Late last week, psychiatry professor Dan Stein, after winning a National Science and Technology Forum (NSTF) Award for research and output, said South Africa needed to invest more deeply into assisting patients with mental disorders.

“There is a feeling that there isn’t enough money for mental health services and research,” he said. “The problem is that not providing enough services and doing the related research on how to optimise such services is vastly more costly than doing so. So every year, we as a country lose more and more money because we haven’t made the right investments in the past.”

Stein is not wrong. Mental health issues cost the economy two to six times the cost of its treatment, or more. South Africans by their millions are receiving psychiatric diagnoses, and yet there is an enormous gap in the funding being given to this area. Shock statistics abound in news reports; however, forming a nuanced picture is more challenging.

When attempting to ascertain the impact of mental health management – or mismanagement – on the country, it is tricky to pin down the numbers. Firstly, one needs to decide on a definition. The term ‘mental illness’ versus ‘mental disorder’ is contested; but Africa Check, speaking to President of the South African Society of Psychiatrists (SASOP), Dr Gerhard Grobler, noted that conditions with a biological basis, such as schizophrenia, fall under mental illness, but professionals mostly referred to the broader category of ‘mental disorders’ which could include conditions such as alcohol and drug dependence….

Health24 gives a sobering overview of psychiatry in South Africa: “[I]n South Africa it is estimated that between four-and-a-half to five million people are suffering from a psychiatric disorder. If you include alcohol and drug abuse in this figure, it rockets to a frightening 15 million people.

“An estimated 20% of children… suffer from a mental [disorder] due to the levels of violence and family problems… and eventually a quarter of the entire population will have suffered from a depressive disorder. Fifty percent of visits to general practitioners are usually due to some sort of mental problem… In South Africa about 10,000 people commit suicide yearly and most of those are young people with economically active lives. And yet only 10 to 15% of people worldwide with mental disorders seek help. To make matters worse, in our country, many of those seeking help find it is not available.”

The trouble in South Africa is that although its mental healthcare policies are progressive, these are not filtering down. For instance, the department of health has reported that 53% of hospitals have been listed to provide 72-hour assessments of psychiatric emergencies, in keeping with the provisions of the Mental Health Care Act. However, reports the South African Depression and Anxiety Group (SADAG), these hospitals frequently don’t have the staff or capacity to provide the care required. Patients end up being admitted to general wards, which adds to the stigma of their illness. Sometimes suicidal patients are turned away due to a lack of space.

In a 2012 study South African psychiatrist Dr Eugene Allers revealed that there were 320 practising psychiatrists in South Africa, a ratio of about 150,000 people per psychiatrist. Just 15% of the population belonged to a medical aid and 200 of the 320 psychiatrists were working in the private sector….

A significant further hurdle for patients is the growing problem of drug supplies. There’s the double burden of drug stockouts and the low priority given to psychiatric medication on the Essential Drug List (the medications the state supplies to state hospitals). According to Health24, “The medications for the treatment of psychiatric disorders are severely limited, making… the recovery of some patients less likely.”

Lettie Mabena (pseudonym) told Mail Guardian of the withdrawals she suffered when her medication was not available for three months, and the SADAG confirmed it dealt with such cases daily.

Keli (not her real name), diagnosed with chronic depression and Borderline Personality Disorder, told Daily Maverick of her own nightmare. “I’m a Tara outpatient. They stock the most generic, or cheapest, of each med. In the past four months they have not had stock of Aropax, a very common antidepressant, twice, and the pharmacists have absolutely no knowledge or sympathy in dealing with this. They simply reply, ‘Get your doctor to put you onto another med.’…


Photo: Otis Historical Archives

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