mental Health Care”

  1. mliaoblog Says:

    The death toll of the Life Esidimeni case has since risen. It is an extremely disastrous outcome to what originally could have been good intentions albeit done with very poor leadership, planning and implementation. It brings to question the viability of a country like South Africa with resource constraints following the international trend of shifting from institutional to community-based mental health care. It may simply be too fast and too soon resulting in poorer outcomes rather than the intended benefits of integrating those with intellectual disability back into the community to lead as normal a life as possible. I think the suggestion of expanding existing resources may be a challenge in reality since the root cause of the problem was an initial lack of funding. South Africa is already grappling with a quadruple burden of disease and unfortunately mental health is just not a priority given the magnitude of the other healthcare challenges. Even so, this should not have resulted in this tragedy had there been better planning and implementation.

  2. iambeckyroar Says:

    Thank you for sharing! I would be interested in hearing more about the social drivers that impact access to care. How does poverty, gender, and (in particular) race mitigate the prevalence rates of different mental health issues — and different groups’ abilities to access care? South Africa still struggles with the legacy of apartheid in a myriad of ways.

    Also, many other initiatives in South Africa have begun to emphasize compassionate care provision, stigma reduction, wellness among health workers. It could be valuable to piggy back off of these initiatives! In particular, many HIV/AIDS programs train health workers on such issues. Given the lack of resources for mental health as an independent initiative, perhaps it could be infused into current HIV/AIDS programs. The health workers could then apply these new skills to other contexts.

  3. ajosyulamd Says:

    Stigma related to mental illness is a problem that exists the world over, certainly here in the US. One of the things that has helped generate national conversation around mental health issues, is the willingness of certain movie, tv and music celebrities to speak out about their struggles. This normalizes the experiences to the lay public. I wonder if there are celebrities who could join the national effort in South Africa and help make this a dinner table conversation. The other aspect is education of the health care providers. Certainly sensitivity towards mental illness needs to be taught to providers so that they treat those with mental illness with dignity and respect. NGOs may be a better source of funding for spreading education both to professional and lay public rather than the government. In India, a movie celebrity Deepika Padukone and a business magnate family Neerja and Ananya Birla, have started foundations (The Live Love Laugh Foundation and Mpower Minds, respectively) to address mental health stigma and use the media (both traditional and social) very effectively to spread the message. Perhaps that is something that could be emulated in South Africa as well.

  4. mariew90 Says:

    Mental health in South Africa is an issue that gets very little attention. In many cases, especially in rural parts of the country, mental illness isn’t viewed as a medical concern but rather, because of traditional beliefs, as a person being bewitched or otherwise cursed. I agree with you completely that South Africa should put more time and resources into properly implementing and training health workers on the Mental Health Care Act. I also think that there should be resources put into a wider community based campaign around mental health and helping people to better understand what it means. Many cases go undiagnosed and ignored purely because people do not know of any way to address the issue. Education and community awareness can go a long way to reducing the stigma that surrounds the issue. We also have to remember that health care workers are part of their communities. Sometimes training in the “bubble” that is the health care system will be effected by, and possibly outweighed by, the deep rooted traditional beliefs and concerns.

  5. ailiu1111 Says:

    Thank you for drawing attention to such a critical issue! I am deeply saddened by the tragic incident at Gauteng Health Department, and unfortunately, such incident is far from an isolated occurrence but an issue that find its’ root ingrained within the local culture. As previously mentioned, mental illness is not viewed according to the western medicine paradigm in South Africa, and the etiology of mental illness is thought to be related to religious/spiritual origins (bewitchment) rather than biomedical causes. However, in order to effectively reduce cultural stigma and improve mental healthcare, we should not dismiss local’s beliefs about mental illness; instead, we should assess and understand these cultural beliefs and design targeted interventions accordingly.

    With limited resources currently devoted to this issue, we should focus on delivering cost-effective interventions that utilizes and subsequently develops local human resources. Group therapy sessions have been shown to be effective when they are delivered by trained community health workers. In addition, as graduates or future graduates of JHU, we should strive to put mental health into the global health agenda using our voices in international agencies, NGOs, or local governments.

  6. gnasser1 Says:

    This is a very delicate and important topic, thank you for the post. In South Africa, “Neuropsychiatric conditions rank third in their contribution to the burden of disease in this country, after HIV/AIDS and other infectious diseases” (Bradshaw et al.2007), so this should definitely be on the radar more. As in other countries with decentralized health systems, the policies regarding mental health should be strengthened locally, with more articulation between all the stakeholders. This should not be taken as a secondary problem. But the Mental Health Act of 2002 should be seen as a “step forward” to a problem that is clearly very much political , since it encompasses issues such as human rights and primary health care. There should be more resources available but also more political support for nationwide policies.

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