IS THERE DISCRIMINATION IN SOUTH AFRICAN MENTAL HEALTH SERVICES?
A consensus reached by the World Psychiatric Association this week and the subsequent reaction of one of South Africa's large Medical Aid Fund Administrators has elicited an outcry from a number of local psychiatrists.
The consensus which stated that atypical antipsychotics should now be the first line of treatment for schizophrenia was greeted with enthusiasm by psychiatrists who are frustrated with having to prescribe the older antipsychotics, which have harsher side effects and are less effective. Unfortunately though, the decision which should signal hope for sufferers of schizophrenia and their families, has a drawback: the new atypical antipsychotics are not on the Essential Drugs List, which are the drugs the government is prepared to supply in state hospitals, and even if the patient is a member of a Medical Aid Fund, chances are that atypical antipsychotics are not covered.
After the announcement of the consensus decision at the World Psychiatric Association meeting held on Monday and Tuesday at the College of Medicine in Johannesburg, a spokesperson for MX Health Institute, which administrates a number of Medical Aid Funds like Polmed, expressed concern regarding the viability of providing equitable service across the board for all members, obviously touching a raw nerve in many psychiatrists who hoped that after the WPA consensus decision, policies concerning the use of these newer drugs would be reviewed. According to Dr Franco Colin, a Pretoria psychiatrist, MX Health severely restricts the use of a number of these newer drugs, with Leponex being the only atypical antipsychotic they are willing to cover, but then only under certain circumstances, with a very specific diagnosis.
The fact Polmed, under the administration of MX Health, classifies psychiatry as an 'auxiliary service' is also a point of concern, and probably closer to the bigger issue at hand, which is that in South Africa there is still a huge stigma attached to mental illness and discrimination towards people with mental illness at all levels. Dr Franco Colin states that: "Mental illness is seen as separate from other illness and not as a general medical condition - which it is."
Whether in the public or private sector of the health system in South Africa, discrimination towards mental illness is evident, the consequences of which, according to Professor Brian Leonard, a psychiatrist on the Executive Committee of the World Psychiatric Association, "are undermining an effective mental health service in South Africa." He explains that sadly, due to an inadequate mental health service infrastructure in this country, especially in the rural areas, the state determines the cost of mental health services largely in terms of the cost of drugs, as this is generally the only treatment available to patients in these areas. The cost of mental illness in terms of mortality rates or loss of productivity in a work setting is overlooked. Due to the expense of many of these psychiatric medications, they are left off the Essential Drug List and off the lists of approved medications of many Medical Aid Funds. This seems strange when doing a cost per pill comparison, that medications for chronic cancer and heart disease which are on the lists, are actually more expensive.
South Africa's Essential Drug List, which is based on that of the World Health Organization, Professor Leonard states, is out of date and in need of revision. The stigma attached to mental illness, which is undermining our mental health services, is an infringement of patient rights, when looked at in terms of the Charter of Human Rights, of which South Africa is a signatory. Politicians and Medical Aid Fund Administrators need to be lobbied and educated before any improvement in the situation is seen.
South African Consumer Advocacy Group, the Depression and Anxiety Support Group, is already involved in investigating the commitment of the various Medical Aid Fund Administrators to mental health issues and is particularly concerned as call stats for the past few months have shown an increase in the number of queries regarding the non-payment by Medical Aid Funders of a number of psychiatric medications.
Medical Aids, like all other South African business, have in the last few years been feeling the economic squeeze, but that does not explain the blatant discrimination in their policies toward mental illness, not only in terms of approved medications, but also in terms of limits. The amount of money available for psychiatric and psychological treatment is more often than not way below that for any other medical condition. In some schemes, up to R800 000 is available for hospitalization for other illnesses and only R6 000 for hospitalization due to a mental health problem.
Dr Eugene Allers, a South African psychiatrist, is due to present a paper on the "Discrimination and Stigmatization of Patients with Psychiatric Illness in South Africa" on the 2nd of September at the first World Congress on Stigma in Leipzig. After reviewing the various Medical Aid Funds in the country, he says he can categorically state that there is huge discrimination by the Medical Aids towards the mentally ill in South Africa.