According to Act 108 of 1996, chapter 2, art 93, under the clause equality, of the South African constitution, it is stated that the state may not unfairly discriminate, directly or indirectly against anyone on one or more grounds including race, gender, sex, pregnancy, marital status, ethnic or social origin, colour, sexual orientation, age, disability, religion, conscious belief, culture, language and birth. Patients with psychiatric problems are included under the heading disability.
The New Mental Healthcare draft bill also specifies that there should be no discrimination against patients with mental illness and that they should have the same rights as other patients. In South Africa unfortunately though, there is still problems of discrimination against patients with psychiatric problems.
In the State sector, psychiatric community clinics are closed down in preference of primary healthcare clinics, which is a problem due to the specialised nature of psychiatry and the specialized care psychiatric patients need. There is a lack of long-term institutional care facilities and there is a major problem to get dedicated psychiatric beds in general hospitals.
In the Private sector private clinics refuse to have special dedicated psychiatric wards for psychiatric patients, as medical aids pay less for patients with psychiatric disorders in psychiatric wards than in other wards and this leads to a loss of income for the private clinics.
The lack of psychiatrists in South Africa presents a huge problem. At the moment there is about 320 practising psychiatrists in South Africa, giving a ratio in general of about 150 000 people per psychiatrist. 15% of the population belong to a medical aid and 200 of the psychiatrists work in the private sector. The ratio of psychiatrist to population in this sector is about 33 000 patients per private psychiatrist. Only 120 psychiatrists work in the state sector, giving a ratio of about 440 000 population per state psychiatrist, 13 times more than in the private sector.
The proposed Essential Drug List (EDL) limits psychiatric medication to Haloperidol and Chlorpromazine as anti psychotics and Diazepam and Lorazepam as anxiolitics and
Amitryptaline and Fluoxetine as the anti depressants.
Medical aids discriminate severely against patients with mental problems and psychiatric illness. Managed healthcare has even further reduced this funding and newer treatments are being excluded or are severely limited. Medical Aids are managing patients’ health and doctors are required to manage patients’ funds.
At this stage only four medical aid plans could be found that did not discriminate against patients with psychiatric, medical and surgical disorders. Other medical aids that do not have limits for medical and surgical patients normally have an average limit of about R12000 for the management of patients with psychiatric disorders. Medical aids with limits on medical and surgical care of about R300 000, limit psychiatric care to about R6 000 per patient per year. These amounts available for the care of patients with psychiatric problems are very restrictive, and doesn’t allow for patients to be adequately treated. Patients cannot be hospitalised, medication or psychotherapy be given over a longer period.
Sheltered workshop subsidies have been stopped and community clinics are been closed down due to a lack of the government funding in favour of primary healthcare, leaving chronically disabled patients without care or work
Certain religions and churches in South Africa prohibit members from consulting mental health workers as mental illness is seen as a sin.
It is therefore necessary that there is a move away from discrimination and stigmatisation of patients with mental illness, locally and internationally. Patients with Mental disorders should be treated like anybody with an illness and should have equal access to healthcare whether private or public.
The South African Society of Psychiatrists is very concerned about the rights and care of patients with psychiatric disorders. We have joined the world fighting stigma and discrimination against patients with psychiatric disorders.
SASOP has suggested a unified symbol to highlight the awareness of mental health. An orange ribbon has been chosen. Wear one to show your support for ending discrimination and stigmatisation against people with mental disorders.