10 October, World Mental Health Day: Many South Africans living without accessible mental health care
For immediate release
The Mental Health and Poverty Project findings indicate that resources continue to be allocated to centralised facilities, while development of community-based services that are integrated into primary health care remains limited.
The Mental Health Care Act, no. 17 of 2002, specifies that, in line with human rights principles, mental health services should be accessible to all people and that care should be delivered in the least restrictive setting. This means moving away from institutionalising those with mental illnesses and towards the development of community-based services.
Crick Lund, Associate Professor in the Department of Psychiatry and Mental Health at the University of Cape Town said:
“There have been significant challenges in the implementation of this Act. Provinces continue to spend as much as 67 – 99% of their mental health budgets on specialist hospitals, leaving little for the development of community-based services. At the same time, nearly 50% of community-based residential facilities are provided by non-governmental organisations, which are often under-funded.”
While provincial data vary significantly, there is a considerable shortage of psychiatrists and psychologists in the public health sector, with evidence that many are working in the private sector. Inge Petersen, Professor of Psychology at the University of KwaZulu-Natal said:
“In contexts where scarce specialist mental health resources are inequitably distributed and inefficiently utilized, the recent Lancet series on global mental health advocates task-shifting. This entails more efficient use of existing specialist mental health resources in training and supervisory roles to non-specialists. There is increasing evidence from low to middle income countries that community health workers can be effectively used to deliver psychosocial treatment and rehabilitative services for specific mental disorders as well as mental health promotion interventions.”
Poor mental health can lead to poor physical health through increased risk behaviour and a compromised immune system. There is thus a need for increased commitment to the integration of mental health services into the general health system, so that people accessing obstetric care, testing or treatment for HIV/AIDS, or other health services, are able to receive mental health care at the same point of care.
Simone Honikman, Director of the Perinatal Mental Health Project at UCT said:
“Antenatal care is accessed by about 92% of pregnant women in South Africa. Thus by providing mental health services at the same site at which women receive their maternity care means that these vulnerable women are not required to spend extra resources to receive their care and furthermore, they need not overcome the barriers of stigma associated with accessing specialist mental health services at separate facilities. Integration of mental health care into primary level maternal care is not only possible and an efficient use of resources, but is also critical to address a significant unmet need for women.”
The lack of accessible mental health care in South Africa places people with mental illness at continued risk of stigmatisation, human rights abuses and exclusion from their communities. A primary health care approach also promotes the empowerment of community members. Ms. Sharon Kleintjes, Research Officer, Mental Health and Poverty Project, University of Cape Town said:
“The Ottawa Charter for Health Promotion advocates for strengthening community action for health. Effective treatments and other supports such as access to housing, supported employment and social grants are basic requirements to allow mental health care users and their supporters to live satisfied and dignified lives in their communities.”
SADAG (The South African Depression and Anxiety Group) is the largest NGO in mental health and offers 16 toll free help lines for callers, referrals services, brochures and counselling. It is open seven days a week from 8am to 8pm 365 days a year. 0800 70 80 90 www.sadag.co.za
Said Zane Wilson founder of SADAG “ Research in South Africa is so limited that it is hard to get to the extent of the lack of access and availability of mental health care. We need more fund by the MRC and Dept. of Health devoted to Mental Health Research to clarify the problems and enable NGO’s to get to the most needy areas of the community. “”
1. The Mental Health and Poverty Project is a 5-year study working in Ghana, South Africa, Uganda and Zambia, and is funded by the UK’s Department for International Development. The South African partner organisations are the University of Cape Town, the University of KwaZulu-Natal and the Human Sciences Research Council. The project has released reports on the mental health situation in each of the above countries, and policy briefs covering a range of related topics. The website is available at:
3. Globally, advocacy efforts for mental health are intensifying as a result of the long-term neglect of mental health as a public health priority. With the aim of protecting the human rights of people with mental illness and improving mental health services in low and middle income countries, the first summit of the Movement for Global Mental Health took place in September 2009 in Athens, Greece. For more information please see: