A THREE-DIMENSIONAL APPROACH TO IMPROVING
MENTAL HEALTH IN SOUTH AFIRCA
The burden of mental health is very real in developing countries such as those in sub-saharan Africa. Recent studies have shown there to be only one psychiatrist for every 390,000 people in South Africa. Furthermore, two thirds of South Africa’s psychiatrists are employed in private practice.
There is a distinct lack of valid data available on the effectiveness of existing institutions in South Africa. Researchers have pointed out that there is a need to develop systematic strategies to monitor and evaluate mental health care systems and interventions. The public health service in South Africa is stunted because of its unhealthy competition with other departments for government funding. In March 1998, Robertson et al reported that the South African government was allocating only 8.5% of the South African Gross Domestic Product (GDP) to the health sector, with only 2.5% of this amount being channelled to mental health. Furthermore, 95% of the mental health budget was spent on institutional care, suggesting that government support for community work in mental health is being neglected.
In further examining the flaws in the current South African health system, Robertson et co. identified the lack of resources, planning and implementation of mental health care systems as well as the overcrowded and understaffed primary care services (maintained by under-trained staff) as negative variables in need of urgent attention. Poverty presents a significant threat despite the fact that South Africa is one of the more affluent nations in sub-saharan Africa. Theft and gang-related violence is another country-specific problem that needs to be addressed.
In an environment such as South Africa, the power of an advocacy organisation can be harnessed in order to compensate for the lack of mental health resources. Third World settings create unique opportunities for support groups to infiltrate communities and make a significant impact on mental health care services. Prof. Mkize, Head of Psychiatry at the University of Transkei, elaborates on the important role support groups play in the South African context: “We need support groups because most of our population do not have access to mental health resources. In Mpumalanga for example, there is only one psychiatrist to serve 1.3-million people. Support Groups empower sufferers to recognise their illness and seek effective treatment”.
Robertson et al report that there are only 15 NGOs active in the mental health sector in South Africa. One such group in South Africa, the Depression and Anxiety Support Group, is the largest private mental health care initiative in South Africa, with over 75 regional support groups active throughout the country – 28 have been specifically created for previously disadvantaged communities. The group interfaces with a broad network of professionals and its members have easy access to an extensive referral system to supportive health professionals. Representing over 8000 members, the Support Group is a member of the GAMIAN (Global Alliance of Mental Illness Advocacy Networks) and is affiliated to IAPO (International Alliance of Patient Organisations).
The Depression and Anxiety Support Group is the first support group in South Africa to take the initiative of infiltrating disadvantaged and rural communities, through education and support programmes. In recognition of the group’s groundbreaking work, the SA Federation of Mental Health and the World Health Organisation recently honoured the group with an award for “reaching service users in previously disadvantaged groups” and “creating several support groups in hitherto unserved areas”.
In infiltrating these disadvantaged areas, the support group has been making use of a three-dimensional approach. The first step of the programme involves the help and expertise of the group’s outreach co-ordinator, Therry Nhlapo. Therry sets up a workshop interfacing with all General Practitioners (and other health-care professionals), social workers and teachers in the vicinity of the targeted community. This is particularly important as many of these areas have health-care and social support services lagging behind in terms of education and expertise regarding the disease. A fair amount of resistance is encountered from certain black health professionals who do not believe that patients can suffer from anxiety and social phobia.
Once the local health professionals have been made aware of the initiative, the second phase of the programme is implemented, with the establishment of a regional support group. These support groups are run mainly by people who previously suffered from depression, anxiety or social phobia, and pursue effective self-help programmes. Regional groups are given full support from the Johannesburg head-office, by way of information, literature and referrals. Guest speakers are often invited to address members. Therry has been instrumental in the creation of 28 outreach support groups, stretching countrywide from Qwa-Qwa to Umtata. The settings vary from townships (such as Alexandra and Soweto), to rural villages and cities. The support group has also impacted significantly on the correctional services. Two well co-ordinated groups are flourishing in the Mogwase and Leeuwkop prisons, and there are plans to develop more groups in the near future.
The drive into rural communities was initially complicated by the forceful presence of traditional healers. However, Therry has been successful in forging links between the Support Group and the very influential Sangoma (traditional healer) Association of South Africa, resulting in closer co-operation between the two groups in the interests of mental health.
The final phase of the programme involves re-assessing the support groups after a period of time has passed. It is important to maintain regular monitoring of the progress and functioning of local support groups. Changes need to be implemented occasionally, in order to improve the functioning of the group.
The success of the rural outreach programmes has brought about a 78% increase in the number of telephone calls taken from rural areas over the past year. The group has also been called in to initiate similar programmes in other regions of the country. The effective work of an advocacy organisation, such as the Depression and Anxiety Support Group in South Africa, illustrates the tangible differences advocacy organisations can bring about in developing nations. The 28 regional support groups empower disadvantaged sufferers, and provide education on the broad spectrum of anxiety and depressive disorders. In the words of Ernest Magopodi, an inmate at Mogwase Prison and member of the prison’s successful Depression and Anxiety support group, “I was a victim – I am now a survivor”.